118例住院患者头孢噻利用药评估及影响因素分析

Evaluation of use of cefoselis by 118 hospitalized patients and analysis of influencing factors

目的了解并评价头孢噻利的临床疗效及安全性,探究其引起转氨酶升高和中枢神经系统不良反应的可能影响因素。方法采用回顾性研究方法,收集医院使用头孢噻利的118例住院患者用药资料,主要关注用药期间转氨酶升高和神经系统不良反应,对其转氨酶升高相关的风险影响因素进行统计回归分析。结果 118例使用头孢噻利患者治疗有效率为63.56%;非产ESBLs肠杆菌科细菌、MSSA,MSCNS及链球菌属对头孢噻利的敏感率>75.00%,产ESBLs菌株、嗜麦芽寡养单胞菌、MRSA及粪肠球菌对其敏感性较差;发生不良反应35例次,占29.66%,其中发生转氨酶(AST、ALT)升高23例,占19.49%,神经系统不良反应5例,占4.24%;肾功能不全、心脏疾病、年龄>65岁、日剂量>3g、抗菌药物联用是引起转氨酶升高的危险因素(P<0.05);脑部疾病和肾功能不全是引起中枢神经系统不良反应的重要因素。结论头孢噻利对各类敏感菌引起的感染临床疗效较好,其引起转氨酶升高和神经系统不良反应及影响因素应引起关注。

OBJECTIVE To evaluate the efficacy and safety of cefoselis, and study the influencing factors for the elevation of transaminase and the adverse reaction of central nervous system. METHODS The data from hospital information system among 118 patients who received cefoselis were analyzed retrospectively. The elevated transaminases and nervous system adverse reactions were mainly concerned and analyzed. The risk factors associated with elevated transaminases in patients who received cefoselis were manifested by logistic regression analysis. RESULTS All of the 118 patients were treated with cefoselis, the effective rate was 63.56G. The drug susceptibility rates of the non-ESBLs-producing Enterobacteriaceae, MSSA, MSCNS, and Streptococcus were 75.00% to cefoselis. However, cefoselis showed poor susceptibility against ESBLs-producing strains, Stenotrophomonas maltophilia, MRSA and Enterococcus faecalis. Totally 35 case-times of adverse reactions occurred, accounting for 29.66%, there were 23 cases （19.49%） with elevated transaminases （AST and ALT） and 5 cases （4.24%） with nervous system adverse reactions. The renal insufficiency, heart disease, more than 65 years of age, daily dose of more than 3 gram, and antibiotics combination were the possible risk factors for the elevated transaminases （p〈0. 05）. The brain diseases and renal insufficiency were the key factors for nervous system adverse reactions. CONCLUSION The cefoselis has significant effect on treatment of the infections caused by the sensitive bacteria, it is necessary to pay attention to the elevated transaminases and nervous system adverse reactions.