比阿培南抗感染治疗在异基因造血干细胞移植应用的临床研究

Clinical research on efficacy of biapenem in treatment of infections after allogeneic hematopoietic stem cell transplantation

目的探讨造血干细胞移植(HSCT)后感染的发生情况及比阿培南经验性抗感染应用的疗效和安全性,为临床应用提供理论依据。方法于2010年10月-2012年12月连续做异基因造血干细胞移植患者,总结100例应用比阿培南经验性治疗,除9例单药外其他91例联合应用,观察其疗效和不良反应发生,查找病原菌和临床诊断证据,统计采用SPSS 13.0软件完成,计量资料采用t检验。结果 100例患者移植后均获得粒细胞和血小板植入,临床确诊感染46例,感染率46.00%,病原菌检出20株,阳性率20.00%,其中血培养检出7株,痰及咽拭子培养检出13株;66例抗感染治疗有效,有效率66.00%,中位退热的时间2.5d,使用比阿培南的中位时间17d。结论异基因造血干细胞移植应用比阿培南抗感染治疗,疗效好,不良反应轻微,对比阿培南在异基因移植经验性治疗提供实践。

OBJECTIVE To investigate the incidence of infections after hematopoietic stem cell transplantation （HSCT） and observe the efficacy and safety of biapenem in empirical therapy for the infections so as to provide theoretical basis for the clinical application. METHODS A total of 100 patients who underwent allo-HSCT continually from Oct. 2010 to Dec. 2012 were enrolled in the study, then the empirical therapy with biapenem （including 9 cases of single use of antibiotics and 91 cases of combination use of antibiotics） was summarized, the clinical efficacy and incidence of adverse reactions were observed, the pathogenic bacteria were identified, the evidence for clinical diagnosis was find out, the statistical analysis was performed with the use of SPSS13.0, and the t-test was conducted for the analysis of count data. RESULTS All the 100 patients have achieved engraftment of granuloeyte and blood platelet, among which 46 cases have been confirmed as infections with the infection rate of 46.00%. Totally 20 strains of pathogens have been isolated with the positive rate of 20.00%, including 7 isolates from blood culture and 13 isolates from sputum and throat swab culture. The anti-infection therapy was effective in 66 cases with the effective rate of 66.00% the median defervescence time was 2.5 days, and the median time of use of biapenem was 17 days. CONCLUSION The biapenem can achieve good clinical efficacy in treatment of infections due to allo-HSCT, with the incidence of adverse reactions low, which provides clinical evidence for the empirical therapy with allo-HSCT.