基于奥马环素治疗的临床疗效及影响因素分析  

Analysis on clinical efficacy and influencing factors based on omadacycline treatment

作　　者：陈一帆 侯周华 胡琴[1,2,5] 黄燕 孟秀娟[6] 王春江 刘韶[1,2,5] CHEN Yi-fan;HOU Zhou-hua;HU Qin;HUANG Yan;MENG Xiu-juan;WANG Chun-jiang;LIU Shao(Department of Pharmacy,Xiangya Hospital,Central South University,Changsha 410008,China;National Clinical Research Center for Geriatric Di-sorders,Changsha 410008,China;Department of Pharmacy,The First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510080,China;Department of Infectious Diseases,Xiangya Hospital,Central South University,Changsha 410008,China;The Hunan Institute of Pharmacy Practice and Clinical Research,Changsha 410008,China;Department of Healthcare-associated Infection Management,Affiliated Hospital of Jining Medical College,Jining 272000,China;Department of Pharmacy,The Third Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院药学部,湖南长沙410008 [2]国家老年疾病临床医学研究中心(湘雅医院),湖南长沙410008 [3]广州医科大学附属第一医院药学部,广东广州510080 [4]中南大学湘雅医院感染病科,湖南长沙410008 [5]湖南省临床药学研究中心,湖南长沙410008 [6]济宁医学院附属医院医院感染管理部,山东济宁272000 [7]中南大学湘雅三医院药学部,湖南长沙410008

出　　处：《中国感染控制杂志》2024年第9期1106-1113,共8页Chinese Journal of Infection Control

基　　金：湖南省自然科学基金项目(2022JJ80045)。

摘　　要：目的探讨奥马环素治疗感染性疾病的临床疗效及治疗效果的影响因素。方法回顾性分析2022年1月-2023年12月在中南大学湘雅医院接受奥马环素单药或联合治疗的住院患者资料。通过单因素分析和多因素logistic回归分析奥马环素治疗无效的影响因素。结果共纳入160例患者,总体治疗有效率为69.4%(111例)。经奥马环素治疗后,观察到治疗有效组患者体温好转[(36.83±0.52)℃VS(37.85±0.92)℃,P<0.001],白细胞计数[(7.78±4.07)×10^(9)/L VS(10.06±6.49)×10^(9)/L,P<0.001]、降钙素原[(0.63±1.19)ng/mL VS(4.43±10.14)ng/mL,P=0.001)]、C反应蛋白[(35.16±37.82)mg/L VS(105.08±99.47)mg/L,P<0.001]和天冬氨酸转氨酶[(50.50±40.04)U/L VS(77.17±91.43)U/L,P=0.004)]均显著下降。仅有1例患者出现腹泻等不良反应,但未中断治疗。单因素分析显示:治疗无效组患者急性生理与慢性健康评分(APACHEⅡ)[17.0(9.5~22.0)VS 12.0(9.0~19.0),P=0.046]和序贯器官衰竭评分(SOFA)[7.0(4.5~10.0)VS 4.0(2.0~9.0),P=0.019]更高。多因素分析显示:终末期肝病(OR=77.691,95%CI:5.448~1107.880,P=0.001)、机械通气(OR=6.686,95%CI:1.628~27.452,P=0.008)及联合万古霉素治疗(OR=6.432,95%CI:1.891~21.874,P=0.003)是奥马环素治疗无效的危险因素;而奥马环素疗程(OR=0.905,95%CI:0.825~0.994,P=0.037)是治疗有效的保护因素。结论奥马环素可作为难治性严重感染的替代疗法,不良反应较少,终末期肝病、机械通气、联合万古霉素治疗是感染患者奥马环素治疗无效的危险因素,足够的奥马环素疗程可改善患者的临床结局,亟待大样本的病例研究来证实该结论。Objective To explore the clinical efficacy and influencing factors of omadacycline(OMC)in the treatment of patients with infectious diseases.Methods Data about hospitalized patients who received OMC monotherapy or combination therapy at Xiangya Hospital of Central South University from January 2022 to December 2023 were analyzed retrospectively.The influencing factors for failure of OMC treatment was analyzed by univariate and multivariate logistic regression analysis.Results A total of 160 patients were included in analysis,with an overall effective treatment rate of 69.4%(n=111).After treatment with OMC,patients in effective group was observed that body temperature improved([36.83±0.52]℃vs[37.85±0.92]℃,P<0.001),white blood cell count([7.78±4.07]×10^(9)/L vs[10.06±6.49]×10^(9)/L,P<0.001),procalcitonin([0.63±1.19]ng/mL vs[4.43±10.14]ng/mL,P=0.001),C-reactive protein([35.16±37.82]mg/L vs[105.08±99.47]mg/L,P<0.001),and aspartate aminotransferase([50.50±40.04]U/L vs[77.17±91.43]U/L,P=0.004)all decreased significantly.Only one patient had adverse reactions such as diarrhea,but treatment was not interrupted.Univariate ana-lysis showed that patients in failure treatment group had a higher acute physiology and chronic health evaluationⅡ(APACHEⅡ)score(17.0[9.5-22.0]vs 12.0[9.0-19.0],P=0.046)and sequential organ failure assessment(SOFA)score(7.0[4.5-10.0]vs 4.0[2.0-9.0],P=0.019).Multivariate analysis showed that end-stage liver disease(OR=77.691,95%CI:5.448-1107.880,P=0.001),mechanical ventilation(OR=6.686,95%CI:1.628-27.452,P=0.008)and the combination treatment of vancomycin(OR=6.432,95%CI:1.891-21.874,P=0.003)were risk factors for the failure of OMC treatment,while the course of OMC treatment(OR=0.905,95%CI:0.825-0.994,P=0.037)was a protective factor for the effective treatment.Conclusion OMC can be used as an alternative therapy for refractory severe infection,with fewer adverse reaction.End-stage liver disease,mechanical ventilation and combination treatment of vancomycin are risk factors for failu

关 键 词：奥马环素 多重耐药菌 非典型病原体 影响因素 疗效 

分 类 号：R453.2[医药卫生—治疗学]