替加环素治疗成人危重症感染患者的疗效影响因素分析

Analysis of Influencing Factors of Tigecycline in the Treatment of Adult Patients with Critical Illness

目的分析替加环素(Tigecycline)治疗成人危重症感染患者的疗效影响因素。方法回顾性分析广州某三甲综合医院2018年10月~2020年10月入住ICU并使用替加环素的病例资料,调查替加环素治疗重症感染的有效率,用单因素和多因素逐步Logistic回归分析影响疗效的危险因素,并用COX回归分析影响预后的危险因素。结果通过统一的纳入和排除标准筛选符合要求的病例共249例,替加环素治疗总有效率为79.92%,微生物清除率为47.48%。疗程和CRRT为疗效的影响因素,国产(海正力星)和进口替加环素的疗效无明显差异(P>0.05)。替加环素治疗有效的疗程应>5 d(AUC 0.713,95%CI:0.652~0.768)。替加环素治疗28 d的全因死亡率为18.88%,APACHEⅡ高评分、CRRT和肺部感染为独立的危险因素,延长疗程有利于降低死亡率。不良反应发生率为16.47%。结论替加环素可作为治疗危重症感染的选择之一,国产(海正力星)与进口(泰阁)替加环素均有较好疗效,适当延长疗程有利于改善临床结果。

OBJECTIVE To analyze the influencing factors of tigecycline in the treatment of critically ill adults.METHODS A retrospective study was performed in critically ill patients treated with tigecycline between October 2018 and October 2020 at a tertiary hospital in Guangzhou.The efficacy of tigecycline was investigated,and risk factors were identified via univariate and multivariate logistic regression analysis.Cox regression analysis was performed for identification of independent prognostic factor.RESULTS A total of 249 cases were screened out by the inclusion and exclusion criteria.The total effective rate of tigecycline treatment was 79.92%and the microbial clearance rate was 47.48%.Treatment course and CRRT were the influencing factors of the curative effect.The effective course of tigecycline therapy would be more than 5 days(AUC 0.713,95%CI:0.652-0.768).There was no significant difference in the efficacy between the imported and domestic(Hai zheng li xing)groups(P>0.05).The all-cause mortality rate for treatment with tigecycline for 28 days was 18.88%.High APACHEⅡscores,CRRT,and pneumonia were independent risk factors,and prolonged treatment was associated with reduced mortality.The rate of adverse reactions was 16.47%.CONCLUSION Tigecycline is a potential choice to treat severe infection in critically ill adults.Both imported and domestic(Hai zheng li xing)tigecycline have good efficacy and a longer duration of tigecycline treatment might be beneficial to improve the clinical outcomes.