替加环素治疗多重或泛耐药鲍曼不动杆菌肺炎疗效观察

Clinical efficacy of tigecycline in the treatment of the pneumonia caused by multidrug resistant / extensively drug-resistant acinetobacter baumanni

目的探讨替加环素治疗多重或泛耐药鲍曼不动杆菌(MDRAB/XDRAB)肺炎的临床疗效。方法采用回顾性分析法,对新乡医学院第一附属医院重症医学科、呼吸科及其监护室2013年7月至2015年12月因MDRAB/XDRAB肺炎住院的84例患者的临床资料进行分析,其中单独使用头孢哌酮/舒巴坦的42例患者为对照组,应用替加环素联合头孢哌酮/舒巴坦治疗的42例患者为观察组。2组患者药物应用均超过3 d,观察2组患者的临床有效率、细菌清除率及病死率,并分析影响观察组临床疗效和细菌清除效果的因素。结果对照组患者治疗有效11例,有效率为26.19%(11/42);11例获得细菌清除,细菌清除率为26.19%(11/42);27例在住院期间死亡,30 d总病死率为64.28%(30/42)。观察组患者治疗有效25例,有效率为59.52%(25/42);27例获得细菌清除,细菌清除率为64.29%(27/42);15例住院期间死亡,30 d总病死率为35.71%(15/42)。观察组患者治疗有效率、细菌清除率均较对照组显著升高,30 d病死率较对照组显著降低(P<0.05)。观察组治疗有效患者与无效患者之间及细菌清除患者和未清除患者之间在入住监护室时间、接受机械通气时间、急性生理学与慢性健康状况评价Ⅱ评分、血清降钙素原及白蛋白水平比较差异有统计学意义(P<0.05)。结论替加环素联合头孢哌酮/舒巴坦治疗MDRAB/XDRAB肺炎,可在一定程度上改善患者症状、体征及提高细菌清除效果。

Objective To investigate the clinical efficacy of tigecycline on pneumonia caused by multidrug resistant / extensively drug-resistant acinetobacter baumannii（ MDRAB / XDRAB）. Methods A retrospective analysis was conducted in 84 adult patients who were proven MDRAB / XDRAB pneumonia from July 2013 to December 2015. Of the 84 cases,there were 42 patients accepted treatment of cefoperazone sulbactam alone（ control group） and 42 patients treated with tigecycline and cefoperazone sulbactam（ observation group）. Antibiotics were used at least three days. The clinical efficacy,bacterial clearance rate and mortality rate of the two groups were observed. The factors which influenced the clinical curative effect and bacteriological efficacy in experimental group were analyzed. Results In the control group,11 cases were clinically effective,accounting for 26. 19%;microbiological eradication was achieved in 11 patients（ 26. 19%）,27 cases died,the 30-day overall mortality was 64. 28%（ 30 /42）. In observation group,25 cases were clinically effective,accounting for 59. 52%（ 25 /42）; microbiological eradication was achieved in 27 patients（ 64. 29%）,and the 30-day overall mortality was 35. 71%（ 15 /42）. Compared with the control group,the clinically effective rate and microbiological eradication rate were significant higher while the 30-day overall mortality was significant lower in the observation group（ P〈0. 05）. There were significant differences in the time of intensive care unit,the duration of mechanical ventilation,the acute physiology and chronic health evaluationⅡscore,the serum procalcitionin and albumin levels between the effective patients and non-effective patients in observation group（ P〈0. 05）. The differences between microbiological eradication patients and non-microbiological eradication patients in observation group was similarly（ P〈0. 05）. Conclusion Tigecycline combined with cefoperazone-sulbactam treatment on patients with MDRAB / XDRAB pneumonia can improve symptom and physical sign and increase the bacterial clearance effect.