头孢他啶阿维巴坦治疗碳青霉烯类耐药革兰氏阴性菌感染患者的真实世界研究  

Real-world study of ceftazidime-avibactam for carbapenem-resistant Gram-negative organism infections

作　　者：游翔 黄小婷 吴朝晖[1,2] 黄品芳[1,2] YOU Xiang;HUANG Xiaoting;WU Chaohui;HUANG Pinfang(Department of Pharmacy,the First Affiliated Hospital of Fujian Medical University,Fujian Fuzhou 350004,China;Department of Pharmacy,National Regional Medical Center,Binhai Campus of the First Affiliated Hospital of Fujian Medical University,Fujian Fuzhou 350212,China)

机构地区：[1]福建医科大学附属第一医院药学部,福建福州350004 [2]福建医科大学附属第一医院滨海院区国家区域医疗中心药学部,福建福州350212

出　　处：《中国医院药学杂志》2025年第2期203-208,共6页Chinese Journal of Hospital Pharmacy

基　　金：福建省中青年教师教育科研项目(编号:JAT210110)。

摘　　要：目的:描述与评价头孢他啶阿维巴坦(ceftazidime-avibactam,CAZ-AVI)治疗碳青霉烯类耐药革兰氏阴性菌(carbapenem-resistant organism,CRO)感染患者的临床特征与结局。方法:回顾性收集2020年9月至2023年12月在福建医科大学附属第一医院接受CAZ-AVI治疗CRO感染患者的相关资料。对临床基本资料进行描述性分析,将30 d病死率及14 d细菌清除率作为评价CAZ-AVI治疗CRO感染患者预后及药物疗效的临床指标,采用单因素及多因素Logistic分析方法,分析影响CAZ-AVI治疗CRO感染患者疗效的相关因素。结果:共40例患者符合纳入标准并进行数据评估,其中35例患者的致病菌为碳青霉烯耐药的肠杆菌科细菌(Carbapenem-resistant Enterobacteriaceae,CRE),5例为碳青霉烯耐药的铜绿假单胞(Carbapenem-resistant Klebsiella pneumoniae,CRPA)。感染部位以肺部感染(72.5%,29/40)及中枢神经系统感染(10%,4/40)为主。CRE组与CRPA组在30 d病死率、14 d细菌清除率及30 d临床治愈率方面均无明显差异。单因素及多因素Logistic分析结果显示,使用CAZ-AVI治疗疗程缩短为CRO感染患者预后不良的独立危险因素,入住ICU为采用CAZ-AVI治疗细菌清除失败的独立危险因素。共3例患者出现了与CAZ-AVI可能相关的腹泻。结论:CAZ-AVI治疗CRO感染患者的疗效和安全性均较好,同时适当延长治疗疗程可能有助于提高治疗的有效率。OBJECTIVE To provide a comprehensive description and evaluation of the clinical characteristics and outcomes associated with the use of ceftazidime-avibactam(CAZ-AVI) in the treatment of patients with carbapenem-resistant Gramnegative organisms(CRO) infections.METHODS The relevant data were retrospectively collected from patients who received CAZ-AVI for CRO infection at the First Hospital of Fujian Medical University from September 2020 to December 2023.The basic clinical data were subjected to descriptive analysis.The 30-day mortality rate and the 14-day bacterial clearance rate were employed as clinical indicators to evaluate the prognosis and drug efficacy of CAZ-AVI in treating CRO infections.The factors affecting the efficacy of CAZ-AVI in treating CRO infections were analyzed using univariate and multivariate logistic regression.RESULTS A total of 40 eligible patients were included for data assessment.Of them,35 patients had carbapenem-resistant Enterobacteriaceae(CRE) as the causative organism,while 5 had carbapenem-resistant Pseudomonas aeruginosa(CRPA).Pulmonary(72.5%,29/40) and central nervous system(CNS) infections(10%,4/40) were the predominant infection sites.No significant differences were observed in the 30-day mortality,14-day bacterial clearance rates,and 30-day clinical cure rate between the CRE and CRPA groups.Univariate and multivariate logistic analyses indicated that a shortened treatment course with CAZ-AVI was an independent risk factor for a poor prognosis of CRO infections.Furthermore,admission to the ICU was identified as an independent risk factor for the failure of bacterial clearance by CAZ-AVI therapy.A total of three patients developed diarrhea related to CAZ-AVI.CONCLUSION The efficacy and safety of CAZ-AVI in the treatment of CRO infections is superior,while the appropriate prolongation of the treatment course may enhance the efficiency.

关 键 词：头孢他啶阿维巴坦 碳青霉烯类耐药革兰氏阴性菌 临床疗效 

分 类 号：R978.1[医药卫生—药品]