多黏菌素E甲磺酸钠治疗碳青霉烯耐药革兰阴性菌感染效果观察  

Efficacy of colistin methanesulfonate sodium on carbapenem-resistant organisms

作　　者：张丹丹[1] 冯婷婷 杨翠翠 郭腾飞[2] 刘彩虹[1] ZHANG Dandan;FENG Tingting;YANG Cuicui;GUO Tengfei;LIU Caihong(l.department of pharmacy,the first affiliated hospital of henan university of science and technology,luoyang,henan 471002,china;department of laboratory medicine,the first affiliated hospital of henan university of science and technology,luoyang,henan 471002,china)

机构地区：[1]河南科技大学第一附属医院药学部,河南洛阳471002 [2]河南科技大学第一附属医院检验科,河南洛阳471002

出　　处：《中华实用诊断与治疗杂志》2024年第10期1063-1068,共6页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20210594);医学科学研究基金项目(BXS5-22009)。

摘　　要：目的比较注射用多黏菌素E甲磺酸钠(CMS)和硫酸多黏菌素B(PMB)治疗碳青霉烯耐药革兰阴性菌(CRO)感染的效果和安全性,探讨CMS治疗CRO肺部感染的最佳给药方式及CRO肺部感染患者CMS雾化吸入治疗无效的影响因素。方法2022年1月—2023年6月河南科技大学第一附属医院诊治CRO感染患者184例,其中采用CMS治疗者92例为CMS组,采用PMB治疗者92例为PMB组,比较2组临床有效率、细菌清除率、肾毒性发生率、肾毒性发生时间及28 d病死率。CMS组肺部感染者84例,采用静脉滴注19例,雾化吸入42例,静脉滴注联合雾化吸入23例,比较3种给药方式患者临床有效率、细菌清除率及肾毒性发生率。CMS组雾化吸入者42例根据疗效分为有效组31例和无效组11例,比较2组临床肺部感染评分(CPIS)、微生物种类等临床资料。采用多因素logistic回归分析CRO肺部感染患者CMS雾化吸入治疗无效的影响因素。结果PMB组临床有效率(82.61%)高于CMS组(65.22%)(χ^(2)=7.216,P=0.007),细菌清除率(34.78%)、28 d病死率(44.57%)、肾毒性发生率(11.96%)、肾毒性发生时间[(6.18±5.32)d]与CMS组[44.57%、33.70%、19.57%、(4.61±3.63)d]比较差异均无统计学意义(χ^(2)=1.839,P=0.175;χ^(2)=2.282,P=0.131;χ^(2)=2.006,P=0.157;χ^(2)=0.946,P=0.352)。CMS雾化吸入者临床有效率(73.81%)高于静脉滴注者(42.11%)、静脉滴注联合雾化吸入者(47.83%)(χ^(2)=5.703,P=0.017;χ^(2)=4.388,P=0.036),静脉滴注者与静脉滴注联合雾化吸入者比较差异无统计学意义(χ^(2)=0.137,P=0.711);雾化吸入者肾毒性发生率(4.76%)低于静脉滴注者(21.05%)、静脉滴注联合雾化吸入者(52.17%)(χ^(2)=3.914,P=0.047;χ^(2)=19.768,P<0.001),静脉滴注者低于静脉滴注联合雾化吸入者(χ^(2)=4.273,P=0.039);3种给药方式患者细菌清除率比较差异无统计学意义(χ^(2)=3.662,P=0.105)。无效组CPIS评分[(9.09±1.30)分]及感染鲍曼不动杆菌、铜绿假单胞菌比率(72.73%、36.36%)Objective To compare the efficacy and safety of colistin methanesulfonate sodium(CMS)injection and polymyxin B(PMB)injection in treatment of carbapenem-resistant organisms(CRO)infection,and to explore the optimal administration method of CMS and the influencing factors of ineffective CMS aerosol inhalation in the treatment of CRO pulmonary infection.Methods A total of 184 patients with CRO infection were diagnosed and treated in the First Affiliated Hospital of Henan University of Science and Technology from January 2022 to June 2023,and were divided into PMB group(n=92)and CMS group(n=92).The clinical effective rate,bacterial clearance rate,incidence of nephrotoxicity,time of nephrotoxicity onset and 28-d fatality rate were compared between two groups.In CMS group,84patients developed pulmonary infection,among whom 19 patients received intravenous drip,42 patients received aerosol inhalation,and 23 patients received intravenous drip combined with aerosol inhalation;the clinical effective rate,bacterial clearance rate,and incidence of nephrotoxicity were compared among these three treatment methods.Forty-two patients receiving aerosol inhalation were divided into effective group(n=31)and ineffective group(n=11),and the clinical data as clinical pulmonary infection score(CPIS)and microbial species were compared between two groups.Multivariate logistic regression was used to analyze the influencing factors of ineffective CMS aerosol inhalation in patients with CRO pulmonary infection.Results The clinical effective rate was higher in PMB group(82.61%)than that in CMS group(65.22%)(χ^(2)=7.216,P=0.007).No significant differences were found in the bacterial clearance rate,28-d fatality rate,incidence of nephrotoxicity and time of nephrotoxicity onset between PMB group[34.78%,44.57%,11.96%,(6.18±5.32)d]and CMS group[44.57%,33.70%,19.57%,(4.61±3.63)d](χ^(2)=1.839,P=0.175;χ^(2)=282,P=0.131;χ^(2)=2.006,P=0.157;χ^(2)=0.946,P=0.352).The clinical effective rate of aerosol inhalation(73.81%)was higher than that of intr

关 键 词：碳青霉烯耐药革兰阴性菌感染 多黏菌素E甲磺酸钠 硫酸多黏菌素B 肾毒性 雾化吸入 鲍曼不动杆菌 铜绿假单胞菌 

分 类 号：R446.5[医药卫生—诊断学]