早产儿感染耐碳青霉烯类肺炎克雷伯菌后的阿米卡星治疗和管理  

Amikacin therapy and management of premature infants infected with carbapenem-resistant Klebsiella pneumoniae

作　　者：胡文娟 杨巧玲 王学彬 谭波宇 陈一欢 孙华君 HU Wenjuan;YANG Qiaoling;WANG Xuebin;TAN Boyu;CHEN Yihuan;SUN Huajun(Department of Pharmacy,Shanghai Children's Hospital,School of medicine,Shanghai Jiao Tong University,Shanghai 200040,China;Department of Neonatology Shanghai Children's Medical Center,School of Medicine,Shanghai Jiao Tong University,Shanghai 200040,China)

机构地区：[1]上海市儿童医院,上海交通大学医学院附属儿童医院药学部,上海200040 [2]上海市儿童医院,上海交通大学医学院附属儿童医院新生儿科,上海200040

出　　处：《中国临床药理学与治疗学》2024年第12期1401-1408,共8页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：中国药学会医院药学专业委员会医院药学科研专项资助项目(CPA-Z05-ZC-2021-002);中国医药教育协会药学服务专业委员会“聚火有才”科研项目重大项目(CMEAPC2024004)。

摘　　要：目的:了解阿米卡星(AMK)治疗早产儿耐碳青霉烯类肺炎克雷伯菌(CRKP)肺炎的疗效和安全性,并建立早产儿阿米卡星使用的管理流程。方法:2019年1月至2021年12月期间接受阿米卡星治疗的CRKP感染早产儿进行回顾性分析,对纳入的感染性指标和安全性指标采用参数数据配对t检验,评估阿米卡星的有效性和安全性,并建立早产儿阿米卡星使用的管理流程。结果:纳入8例CRKP感染病例,主要诊断为肺炎和脓毒症。8名早产儿在阿米卡星治疗前进行阿米卡星耳毒性基因线粒体基因MT-RNR1(MT-RNR11494C>T和MTRNR11555A>G)筛查,均未发现基因变异,接受硫酸阿米卡星注射液治疗7 d后,感染指标均有所改善(P<0.01)。用药前后未发现患儿出现临床耳毒性和肾毒性。结论:氨基糖苷类药物仍是早产儿疑似感染尤其是耐药菌感染经验性治疗的主要抗生素选择之一。虽然存在耳毒性和肾毒性风险,我们提供了新生儿使用阿米卡星治疗的管理流程和建议,以降低阿米卡星的耳毒性和肾毒性风险。AIM:To understand the efficacy and safety of amikacin(AMK)for the treatment of carbapenem-resistant Klebsiella pneumoniae pneumoniae(CRKP)in preterm infants and to establish a management process for the use of amikacin in preterm infants.METHODS:CRKP-infected preterm infants treated with amikacin between January 2019 and December 2021 were retrospectively analyzed,and parametric data paired t-tests were used to assess the efficacy and safety of amikacin for the included infectious and safety indicators,and to establish a management process for amikacin use in preterm infants.RESULTS:Eight cases of CRKP infection were included,with the main diagnosis of pneumonia and sepsis.eight preterm infants were screened for the AMK ototoxicity gene mitochondrial gene MT-RNR1(MT-RNR11494C>T and MTRNR11555A>G)before amikacin treatment,and none of them were found to have the gene variant.after receiving amikacin sulphate injection treatment for 7 days,the indicators of infectivity were improved,and was statistically significant(P<0.01).No clinical ototoxicity or nephrotoxicity was observed in the children before or after treatment.CONCLUSION:Aminoglycosides are still the main antibiotics used for the empirical treatment of suspected infections in preterm infants,especially drug-resistant bacterial infections.Despite the risk of ototoxicity and nephrotoxicity,we provide management procedures and recommendations for neonatal treatment with amikacin to reduce the risk of ototoxicity and nephrotoxicity in AMK.

关 键 词：阿米卡星 氨基糖苷类 耳毒性 肾毒性 早产儿 耐碳青霉烯类肺炎克雷伯菌 

分 类 号：R969[医药卫生—药理学]