替加环素或米诺环素联合头孢哌酮钠舒巴坦钠治疗多重耐药鲍曼不动杆菌的临床疗效比较

Clinical therapeutic effect comparision of tigecycline or minocycline combined with cefoperazone-sulbactam in the treatment of multidrug-resistant acinetobacter baumannii infection

目的:探讨不同抗生素方案治疗多重耐药鲍曼不动杆菌的临床疗效差异。方法:研究选取我院2018年1月—2020年11月收治的110例多重耐药鲍曼不动杆菌感染患者,按随机分组方法分为A、B、C 3组,各采用不同的抗感染方案:A组使用头孢哌酮钠舒巴坦钠,B组在A组用药方案上联合使用替加环素,C组在A组用药方案上联合米诺环素。通过观察CPIS评分、PCT、CRP、IL-6、机械通气时间、ICU入住时间及不良反应情况等,比较3组患者临床疗效差异。结果:实际入选92例,A组36例,B组29例,C组27例。3组患者治疗前指标比较差异无统计学意义,治疗1周后的B组在CPIS评分、PCT、CRP、机械通气时间、ICU入住时间方面均优于A组及C组(C组CRP除外),差异有统计学意义。C组与A组比较在CRP、机械通气时间方面差异有统计学意义。不良反应方面,B组的消化道症状及C组的皮疹症状与A组比较,差异有统计学意义,两组不良反应处理后很快好转。结论:针对多重耐药鲍曼不动杆菌,头孢哌酮钠舒巴坦钠联合替加环素疗效比单用头孢哌酮钠舒巴坦钠或联合米诺环素效果要好,推荐使用头孢哌酮钠舒巴坦钠联合替加环素。

Objective: To investigate the differences in clinical efficacy of different antibiotic regimens in the treatment of multidrug-resistant acinetobacter baumannii. Methods: The study selected 110 patients with multidrug-resistant acinetobacter baumannii infection in our hospital from Jan 2018 to Nov 2020, and divided them into three groups(A, B, and C) according to the random grouping method. A total of 92 cases were actually selected. Anti-infection aspect: group A used Cefoperazone sodium and sulbactam sodium alone, group B combined with tigecycline, group C combined with minocycline. By observing CPIS score, PCT, CRP, IL-6, duration of mechanical ventilation, ICU stay duration, and adverse reactions, the differences in clinical efficacy of the three groups of patients were compared. Results: There was no significant difference in the indicators of the three groups before treatment. One week after treatment, group B was better than the other two groups in terms of CPIS score, PCT, CRP, duration of mechanical ventilation, and ICU stay duration(except for CRP in group C). The difference was statistically significant. There were statistically significant differences between group C and group A in terms of CRP and duration of mechanical ventilation. In terms of adverse reactions, the gastrointestinal symptoms of group B and the rash symptoms of group C were different from those of group A. The adverse reactions of the two improved quickly after treatment. Conclusion: For multidrug-resistant acinetobacter baumannii, Cefoperazone sodium and sulbactam sodium combined with tigecycline has a better effect than using it alone or combined with minocycline. Cefoperazone sodium and sulbactam sodium combined with tigecycline is recommended.