替加环素对高龄广泛耐药革兰阴性杆菌医院获得性肺炎疗效及安全性分析

Evaluate the Efficacy and Safety of Tigecycline in Treatment of Hospital-acquired Pneumonia with Extensive Drug-resistant Gram-negative Bacilli in Senile Patients

目的分析替加环素对广泛耐药(XDR)革兰阴性杆菌医院获得性肺炎(HAP)高龄老年患者的疗效及安全性。方法选取某院2015年10月1日-2018年4月30日期间住院的72例广泛耐药革兰阴性杆菌HAP患者作为研究对象,年龄均大于80岁且接受替加环素治疗,收集患者一般情况、实验室检查及痰病原学等研究资料,评价替加环素疗效及安全性。结果 72例患者中鲍曼不动杆菌占52例(72.2%),肺炎克雷伯菌占20例(27.8%);接受替加环素治疗后临床有效38例(52.8%),无效34例(47.2%);替加环素加倍剂量治疗有效率为75%(12/16)优于常规剂量有效率46.4%(26/56,P=0.043,χ~2=4.076),联合用药有效率64%(32/50)优于单药治疗有效率27.3%(6/22,P=0.004,χ~2=8.269)。Logistic回归显示替加环素加倍剂量(OR 0.085, P=0.008)及联合用药(OR 0.021, P=0.036)是影响临床疗效的独立保护因素,而病程长(OR1.064, P=0.023)、较高的APACHEⅡ评分(OR 1.276, P<0.001)是临床疗效不佳的独立危险因素。替加环素常规剂量与加倍剂量、单药治疗及联合用药在微生物清除率方面差异无统计学意义。治疗前后患者的血红蛋白、血小板及肝肾功能等实验室指标无明显变化,未发现发生药物不良反应。结论替加环素对广泛耐药革兰阴性杆菌HAP的高龄老年患者有一定治疗作用,加倍剂量及联合用药疗效更佳,且具有较好的安全性。

Objective To analyze the efficacy and safety of tigecycline in treatment of hospital-acquired pneumonia(HAP) with extensive drug-resistant(XDR) gram-negative bacilli in elderly patients. Methods 72 cases were recruited in the research from Oct 2015 to April 2018 in Hospital. All the patients were older than 80 years old and treated with tigecycline. Research data included general conditions, laboratory findings and sputum culture results. These data was used to evaluate the efficacy and safety of tigecycline. Results In 72 cases, 52(72.2%)were acinetobacter baumannii and 20(27.8%) were klebsiella pneumonia, 38 cases(52.8%) were clinically effective and 34 cases(47.2%) were not. The clinical efficacy rate was 46.4%(26/56) in conventional dose group and 75%(12/16, P=0.043) in double dose group. The efficacy rate in the group of tigecycline combined with other antibiotics(32/50, 64%)was higher than the group of using tigecycline alone(6/22, 27.3%, P=0.004).Multivariable Logistic regression analysis showed that longer courses of disease(OR 1.064, P=0.023)and higher APACHE Ⅱ score(OR 1.276, P<0.001)was the independent risk factors affecting the clinical effect. Double dose treatment(OR 0.085, P=0.008)and combined with other antibiotics(OR 0.021, P=0.036)was independent protective factors. There was no significant difference of microbial clearance rate between the conventional dose group and double dose group. There was no significant change in blood routine, hepatic and renal function of the patients before and after treatment, and no adverse drug reaction was found. Conclusion Tigecycline has a certain therapeutic effect on XDR gram-negative bacilli HAP in senile patients. Double dose of tigecycline and combined with other antibiotics could improve clinical efficacy with well safety.