高剂量替加环素与多黏菌素B治疗肺部耐碳青霉烯类革兰阴性杆菌感染的疗效比较  

Comparison of efficacy of high dose tigecycline and polymyxin B in the treatment of pulmonary infection due to carbapenem-resistant organism

作　　者：张步瑶 侯琴兰 尹敏慧 王鹏宇 胡成欢 黄勋[4] 赵双平[1,2,3] ZHANG Buyao;HOU Qinlan;YIN Minhui;WANG Pengyu;HU Chenghuan;HUANG Xun;ZHAO Shuangping(Department of Critical Care Medicine,Xiangya Hospital,Central South University,Changsha 410008,China;National Clinical Research Center for Geriatric Disorders,Changsha 410008,China;Hunan Provincial Clinical Research Center of Critical Care Medicine,Changsha 410008,China;Center for Healthcare-associated Infection Control,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院重症医学科,湖南长沙410008 [2]国家老年医学研究中心(湘雅医院),湖南长沙410008 [3]湖南省重症医学临床研究中心,湖南长沙410008 [4]中南大学湘雅医院医院感染控制中心,湖南长沙410008

出　　处：《中国感染控制杂志》2025年第1期15-22,共8页Chinese Journal of Infection Control

基　　金：国家重点研发计划项目(2020YFC2005403);吴阶平医学基金会临床科研专项资助基金项目(320.6750.18425)。

摘　　要：目的比较高剂量替加环素(TGC)与多黏菌素B(PMB)治疗肺部耐碳青霉烯类革兰阴性杆菌(CRO)感染的临床疗效.方法回顾性分析中南大学湘雅医院重症医学科2019年1月—2022年3月肺部CRO感染并接受以PMB或高剂量TGC为基础联合其他抗菌药物治疗方案患者的临床资料,包括基础情况、病原学结果、抗菌药物使用方案、临床疗效、30天病死率、细菌清除率等.结果共纳入173例患者,其中TGC组103例,PMB组70例.与TGC组相比,PMB组的急性生理学和慢性健康状况评价(APACHEⅡ)评分较高(25.0VS20.0,P<0.001),但临床有效率差异无统计学意义(67.1%VS52.4%,P=0.054).分层分析发现,APACHEⅡ评分≥15分时,与TGC组(n=78)相比,PMB组(n=66)的APACHEⅡ评分较高(27.0 VS22.0,P=0.005),临床有效率较高(66.7%VS47.4%,P=0.020).使用logistic回归分析调整混杂因素后发现,与TGC治疗相比,PMB治疗是临床有效率的保护因素.结论在肺部CRO感染患者治疗中,与以高剂量TGC为基础的治疗方案相比,以PMB为基础的治疗方案对临床有效率具有显著的保护作用.Objective To compare the clinical efficacy of high-dose tigecycline(TGC)and polymyxin B(PMB)in the treatment of pulmonary infection due to carbapenem-resistant organism(CRO).Methods Clinical data of patients with CRO pulmonary infection and received PMB or high-dose TGC combined with other antimicrobial treatment regimens in Department of Critical Care Medicine of Xiangya Hospital,Central South University from January 2019 to March 2022 were analyzed retrospectively,including basic information,pathogen detection results,antimicrobial use regimen,clinical efficacy,30-day mortality,bacterial clearance rate,etc.Results A total of 173 patients were included in analysis,with 103 in the TGC group and 70 in the PMB group.Compared with TGC group,PMB group had a higher score of acute physiology and chronic health evaluationⅡ(APACHEⅡ)(25.0 vs 20.0,P<0.001),but clinical efficacy rates were not statistically different(67.1%vs 52.4%,P=0.054).Stratified analysis revealed that when the APACHEⅡscore was≥15 points,compared with TGC group(n=78),PMB group(n=66)had a higher APACHEⅡscore(27.0 vs 22.0,P=0.005)and a higher clinical efficacy rate(66.7%vs 47.4%,P=0.020).After adjusting confounding factors through logistic regression analysis,it was found that PMB treatment was a protective factor for clinical efficacy rate compared with TGC treatment.Conclusion For treating pulmonary infection caused by CRO in patients,PMB-based treatment regimen has a significant protective effect on the clinical efficacy rate compared with the high-dose TGC-based treatment regimen.

关 键 词：替加环素 多黏菌素B 耐碳青霉烯类革兰阴性杆菌 临床疗效 CRO 

分 类 号：R181.32[医药卫生—流行病学]