多黏菌素B与替加环素分别联合美罗培南治疗广泛耐药鲍曼不动杆菌重症肺炎的临床效果

Clinical effect of polymyxin B and tigecycline combined with meropenem in the treatment of severe pneumonia caused by extensively drug-resistant Acinetobacter baumannii

目的比较多黏菌素B与替加环素分别联合美罗培南治疗广泛耐药鲍曼不动杆菌重症肺炎的临床效果。方法回顾性选取2019年1月-2020年6月广西壮族自治区江滨医院重症医学科(ICU)收治的广泛耐药鲍曼不动杆菌重症肺炎患者94例,根据治疗方法不同分为多黏菌素B组36例和替加环素组58例,多黏菌素B组采用多黏菌素B联合美罗培南治疗,替加环素组采用替加环素联合美罗培南治疗。比较2组患者临床疗效、入住ICU时间、病原学疗效,治疗72 h后C反应蛋白(CRP)、降钙素原(PCT)水平下降值,不良反应。结果治疗72 h后,2组患者总有效率比较差异无统计学意义(χ^(2)=0.081,P=0.777)。多黏菌素B组患者入住ICU时间为(19.22±4.81)d,替加环素组患者入住ICU时间为(17.62±3.63)d,2组患者入住ICU时间比较差异无统计学意义(t=1.831,P=0.070)。治疗72 h后,多黏菌素B组患者CRP和PCT下降值均高于替加环素组(P<0.05),病原学清除率高于替加环素组(χ^(2)=6.228,P=0.013),6例肾功能不全患者使用多黏菌素B期间出现血肌酐升高,治疗结束后恢复至用药前水平,19例(52.78%)患者发生颜面部色素沉着,停药后2周后未见明显改善,未发现神经毒性反应,替加环素组患者出现胆红素升高14例(24.14%),停用后恢复至用药前水平。结论多黏菌素B与替加环素分别联合美罗培南治疗广泛耐药鲍曼不动杆菌重症肺炎的临床疗效相似,多黏菌素B联合美罗培南的炎性反应控制及病原学疗效具有一定优势。

Objective To compare the clinical effects of polymyxin B and tigecycline combined with meropenem in the treatment of severe pneumonia caused by extensively drug-resistant Acinetobacter baumannii.Methods A retrospective selection of 94 patients with extensively drug-resistant Acinetobacter baumannii severe pneumonia admitted to the Department of Intensive Care Medicine(ICU)of Jiangbin Hospital in Guangxi Zhuang Autonomous Region from January 2019 to June 2020 were divided into 36 cases in polymyxins B group and 58 cases in tigecycline group according to different treatment methods.The polymyxin B group was treated with polymyxin B combined with meropenem,and the tigecycline group was treated with tigecycline combined with meropenem.The clinical efficacy,length of stay in ICU,etiological efficacy,C-reactive protein(CRP)level and procalcitonin(PCT)decreased after 72 hours of treatment and adverse reactions of the two groups were compared.Results After 72 hours of treatment,there was no significant difference in the total effective rate between the two groups(χ^(2)=0.081,P=0.777).The time of staying in the ICU for patients in the polymyxin B group was(19.22±4.81)d,and the time of staying in the ICU for patients in the tigecycline group was(17.62±3.63)d,there was no significant difference in the time of staying in the ICU between the two groups(t=1.831,P=0.070).After 72 hours of treatment,the decrease of CRP and PCT in the colistin B group were higher than that in the tigecycline group(P<0.05).The pathogen clearance rate of patients in the polymyxin B group was higher than that in the tigecycline group(χ^(2)=6.228,P=0.013).In the polymyxin B group,6 patients with renal insufficiency experienced increased serum creatinine during the use of polymyxin B,and returned to the pre-medication level after the treatment.19 patients(52.78%)developed facial pigmentation,after stopping the medication no significant improvement was seen after 2 weeks,and no neurotoxicity was found.In the tigecycline group,14 patients(24.14%)had elevated bilirubin,which returned to the pre-treatment level after stopping.Conclusion The clinical efficacy of polymyxin B and tigecycline combined with meropenem in the treatment of severe pneumonia caused by extensively drug-resistant Acinetobacter baumannii is similar.Polymyxin B combined with meropenem has certain advantages in inflammatory response control and pathogenic efficacy.