替加环素注射剂治疗多重耐药菌感染老年危重症患者的疗效分析

Analysis efficacy of tigecycline in the treatment of multidrug-resistant bacterial infections in elderly patients with critical illness

目的分析替加环素注射剂治疗多重耐药菌感染老年危重症患者的预测因素。方法回顾性分析40例应用替加环素治疗多重耐药菌感染老年危重症患者的临床资料。所有患者均予以替加环素静脉注射,首剂100 mg,之后每次50~100 mg,q12 h,疗程4~19 d。根据感染是否得到控制将治疗结局分为有效组22例和无效组18例。比较2组患者的实验室指标、急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评估(SOFA)、简化急性生理学评分Ⅱ(SAPSⅡ)。用受试者工作特征曲线(ROC曲线)评估APACHEⅡ评分、SOFA评分和SAPSⅡ评分对替加环素疗效的预测价值。结果治疗前和治疗后,有效组的肌酐清除率(Ccr)分别为(64.44±27.24),(71.78±30.38)mL·min^(-1),降钙素原(PCT)分别为0.41(0.05,25.00)ng·mL^(-1)和0.13(0.05,4.00)ng·mL^(-1),差异均有统计学意义(均P<0.05)。治疗前和治疗后,无效组Ccr分别为(58.34±28.18),(47.58±31.91)mL·min^(-1),APACHEⅡ评分分别为(25.06±10.18),(30.83±14.71)分,SOFA评分分别为(9.89±5.32),(12.78±5.75)分,SAPSⅡ评分分别为(60.39±20.18),(72.33±22.72)分,差异均有统计学意义(均P<0.05)。APACHEⅡ评分、SOFA评分和SAPSⅡ评分预测替加环素治疗无效的ROC曲线下面积分别为0.73,0.74和0.78,差异有统计学意义(均P<0.05)。结论 APACHEⅡ评分、SOFA评分和SAPSⅡ评分对替加环素治疗多重耐药菌感染老年危重症患者的疗效具有一定的预测意义。

Objective To investigate the efficacy and predictive factors of tigecycline in the treatment of multi drug - resistant infections in elderly patients with critical illness. Methods Forty elderly patients with critical illness treated by tigecycline for multi drug - resistant infections were enrolled, the efficacy was evaluated and predictive factors were explored. Tigecycline was administered intravenously with initial dose of 100 mg, followed by 50 - 100 mg every 12 h for 4 to 19 d. Their clinical data, sites of infection, pathogens, medication prescribed, laboratory parameters, acute physiology and chronic health evaluation Ⅱ score （APACHE IT ） , sequential organ failure assessment（SOFA）, simplified acute physiology score Ⅱ （SAPS Ⅱ ） before and after treatment were collected. Patients enrolled in the study were divided into an ineffective group（n = 18 cases） and an effective group （ n = 22 cases）. Receiver operating characteristic （ROC） curve was performed to evaluate the value of APACHE Ⅱ score, SOFA score and SAPS Ⅱ score in predicting the efficacy of tigecycline. Results In effective group, endogenous creatinine clearance rate （Ccr） before and after treatment were （64. 44 ±27.24）, （71.78 ± 30. 38 ）mL · min-1, procalcitonin （PCT） were 0. 41（0. 05, 25.00）, 0. 13（0. 05, 4. 00） ng· mL-1, with significant difference （P 〈0. 05）. In ineffective group, Ccr before and after treatment were （58.34 ±28. 18）, （47.58 ±31.91 ） mL · min^-1 （P 〈0. 05）. In ineffective group, the APACHE Ⅱ scores before and after treatment were 25.06 ± 10. 18 and 30. 83 ± 14.71, the SOFA scores were 9. 89 ± 5.32 and 12. 78 ± 5.75, the SAPS Ⅱ scores were 60. 39 ± 20. 18 and 72.35 · 22. 72, respectively, showing significant statistical differences （ P 〈 0. 05 ）. There were significant statistical differences （ P 〈 0.05 ） among AUC of APACHE Ⅱ score, SOFA score and SAPS Ⅱ score in ROC analysis, which were 0. 73, 0. 74 and 0. 78 respectively. Conclusion APACHEⅡ score, SOFA score and SAPS Ⅱ score have a significant predictive value for the efficacy of tigecycline treatment of multiple drug - resistant infections in elderly critically ill patients.