替加环素治疗107例粒细胞缺乏合并感染血液病患者的临床观察

Efficacy observation of tigecycline in the treatment of 107 patients with infection due to granulocytopenia

目的 观察替加环素治疗粒细胞缺乏合并感染血液病患者的疗效和安全性.方法 回顾性分析107例使用替加环素治疗粒细胞缺乏并感染血液病患者的临床资料,替加环素初始剂量100mg,维持剂量50 mg,每12h1次,30～60 min静脉滴注完毕,患者体温正常5～7 d后开始予抗菌药物降阶梯治疗或停药.结果 107例患者住院期间共分离出病原菌104株,其中多重药耐菌株（MDR）60株,泛耐药菌株（XDR）2株.全部107例患者中,30例单用替加环素,21例初始单用替加环素后联合其他抗菌药物,56例初始即替加环素联合其他抗菌药物,3组患者治疗有效率分别为63.3％、61.9％及62.5％,差异无统计学意义（P=0.994）,替加环素治疗总有效率为62.6％.39例分离出MDR的患者中,22例体温得到控制,8例体温未得到控制,9例死亡,临床有效率为56.4％.替加环素起效的中位时间为3d.不良反应以恶心（11.2％）、呕吐（8.4％）为主,均可以耐受.结论 替加环素治疗粒细胞缺乏血液病患者耐药菌感染具有较好的疗效,引发的不良反应少,安全可耐受.

Objective To observe the curative effect and side effect oftigecycline in the treatment of patients with infection caused by granulocytopenia.Methods The clinical data of 107 patients who were treated with tigecycline for infection due to granulocytopenia were retrospectively reviewed.The tigecycline was administered by intravenously （30-60 min drip infusion） as the initial dose of 100 mg and maintenance does of 50 mg,every 12h.The whole treatment course kept for 5-7 d when the body temperature was normal and then thc step-down treatment or discontinuation of the drug was adopted.Results A total of 104 strains of bacteria were isolated from 107 cases of hospitalized patient,including 60 multi-drug resistant strains （MDR）and 2 extensively-drug resistant strains （XDR）.The total effective rate of tigecycline treatment was 62.6%,including 30 cases with tigecycline alone （63.3% of the effective rate）,21 cases with tigecycline as initial treatment followed by combination with other antibiotics （61.9% of the effective rate）,and 56 cases with tigecycline in combination with other antibiotics from the beginning of the treatment （62.5% of the effective rate）.There was no statistical significant difference between the 3 treatment groups （P=0.994）.Among the 39 patients with MDR strains,22 patients＆#39; temperature was controlled,9 patients died,and 8 patients＆#39; temperature remained uncontrolled.The clinical effective rate of these patients was 56.4%.The median onset time of tigecycline treatment was 3 days.The adverse drug reactions of nausea （11.2%） and vomiting （8.4%） were tolerable.Conclusion Tigecycline is effective in treatment of resistant bacteria infection in patients with granulocytopenia.The side effects of tigecycline were few,safe and generally well tolerated.