耐碳青霉烯类肺炎克雷伯杆菌肺部感染患者不同抗菌药物联合治疗方案的疗效与安全性分析

Efficacy and Safety of Different Antimicrobial Combination Regimens in Carbapenem-resistant Klebsiella Pneumoniae Pulmonary Infections

目的:探讨不同联合抗感染方案在治疗耐碳青霉烯类肺炎克雷伯杆菌(CRKP)肺部感染中的疗效与安全性。方法:2017年1月~2019年12月在南京医科大学第二附属医院诊断为CRKP肺部感染的165例患者,根据不同药物治疗方案分为:①替加环素组(85例):替加环素首剂200 mg,维持剂量100 mg q12h,静脉滴注;②多粘菌素B组(80例):多粘菌素B首剂2.5 mg·kg^(-1),维持剂量1.25 mg·kg^(-1),静脉滴注;两组患者均根据临床需要联合亚胺培南西司他丁或美罗培南,治疗时间超过7天;分析两组患者的疗效和安全性。结果与结论:患者首次痰培养的CRKP均对替加环素和多黏菌素B敏感,对美罗培南耐药。两组患者一般情况无统计学差异。临床总有效率:替加环素组为89.4%,多粘菌素B为92.5%,差异无统计学意义(P>0.05)。肝功能损害:替加环素组11例(12.9%),多黏菌素B组8例(10%),差异无统计学意义;肾功能损害:替加环素组3例(3.5%),多黏菌素B组4例(5.0%),差异无统计学意义(P>0.05);胃肠道反应:替加环素组4例(4.7%),多黏菌素B组0例,差异有统计学意义(P<0.05)。多粘菌素B组细菌清除率及临床疗效略高。替加环素大剂量使用需警惕肝功能损害及胃肠道不良反应。

Objective:To investigate the efficacy and safety of different antimicrobial regimens in patients with pulmonary infections caused by carbapenem-resistant Klebsiella pneumoniae(CRKP).Methods:Patients diagnosed with CRKP pulmonary infections in the Second Affiliated Hospital of Nanjing Medical University from January 2017 to December 2019 were divided into two groups according to different drug treatment schemes.For the tegacyclin group,the first dose of tegacyclin was 200 mg,the maintenance dose was 100 mg q12h,ivgtt;For the polymyxin B group,the first dose of polymyxin B was 2.5 mg·kg^(-1),the maintenance dose was 1.25 mg·kg^(-1),ivgtt.Both groups were treated with imipenem-cilastatin or meropenem for more than 7 days according to clinical needs.The efficacy and adverse reactions of the two groups were analyzed.Results&Conclusions:A total of 165 patients were included in this study,including 85 patients in the tegacyclin group and 80 patients in the polymyxin B group.CRKP in the first sputum cultures of all patients were sensitive to tegacyclin and polymyxin B and resistant to meropenem.There was no significant difference between the two groups in baseline data.The total clinical effective rates were 89.4%in the tegacyclin group and 92.5% in the polymyxin B group,respectively.The clearance rates of sputum culture CRKP were 75.3% in the tegacyclin group and 81.3% in the polymyxin B group.There was no significant difference between the two groups in the above efficacy indexes.Liver function was impaired in 11 cases(12.9%)of the tegacyclin group and 8 cases(10%)of the polymyxin B group(P>0.05);There were 3 cases(3.5%)in the tegacyclin group and 4 cases(5.0%)in the polymyxin B group with kidney impairments(P>0.05).The gastrointestinal reaction in the tegacyclin group(4.7%)was significantly higher than that in the polymyxin group(0)(P<0.05).When tegacyclin is used in large doses,it is necessary to be alert to its gastrointestinal adverse reactions.