美罗培南治疗小儿血液肿瘤194例疗效分析

Clinical practice of meropenem for children with neoplasms

目的考察美罗培南在小儿血液肿瘤感染患者中的疗效。方法2001—2005年对上海交通大学附属上海儿童医学中心血液肿瘤科194例感染患儿回顾性对比美罗培南、亚胺培南/西司他丁和以头孢他啶为代表的三代头孢的体外活性、临床疗效和不良反应。结果除凝固酶阴性的葡萄球菌,美罗培南对血液肿瘤发热患儿最常见的细菌均具有良好的抗菌活性。美罗培南的抗菌谱与亚胺培南相似,但明显优于头孢他啶,其中美罗培南和亚胺培南对噬麦芽寡养单胞菌的敏感性欠佳,而头孢他啶对该菌的敏感性较好,各类抗菌药物体内与体外的敏感度相当,美罗培南较亚胺培南的胃肠道反应少而轻。结论美罗培南是小儿血液肿瘤合并感染时良好的经验性用药选择。

Objective To evaluate meropenem for the treatment of infection in children with neoplasms. Methods Compare the susceptibility in vitro, clinical efficacy and side effect of meropenem, imipenem/cilastatin and cefotaxime retrospeetively which were used in 194 febrile episodes with neoplasms in our hospital. Results Meropenem was effective to the most of bacteria except for staphylococcus epidermidis infection. The antimicrobial spectrum of meropenem was the same as imipenem/cilastatin and wider than cefotaxime, but cefotaxime was more suseeptive to Stenotrophomonas mahophilia than tbe other two. The susceptibilities in vivo of the three medicines were equivalent to those in vitro. Meropenem had less side effect of digestive system than imipenem. Conclusion Empirical therapy with meropenem is a good choice of treating infection in children with neoplasms.