替加环素和多黏菌素B治疗重症患者耐碳青霉烯类肠杆菌科细菌肺炎的疗效和安全性分析  

Efficacy and safety analysis of tigecycline and polymyxin B in the treatment of carbapenem-resistant enterobacteriaceae pneumonia in critically ill patients

作　　者：查娴[1] 陈大宇 邵华[1] ZHA Xian;CHEN Dayu;SHAO Hua(Department of Pharmacy,Zhongda Hospital Southeast University,Nanjing 210009,Jiangsu,China;Department of Pharmacy,Nanjing Drum Tower Hospital the Affiliated Hospital of Nanjing University,Nanjing 210009,Jiangsu,China)

机构地区：[1]东南大学附属中大医院药学部,江苏南京210009 [2]南京大学医学院附属鼓楼医院药学部,江苏南京210009

出　　处：《中国临床药理学与治疗学》2024年第2期154-163,共10页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：江苏省药学会-奥赛康医院药学基金科研项目(A202107);南京药学会-常州四药医院药学科研基金项目(2020YX021)。

摘　　要：目的:比较替加环素和多黏菌素B治疗重症患者耐碳青霉烯类肠杆菌科细菌(CRE)肺炎的疗效和安全性。方法:回顾性分析2018年1月1日至2023年6月30日于我院重症医学科(ICU)接受替加环素或多黏菌素B治疗的CRE肺炎患者的临床资料。主要结局包括28 d全因病死率和28 d临床治愈率。次要结局包括ICU病死率、住院病死率、住院时间、ICU住院时间、微生物清除率、机械通气时间。采用Cox回归分析检验影响28 d临床治愈率的独立预测因素。结果:倾向性评分匹配后纳入83名患者,其中替加环素组54例,多黏菌素B组29例。替加环素组28 d全因病死率为31.5%(17/54),多黏菌素B组为37.9%(11/29),差异无统计学意义(P=0.554);替加环素组28 d临床治愈率为63%(34/54),显著高于多黏菌素B组的34.5%(10/29)(P=0.013)。两组的次要结局指标均无统计学差异。多因素回归分析发现,使用替加环素是28 d临床治疗有效的独立预测因素(HR:2.083,95%CI 1.018-4.263,P=0.045)。但替加环素组用药后活化部分凝血活酶时间、凝血酶原时间较多黏菌素B组显著延长(P=0.047;P=0.027),纤维蛋白原显著下降(P<0.001)。结论:替加环素组和多黏菌素组28 d全因病死率无显著差异;与多黏菌素B相比,替加环素可能与更高的28 d临床治愈率相关。同时需注意,替加环素可能增加凝血功能异常的风险。AIM:To compare the efficacy and safety of tigecycline with polymyxin B in the treatment of carbapenem resistant enterobacteriaceae(CRE)pneumonia in critically ill patients.METHODS:A retrospective analysis was performed on the clinical data of patients with CRE pneumonia who received tigecycline or polymyxin B therapy from January 1,2018 to Jun 30,2023 in the Intensive Care Unit(ICU).Primary outcomes included the 28-day allcause mortality and clinical cure rate within 28days.Secondary outcomes included the ICU mortality,inhospital mortality,the length of hospital stay and ICU stay,microbial eradication,duration of mechanical ventilation.Independent predictors affecting 28-day clinical cure rate were tested using Cox regression analyses.RESULTS:A total of 83 eligible patients were included in the final analysis after propensity score matching,54 in the tigecycline group and 29 in the polymyxin B group.The 28-day all-cause mortality was 31.5%(17/54)in the tigecycline group and 37.9%(11/29)in the polymyxin B group,the difference was not statistically significant(P=0.554);the clinical cure rate was 63%(34/54)in the tigecycline group,which was significantly higher than that of the polymyxin B group of 34.5%(10/29)(P=0.013).There were no statistical differences between the two groups in terms of secondary outcomes.Multivariate logistic regression analysis found that the use of tigecycline was an independent predictor of the 28-day clinical cure rate(HR 2.083,95%CI 1.018-4.263,P=0.045).However,activated partial thromboplastin time(APTT)and prothrombin time(PT)were significantly prolonged in the tigecycline group compared with the polymyxin B group(P=0.047;P=0.027),and fibrinogen(FIB)was significantly decreased(P<0.001)after drug administration.CONCLUSION:There was no significant difference in 28-day all-cause mortality between the tigecycline and polymyxin groups;tigecycline might be associated with a higher 28-day clinical cure rate compared with polymyxin B.It should be noted that tigecycline may increase the risk of c

关 键 词：替加环素 多黏菌素B 肺炎 耐碳青霉烯类肠杆菌科细菌 

分 类 号：R563[医药卫生—呼吸系统]