CAZ-AVI与多黏菌素B治疗重症CRKP肺炎患者的效果及安全性比较  

Ceftazidime-Avibactam versus polymyxin B in the treatment of pneumonia caused by carbapenem-resistant Klebsiella pneumoniae pneumonia

作　　者：石颖 胡静 刘佩本 王婷婷 左祥荣 曹权 Shi Ying;Hu Jing;Liu Peiben;Wang Tingting;Zuo Xiangrong;Cao Quan(Department of Critical Care Medicine,Northern Jiangsu People's Hospital of Jiangsu Province,Yangzhou 225002,China;Department of Critical Care Medicine,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]江苏省苏北人民医院重症医学科,江苏扬州225002 [2]南京医科大学第一附属医院重症医学科,江苏南京210029

出　　处：《中华重症医学电子杂志》2024年第1期16-24,共9页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

基　　金：江苏省“青年医学人才”项目(QNRC2016557);江苏省第五期“333高层次人才培养工程”第三层次人才项目;江苏省高层次卫生人才“六个一工程”拔尖人才科研项目(LGY2019067);江苏省苏北人民医院青年托举专项基金项目(SBQN22025)

摘　　要：目的比较以头孢他啶-阿维巴坦(CAZ-AVI)与多黏菌素B为基础的抗感染治疗策略在重症耐碳青霉烯类肺炎克雷伯杆菌(CRKP)肺炎患者中的效果与安全性。方法回顾性分析2019年6月至2020年9月在南京医科大学第一附属医院ICU诊断为CRKP相关肺炎并接受CAZ-AVI(46例)或多黏菌素B(40例)为基础治疗的86例患者的临床资料,比较CAZ-AVI组和多黏菌素B组的临床治愈率、微生物清除率、28 d生存率和安全性等情况。结果86例研究对象中,CAZ-AVI组CRKP清除率为71.7%(33/46),多黏菌素B组为45.0%(18/40),2组比较,差异有统计学意义(χ^(2)=6.338,P=0.012)。CAZ-AVI组临床治愈率为52.2%(24/46),28 d生存率为69.6%(32/46),多黏菌素B组分别为32.5%(13/40)、75.0%(30/40),2组比较,差异均无统计学意义(χ^(2)=3.378,P=0.066;χ^(2)=0.314,P=0.575)。应用多因素logistic回归分析和倾向性评分(PS)回归调整法发现,CAZ-AVI组患者临床治愈率比多黏菌素B组高(P值分别为0.017、0.025),校正ORs和95%CIs分别为3.550(1.250~10.078)、3.062(1.150~8.149);CAZ-AVI组患者微生物清除率亦比多黏菌素B组高(P值分别为0.012、0.015),校正ORs和95%CIs分别为3.320(1.308~8.427)、3.297(1.259~8.637);2组28 d生存率差异无统计学意义(P值分别为0.990、0.850)。CAZ-AVI组不良反应发生率低于多黏菌素B组,差异有统计学意义(8.7%vs 30.0%,χ^(2)=6.413,P=0.011)。结论对于CRKP引起的肺炎,CAZ-AVI治疗效果可能优于多黏菌素B。Objective To assess the efficacy and safety of Ceftazidime-Avibactam(CAZ-AVI)versus polymyxin B-based anti-infective therapy in patients with severe carbapenem-resistant Klebsiella pneumoniae(CRKP)pneumonia.Methods From June 2019 to September 2020,the data from patients in ICU of the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed.These patients were diagnosed with pneumonia caused by CRKP and were treated with either CAZ-AVI or polymyxin B-based anti-infective therapy.Clinical and microbiologic cure rates,28-day survival,and safety evaluation were compared between patients in two groups.Results Among the 86 subjects,CRKP clearance was 71.7%(33/46)in the CAZ-AVI group and 45.0%(18/40)in the polymyxin B group,there was significant difference between two groups(χ^(2)=6.338,P=0.012).The clinical cure rate was 52.2%(24/46),the 28-day survival rate was 69.6%(32/46)in the CAZ-AVI group while 32.5%(13/40)and 75.0%(30/40)in polymyxin B group,there were no significant difference between two groups(χ^(2)=3.378,P=0.066;χ^(2)=0.314,P=0.575).The multivariate logistic regression analysis and propensity score(PS)regression adjustment method were employed.The results indicated that the clinical cure rate was significantly higher in the CAZ-AVI group compared to the polymyxin B group(P values of 0.017 and 0.025,respectively).The adjusted odds ratios(ORs)and 95%confidence intervals(CIs)were 3.550(1.250-10.078)and 3.062(1.150-8.149),respectively.The microbial clearance in CAZ-AVI patients was significantly higher relative to the polymyxin B group(P values:0.012,0.015,respectively),adjusted ORs and 95%CIs were 3.320(1.308-8.427),3.297(1.259-8.637).There was no significant difference in 28-day survival between the 2 groups(P values were 0.990 and 0.850,respectively).The CAZ-AVI group had a lower incidence of adverse reactions when compared with the polymyxin B group(8.7%vs 30.0%,χ^(2)=6.413,P=0.011).Conclusion CAZ-AVI be a reasonable alternative to polymyxin B in the treatment of pneumonia ca

关 键 词：耐碳青霉烯类肺炎克雷伯杆菌 头孢他啶-阿维巴坦 多黏菌素B 临床结果 安全性评价 

分 类 号：R563.1[医药卫生—呼吸系统]