亚胺培南/西司他丁与哌拉西林/他唑巴坦治疗30例脓毒症患者疗效比较

Comparison of Imipenem-cilastatin and Piperacillin-tazobactam on 30 Case Septic Patients as Initial Empirical Monotherapies

目的比较两种广谱抗生素作为经验性首选单一疗法对脓毒症的疗效。方法根据纳入标准纳入30例需要呼吸机辅助通气的脓毒症及多脏器功能障碍患者,分别首选亚胺培南/西司他丁和哌拉西林/他唑巴坦静脉注射(各15例),总疗程7d。结果经治疗后亚胺培南/西司他丁组患者具有较低的降钙素原(PCT)和革兰阴性菌脂多糖(LPS)水平,两组差异具有统计学意义(P值分别为0.022和0.0001)。亚胺培南/西司他丁(1:1)组3例患者死亡,哌拉西林/他唑巴坦(8:1)组6例死亡,两组差异具有统计学意义(P=0.028),而两组ICU住院日、呼吸机使用时间均无统计学差异。亚胺培南/西司他丁组5例患者痰培养发现鲍曼不动杆菌,而哌拉西林/他唑巴坦组仅3例,两组鲍曼不动杆菌发生率差异有统计学意义(P=0.011)。结论对于非院内感染菌所致脓毒症,亚胺培南/西司他丁疗效优于哌拉西林/他唑巴坦,但可能增加院内鲍曼不动杆菌感染的风险。

Objective To compare two broad-spectrum antibiotics in treating sepsis as initial empirical mono-therapies.Methods According the inclusion criteria,included 30 cases with sepsis and multiple organ dysfunctions who needed to be supported by ventilators.The patients were assigned to two groups：venous injection of imipenem-cilastatin group and piperacillin-tazobactam group（15 cases respectively） .The total treatment duration was seven days.Results After treatment,the preprocalcitonin（PCT） and lipopolysaccharide were lower in imipenem-cilastatin group,both of which the differences were significant（p value was 0.022 and 0.0001 respectively） .There were 3 death in imipenem-cilastatin（1：1） group and 6 in piperacillin-tazobactam（8：1） group,the difference was significant too（P=0.028） .The differences of ICU stay and ventilation duration were insignificant.Five patients in imipenem-cilastatin group were acinetobacter baumannii positive in sputum culture,while only 3 in piperacillin-tazobactam group.The difference was significant（P=0.011） .Conclusion For septic patients other than nosocomial infection,imipenem-cilastatin had a better effect than piperacillin-tazobactam.But it may possibly added risk of in-hospital acinetobacter baumannii infection.