三种常用碳青霉烯类抗菌药物治疗急性胆道感染的疗效、安全性及药物经济学比较

Comparison of the efficacy,safety and drug economics of the 3 carbapenem drugs in treatment of acute biliary tract infection

目的:评价比阿培南、美罗培南和亚胺培南三种碳青霉烯类抗菌药物的疗效、安全性和经济性。方法:筛选2017年1月至2018年12月在南京医科大学康达学院第一附属医院住院治疗的急性胆道感染患者,其中使用比阿培南的患者168例,使用美罗培南的患者132例,使用亚胺培南的患者216例,分别随机编号为1~168、1~132和1~216。利用Excel中的RANDBETWEEN函数分别随机抽取100例。以连续治疗5 d为时间节点,收集3组患者的临床表现、实验室和影像学检查结果、细菌培养情况和药品不良反应(ADRs)发生情况等数据。结果:3组患者的有效率和细菌清除率均是亚胺培南组>比阿培南组>美罗培南组。亚胺培南组、比阿培南组以及美罗培南组有效率分别为88.0%、79.0%和74.0%。细菌清除率分别为85.7%、78.3%和55.6%,差异均有统计学意义(P<0.05)。ADRs发生率分别为6.0%、4.0%和8.0%(P>0.05)。在经济性方面,成本-效果分析得到的以有效率为效果的增量成本-效果比(incremental cost-effectiveness analysis,ICER)为18077.8元,以细菌清除率为效果的ICER为21986.5元。结论:三种常用碳青霉烯类抗菌药物中,比阿培南的临床疗效确切,性价比最高。

Objective:To evaluate the efficacy,safety and drug economics of biapenem,meropenem and imipenem.Methods:The patients with acute biliary tract infection hospitalized in the First Affiliated Hospital of Kangda College of Nanjing Medical University from January 2017 to December 2018 were screened,including 168 patients treated with biapenem,132 patients treated with meropenem and 216 patients treated with imipenem,and they were randomly and respectively designated as 1-168,1-132 and 1-216.From the subjects,100 patients were randomly selected by RANDBETWEEN function of Excel.With 5 days of continuous treatment as the time node,related data concerning clinical manifestations,the results of laboratory images,bacterial culture,and adverse drug reactions(ADRs)of the 3 groups were collected for study.Results:The effective rates and bacterial clearance rates of the 3 groups were:the imipenem group>biapenem group>meropenem group.The effective rates of the imipenem group,the biapenem group and the meropenem group were 88.0%,79.0%and 74.0%,respectively,and the bacterial clearance rates were 85.7%,78.3%and 55.6%,respectively,with statisitical significance(P<0.05).The rates of ADRs were 6.0%,4.0%and 8.0%,respectively(P>0.05).In terms of economy,the incremental cost-effectiveness analysis(ICER)value with efficiency as the effect was 18077.8 yuan,and the ICER value with bacterial clearance as the effect was 21986.5 yuan.Conclusion:Of the 3 commonly-used carbapenem antibiotics,biapenem has the exact clinical efficacy with best cost performance.