替加环素联合舒巴坦钠治疗泛耐药鲍曼不动杆菌医院获得性肺炎的回顾性分析

A Retrospective Analysis of Combined Treatment of Tigecycline and Sulbactam on Hospital-Acquired Pneumonia Patients Caused by Extensively Drug-Resistant Acinetobacter Baumannii

目的探讨替加环素联合舒巴坦钠对泛耐药鲍曼不动杆菌医院获得性肺炎的临床疗效和细菌学疗效。方法回顾性分析本院2012-02-2015-12泛耐药鲍曼不动杆菌医院获得性肺炎的43例病例资料,其中试验组23例,使用替加环素联合舒巴坦钠治疗,对照组20例,使用亚胺培南钠/西司他丁钠联合舒巴坦钠治疗,2组患者用药时间均超过3d,观察及比较2组治疗前后的影像学结果、细菌培养及药敏结果、体温（T）、白细胞计数（WBC）和降钙素原（PCT）的变化,记录各组患者微生物清除率、30 d病死率及临床疗效。结果在临床有效率和微生物清除率上,试验组为65.22%（15/23）和52.17%（12/23）,均显著高于对照组的50.00%（10/20）和45.00%（9/20）,P〈0.05;而30 d病死率接近,为21.74%（5/23）和15.00%（3/20）,P〉0.05。2组患者的住院时间和不良反应发生率没有显著差异。在MIC≤2μg/mL时试验组临床有效率和微生物清除率分别为60.00%（9/15）和66.66（10/15）,显著高于MIC〉2μg/mL的37.50%（3/8）和25.00%（2/8）,P〈0.05;而患者APACHEⅡ评分值≤15时,试验组临床有效率和微生物清除率分别为77.77%（7/9）和66.66%（6/9）,显著高于APACHEⅡ评分值〉15时的57.14%（8/14）42.86%（6/14）,P〈0.05。结论有限的病例结果显示替加环素联合舒巴坦钠治疗泛耐药鲍曼不动杆菌医院获得性肺炎的临床有效率较高,但仍有待开展多中心、大样本量的前瞻性临床研究进一步证实。

OBJECTIVE To evaluate the clinical response and microbiological response of tigecycline combined with sulbactam regimens in hospital-acquired pneumonia patients infected by extensively drug-resistant Acinetobacter baumannii. METHODS A retrospective analysis was conducted in 43 adult patients with proven XDR A. baumannii pneumonia treated with tigecycline combined with sulbactam（ experimental group） or imipenem / cilastatin combined with sulbactam（ control group） from February 2012 to December 2015. Duration of antibiotic therapy were all more than 3 d. Clinical characteristic,the clinical cure rates,microbiological eradication rates,30 d mortality,length of hospital stay,adverse reactions,white blood cell count（ WBC） and procalcitonin（ PCT） before and after therapy were observed and compared between the 2 groups. Meanwhile,the influences of bacterial MIC and APACHE Ⅱ on the clinical cure rates and microbiological eradication rates were evaluated. RESULTS The rates of clinical cure rates and microbiological eradication rates in experimental group were significantly increased compare with control group after therapy（ clinical cure rates： 65.22% vs 50.00%; microbiological eradication rates： 52. 17% vs 45. 00%）,P〈0. 05. And the rates of clinical cure rates and microbiological eradication rates in bacterial low MIC sub-group（ MIC≤2 μg / mL） were increased more significantly than those in bacterial high MIC sub-group（ MIC〉 2 μg / mL） after therapy（ clinical cure rates： 60. 00% vs 66. 66%; microbiological eradication rates： 37. 50% vs 25.00%）,P〈0.05. And the rates of clinical cure rates and microbiological eradication rates in low APACHE Ⅱ sub-group（ APACHEⅡ≤15 μg /mL） were increased more significantly than in high APACHE Ⅱ sub-group（ APACHE Ⅱ〉 15 μg /mL） after therapy（ clinical cure rates： 77.77% vs 66.66%; microbiological eradication rates： 57.14% vs 42.86%）,P〈0.05. 30-day mortality was no significantly different in 2 groups（ 21.74% vs 15. 00%）,P〉0. 05. Length of hospital stay and adverse reactions between the 2 groups were also no statistically significant different. The levels of WBC after therapy in experimental group were decreased obviously,and the levels of PCT after therapy in 2 groups were no significantly different. CONCLUSION A good clinical effect was showed in the treatment of tigecycline and sulbactam on hospital-acquired pneumonia patients caused by extensively drug-resistant XDR A. baumannii in this review. However,a multicentre,large-smple clinical trial is needed because of limited data.