替加环素治疗呼吸机相关性肺炎患者泛耐药鲍氏不动杆菌感染的临床研究

Clinical curative effect of tigecycline on treatment of pandrug-resistant Acinetobacter baumannii infection in patients with ventilator-associated pneumonia

目的探讨替加环素治疗重症呼吸机相关性肺炎患者泛耐药鲍氏不动杆菌感染的临床疗效。方法对2012年7月-2014年3月16例高龄患者确诊发生泛耐药鲍氏不动杆菌重症呼吸机相关性肺炎,给予替加环素首剂100mg,之后每次50mg,静脉滴注12h1次;同时联合舒巴坦或碳青霉烯类或单独用药,治疗时间为10~14d;监测治疗期间所有患者的症状、体征,定期检测血常规、肝肾功能、胸部X线片及痰液培养及药物不良反应。结果 16例患者4例死亡、5例痊愈、7例有效,总有效率75.0%;16例患者10例细菌培养显示清除、6例未清除;5例痊愈及7例有效,患者影像学有明显改善,死亡患者影像学呈加重、恶化;3例患者出现轻度肝功能损害,经积极护肝治疗后痊愈。结论替加环素单独或联合用药治疗泛耐药鲍氏不动杆菌感染重症呼吸机相关性肺炎疗效明确,安全。

OBJECTIVE To explore the clinical effect of tigecycline on treatment of pandrug-resistant Acinetobacter baumannii infection in patients with ventilator-associated pneumonia.METHODS From Jul 2012 to Mar 2014,a total of 16 senile patients with confirmed severe pandrug-resistant A.baumannii ventilator-associated pneumonia were treated with 100 mg of tigecycline for the first dose,followed by 50 mg for each time,intravenous drip every12hours;meanwhile the combined medication with sulbactam or carbapenems or single medication was conducted for 10-14 days.The symptoms,signs,blood routines,hepatic and renal function,chest X ray,sputum culture,and drug-induced adverse reactions of all the patients were monitored during the treatment.RESULTS Of the 16 patients,4died,5were cured,and 7were effective,with the total effective rate 75.0%.The result of the bacterial culture showed that the strains were cleared in 10 of 16patients but were not cleared in 6cases.The imageological findings of the 5cases of the cured and 7cases of the effective were remarkably improved,while the imageological findings of the dead cases showed aggravation or exacerbation.Three patients had mild liver function damage and were cured after active liver protection.CONCLUSIONThe single or combined use of tigecycline can achieve significant effect on treatment of the pandrug-resistant A.baumanniiinfection in the patients with severe ventilator-associated pneumonia,with the safety high.