替加环素治疗外科ICU难治性腹腔感染的临床疗效

Tigecycline for complicated intra abdominal infections in surgical intensive care units

目的分析总结替加环素治疗重症患者复杂腹腔感染的疗效及影响因素。方法回顾性收集2011年11月至2014年8月中山大学附属第一医院外科ICU中复杂腹腔感染患者的临床资料。分析患者一般资料，包括性别、年龄、疾病严重程度评分、细菌菌株分布情况，使用替加环素前抗菌药物情况、替加环素治疗剂量及疗程，疗效及影响疗效的因素。结果2011年11月至2014年8月外科ICU收治患者1862例，复杂腹腔感染患者304例，其中54例使用替加环素治疗，50例使用时间超过3d纳入分析。感染致病菌前三位为鲍曼不动杆菌（23．1％）、肺炎克雷白菌（18．5％）、大肠埃希菌（16．9％），其中混合感染41例；合并肺部感染31例，合并血流感染6例；合并多器官功能衰竭者41例；患者在使用替加环素前均使用多种抗感染药物，最多者达13种；替加环素平均疗程8．9d，治疗总有效率为62％，38％感染治愈转出ICU，24％感染有效控制，72h内降钙素原下降超过50％。Logistic回归分析显示影响72h疗效的因素有疾病严重程度、替加环素剂量。结论重症患者的腹腔感染复杂难治，经过前期多种抗菌药物治疗仍难以控制者，往往耐药性增加，替加环素可作为这类患者抗感染治疗的有效选择。

Objective To analyze clinical effectiveness of tigecycline for complicated intra abdominal infections （clAIs） in surgical intensive care units. Methods The clinical data of patients diagnosed as clAIs from Nov 2011 to Aug 2014 were retrospectively collected. Data of sex, age, severity of disease, bacterial strains and drug resistance, prior antibiotics, dosage of tigecycline were included. Results 1 862 patients were admitted into surgical intensive care unit from Nov 2011 to Aug 2014. 54 patients were finally treated by tigecycline among 304 patients diagnosed as clAIs. Acinetobacter baumannii （23.1%）, Klebiella pneumonia （ 18.5% ）, Escherichia coli （ 16. 9% ） were the top three pathogenic bacteria. 41/50 were of multiple bacterial infection. Previously adopted antibiotics were miscellaneous, the number of used antibiotics was up to 13 for one patient. Coverage of tigecycline averaged at 8.9 days. Tigecycline effective rate was 62%, 38% （19/50） clAIs were completely controlled and cured,24% （12/50） patients showed effectiveness of tigercycline that procalcitonin decreased 50% within 72 h. Logistic regression analysis showed that severity of disease and tigecycline dose contribute to the effectiveness within 72 h. Conclusions Tigecycline is effective aherative for patients diagnosed as complicated intra abdominal infections in surgical intensive care units.