哌拉西林/舒巴坦治疗院内获得性肺炎的疗效和药物经济学分析

Pharmaceutical–economic analysis and efficacy evolution of piperacillin/sulbactam in treatment of hospital acquired pneumonia

目的运用药物经济学原理，比较哌拉西林钠／舒巴坦钠及头孢吡肟治疗院内获得性肺炎（HAP）的疗效和费用。方法回顾性调查我院2009年1月～2010年3月应用两种抗生素治疗HAP的临床病历，比较分离菌对常见抗菌药物的敏感性，了解两种药物体内疗效，分析药物利用及成本消耗情况。结果239例HAP患者共分离到致病菌246株，有7例患者一次痰标本分离出两种或以上病原菌。病原茵构成显示，铜绿假单胞菌（21．1％）、肺炎克雷伯菌（17．9％）、鲍曼不动杆菌（13．4％）和金黄色葡萄球菌（13．4％）是HAP的主要病原茵。哌拉西林／舒巴坦对铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌、甲氧西林敏感金黄色葡萄球菌（MSSA）的敏感率分别为83．3％，70．0％，80．0％和100％。体内疗效比较，哌拉四林／舒巴坦组总有效率为89．6％，头孢吡肟组的总有效率89．5％。疗效-成本分析表明，哌拉西林／舒巴坦组每单位疗效所花费的成本（C总／E）和抗生素所花费的成本（C抗／E）都低于头孢吡肟组。结论在治疗中重度院内扶得性肺炎中，哌拉西林／舒巴坦在体外抗菌活性、体内疗效和药物经济学3方面都具备一定优势，可作为重要备选药物使用。

Objective By using pharmaceutical-economic principle to comparing the curative effect and cost of piperacillin/sulbactam and Cefepime in the treatment of hospital acquired pneumonia. Method Retrospective sampling was administered to get lower respiratory tract infection cases during the period of Jan 2009 to Mar 2010 and in vitro activities, in vivo clinical efficacy and cost-effectiveness ofpiperacillin/sulbactam and cefepime were analyzed. Results The common pathogens of lower respiratory tract infection were Pseudomonas aeruginosa（21.2%）, Klebsiella pneumoniae（17.7% ）, Acinetobacter baumanni（13.3% ） and Staphylococcus aureus（13.3%） among 226 strains isolated from 248 cases in this study, piperacillin/sulbactam showed good activity against Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumanni and MSSA, with the susceptibility of above 70%. Overall clinical efficacy rates of piperacillin/sulbactam and cefepime were 89.6% and 89.5%, respectively. Cost- effectiveness analysis shows that piperacillin/tazobactam have better ratio of effectiveness to cost. Conclusion Piperacillin/sulbactam showed higher curative effect and lower economic cost in the treatment of hospital acquired pneumonia.