比较哌拉西林/他唑巴坦与头孢哌酮/舒巴坦经验性治疗儿童急性淋巴细胞白血病化疗后感染  

Piperacillin/Tazobactam Versus Cefoperazone/Sulbactam in the Empiric Treatment of Post-Chemotherapy Infections in Children with Acute Lymphoblastic Leukemia

作　　者：蔡志明[1] CAI Zhiming(Quanzhou First Hospital,Quanzhou 362000,China)

机构地区：[1]泉州市第一医院,福建泉州362000

出　　处：《中国医药指南》2023年第36期8-11,共4页Guide of China Medicine

摘　　要：目的研究分析急性淋巴细胞白血病(ALL)患儿化疗后并发感染的情况,以指导使用抗生素的策略。方法本研究收集2020年1月至2022年12月期间在我院儿科初诊断并接受CCCG-2020-ALL方案化疗的65例ALL患儿发生感染及相关病原菌的特点,分析感染发生的部位与相关病原菌种类、耐药情况及抗生素治疗情况。结果研究总共收集化疗后感染者314次。明确部位的感染以肺部感染最多,达97次(30.89%)。病原检测阳性61次,检出细菌37株。检出G-菌株主要是大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌。G+菌株主要是凝固酶阴性葡萄球菌,其次是金黄色葡萄球菌。大肠埃希菌中产ESBLs占66.67%,耐甲氧西林葡萄球菌占50.00%。G-菌株对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦体外药敏试验敏感性高。金黄色葡萄球菌株对环丙沙星、庆大霉素敏感性高。哌拉西林/他唑巴坦经验性治疗220次,有效率85.91%。头孢哌酮/舒巴坦经验性治疗94次,有效率71.28%,两种药物治疗有效率差异有统计学意义,P<0.05。结论哌拉西林/他唑巴坦可作为急性淋巴细胞白血病儿童化疗后并发感染的经验性治疗的优选。Objective To study and analyze the situation of infection after chemotherapy in children with acute lymphoblastic leukemia(ALL),so as to guide the strategy of antibiotic use.Methods In this study,65 children with ALL who were initially diagnosed and received CCCG-2020-ALL chemotherapy in our department of pediatrics from January 2020 to December 2022 were collected,and the characteristics of infection and related pathogens were analyzed.The location of infection,types of related pathogens,drug resistance and antibiotic treatment were analyzed.Results A total of 314 post-chemotherapy infections were collected for the study.Infections at definite sites were most frequent in the lungs with 97(30.89%).The pathogen test was positive 61 times,and 37 strains of bacteria were detected.The main G-strains detected were escherichia coli,klebsiella pneumoniae and pseudomonas aeruginosa.G+strains were mainly coagulase negative staphylococcus,followed by staphylococcus aureus.ESBLs accounted for 66.67%of escherichia coli and methicillin-resistant staphylococcus accounted for 50.00%.G-strain was highly sensitive to piperacillin/tazobactam and cefoperazone/sulbactam in vitro.Staphylococcus strains were highly sensitive to ciprofloxacin and gentamicin.Piperacillin/tazobactam were empirically treated 220 times,and the effective rate was 85.91%.Cefoperazone/sulbactam was treated empirically for 94 times,and the effective rate was 71.28%.There was significant difference in the effective rate between the two drugs(P<0.05).Conclusions Piperacillin/tazobactam can be used as the best choice for the empirical treatment of infection after chemotherapy in children with acute lymphoblastic leukemia.

关 键 词：急性淋巴细胞白血病 儿童 感染 哌拉西林/他唑巴坦 

分 类 号：R733.7[医药卫生—肿瘤]