以多黏菌素B为基础的抗感染方案治疗耐碳青霉烯类肺炎克雷伯杆菌感染的临床分析

Clinical Study on Polymyxin B-based Anti-infection Regimen in the Treatment of Carbapenem-resistant Klebsiella Pneumoniae Infection

目的探讨以多黏菌素B为基础的抗感染方案治疗耐碳青酶烯类肺炎克雷伯杆菌感染的临床用法及疗效。方法回顾性分析2018年1月至2019年7月收治的耐碳青酶烯类肺炎克雷伯杆菌感染患者41例的临床资料。结果①41例患者均予多黏菌素B为基础的抗感染方案,细菌清除率达68.3%,总治疗有效率达53.7%;②用药时间≥7 d组细菌清除率及治疗总有效率均高于用药时间<7天组(P <0.05);③多黏菌素B联合替加环素组与多黏菌素B联合其他用药组两组在细菌清除率及治疗总有效率中差异均无统计学意义(P> 0.05)。结论多黏菌素B对于耐碳青酶烯类肺炎克雷伯杆菌感染具有良好的效果,足量的给药疗程能提高多黏菌素B治疗耐碳青酶烯类肺炎克雷伯杆菌感染的细菌清除率及临床治疗有效率。在多黏菌素B的联合用药上,相比联合碳青霉烯类、磷霉素或左氧氟沙星等,选择联合替加环素在细菌清除及临床疗效中并没有显示出效价优势。

Objective This study was aimed to investigate the clinical use and efficacy of polymyxin B-based anti-infection regimen in the treatment of carbapenem-resistant Klebsiella pneumoniae infection. Methods The data of 41 patients with carbapenem-resistant Klebsiella pneumoniae infection in ICU from January 2018 to July 2019 were analyzed retrospectively. Results(1)All 41 patients were given polymyxin B-based anti-infective regimen. The bacterial clearance rate was 68.3%, and the clinical efficiency rate was 53.7%.(2)The bacterial clearance rate and the clinical efficiency rate of patients with treatment time over 7 days were higher than the rest ones(P<0.05).(3)There was no significant difference in bacterial clearance rate and clinical efficiency rate between polymyxin B combined with tigecycline group and polymyxin B combined with other drugs group(P>0.05). Conclusions Polymyxin B has a good effect on carbapenem-resistant Klebsiella pneumoniae infection. Adequate course of treatment can improve bacterial clearance rate and clinical treatment efficiency. Compared with the combination of carbapenems, fosfomycin or levofloxacin, the combination of tigecycline showed no potency advantage in bacterial clearance and clinical efficacy.