头孢他啶-阿维巴坦治疗肾移植术后碳青霉烯类耐药肺炎克雷伯菌感染的临床疗效分析

Clinical efficacy of ceftazidime-avibactam in treating carbapenem-resistant Klebsiella pneumoniae infection after kidney transplantation

目的探讨头孢他啶-阿维巴坦治疗肾移植术后耐碳青霉烯类肺炎克雷伯菌(CRKP)感染的临床疗效,为肾移植术后患者抗感染治疗提供临床经验。方法对2019年6月—2021年5月连续使用头孢他啶-阿维巴坦治疗≥72 h的CRKP感染患者进行了回顾性观察研究。收集患者一般特征、临床和微生物学数据,评估头孢他啶-阿维巴坦治疗后的临床治愈、微生物学治愈和全因住院死亡率,分析临床和微生物学治愈与失败患者临床特点的差异。结果共纳入19例肾移植术后感染患者,平均年龄(38.2±10.2)岁,最常见的感染类型为手术部位感染(78.9%),其次为血流感染(52.6%)、肺部感染(42.1%)和尿路感染(21.1%)。感染开始至接受头孢他啶-阿维巴坦治疗的中位时间为5.0 d,治疗平均时间为12.3 d。临床治愈率、微生物学治愈率、全因住院死亡率分别为57.9%、63.2%、10.5%。与临床治疗失败有关的因素为较高的序贯器官衰竭评估评分、菌血症、肺炎、感染开始至接受头孢他啶-阿维巴坦治疗的时间和头孢他啶-阿维巴坦作为挽救性治疗;与微生物学治疗失败有关的因素为菌血症、肺炎、头孢他啶-阿维巴坦作为挽救性治疗。结论头孢他啶-阿维巴坦是治疗CRKP感染的有效抗菌药物,为肾移植术后CRKP感染的治疗提供了重要选择,但其疗效仍需大规模对照研究来证实。

Objective To investigate the clinical efficacy of ceftazidime-avibactam(CAZ-AVI)in the treatment of carbapenemresistant Klebsiella pneumoniae(CRKP)infection after kidney transplantation,and to provide clinical experience for the antimicrobial treatment of patients after kidney transplantation.Methods We conducted a retrospective observational study in the patients with CRKP infection who received continuous CAZ-AVI treatment for≥72 hours between June 2019 and May 2021.Demographic,clinical,and microbiological data were collected to assess clinical cure,microbiological cure,and all-cause in-hospital mortality after treatment with CAZ-AVI,and examine the differences in clinical characteristics between patients who were clinically cured and failed and those who were microbiologically cured and failed.Results A total of 19 patients(mean age of 38.2±10.2 years)were included.The most common site of infection was surgical site(78.9%),followed by bloodstream(52.6%),pulmonary(42.1%),and urinary tract(21.1%).The median time from the onset of infection to treatment with CAZ-AVI was 5.0 days.The mean time of CAZ-AVI treatment was 12.3 days.The clinical cure rate,microbiological cure rate and all-cause mortality rate were 57.9%,63.2%and 10.5%,respectively.Higher SOFA score,bacteremia,pneumonia,time from infection onset to CAZ-AVI treatment,and use of CAZ-AVI as salvage therapy were the factors associated with clinical failure.Bacteremia,pneumonia,and CAZ-AVI as salvage therapy were the factors associated with microbiological failure.Conclusions CAZ-AVI is an effective antibiotic for treating CRKP infection,which provides an important option for the treatment of CRKP infection after kidney transplantation.Large-scale controlled studies are still needed to confirm the clinical efficacy of CAZ-AVI in the treatment of CRKP infection after kidney transplantation.