晚期癌症合并感染的抗菌药物治疗

Antibiotic Treatment for Late Stage Cancer Complicated with Infection

目的探讨晚期癌症合并感染患者不同抗菌药物治疗方法与效果。方法回顾性调查我科2004年1月至2005年6月68例82例次癌症并发感染患者,分析感染部位构成比及易感因素个数,治疗开始即采用广谱抗菌药物组(A)与窄谱抗菌药物组(B)、降阶梯治疗组(a)与升阶梯治疗组(b)的疗程和疗效。结果感染部位以呼吸道感染最多见,占68.29%;易感因素个数a组与b组差异有显著性(P<0.05);各组疗程差异均无显著性,但B、b组治疗后体温及中性粒细胞比值下降幅度较大;a组总有效率高,而且治疗达到治愈或好转所需时间短(P<0.05)。结论降阶梯疗法不增加细菌耐药性的发生,可减少或避免反复盲目调换抗菌药物及联合用药的毒副作用,缩短了疗程,节约了费用,严重感染的患者,感染来势凶猛而尚无病原学及药敏结果时,抗感染降阶梯治疗是最佳选择。

OBJECTIVE To study the effect of various antibiotics in the treatment of patients with late stage cancer complicated with infection. METHODS In our retrospective investigation, there were 82 episodes of 68 cancer patients complicated with infection from Jan 2004 to Jun 2005. We analyzed the constituent proportion of infection and susceptible factors. The patients were divided into 4 groups, group A treated with broad-spectrum antibiotic, group B treated with narrow-spectrum antibiotic, group a treated with de-escalation therapy and group b treated with escalation therapy. We observed the course of therapy and the clinical effect. RESULTS The respiratory tract infection was the most one and it was 68.29% （56/82）. Its susceptible factors were obviously different between group a and group b （P〈0. 05）. There was no significant difference in clinical effect among all the groups, but the declined ratio between temperature and neutrophils was the most significant after treating in group B and group b. The total effective rate of group a was high and the time of cure or improvement was the shortest （P〈0.05）. CONCLUSIONS De-escalation therapy doesn＇t increase the drug resistance of bacteria, but could decrease or avoid the occurrence of toxic and side effecs after repeatedly and blindly changing antibiotic and combined medication, and shorten the course of treatment and expenses. For serious infection and violent incidence without definite etiology and drug sensitive results, the de-escalation therapy is the best choice for anti-infection.