头孢哌酮/舒巴坦与美罗培南轮换性治疗降低产超广谱β-内酰胺酶和耐碳青霉烯类大肠埃希菌的发生率

Rotation Therapy of Cefoperazone/Sulbactam and Meropenem to Reduce the Incidence Rate of Extended Spectrum β-Lactamase Producing and Carbapenem Resistant Escherichia Coli

目的 观察使用头孢哌酮/舒巴坦与美罗培南治疗感染产超广谱β-内酰胺酶大肠埃希氏菌(extended spectrumβ-lactamase producing Escherichia coli,ESBLs-E.coli)肺炎患者的临床疗效,轮换性治疗降低产ESBLs-E.coli和耐碳青霉烯类大肠埃希菌(carbapenem resistant E.coli,CR-E.coli)的发生率。方法 将2019年6月—2021年6月青岛大学上海临床医学院呼吸内科轻中度肺部感染ESBLs-E.coli的419例患者按照如下治疗方案分3组:采用头孢哌酮/舒巴坦治疗14 d的104例患者为舒普生组;采用美罗培南治疗14 d的127例患者为美平组;先用头孢哌酮/舒巴坦治疗7 d,再用美罗培南治疗7 d的188例患者为轮换组。3组患者除抗菌药物使用方法不同外其他治疗方案一致,14 d后观察3组患者的临床疗效,连续3 d采集全部治疗未痊愈患者肺泡灌洗液做细菌培养鉴定及药敏分析,对治疗后患者肺泡灌洗液培养出ESBLs-E.coli及CR-E.coli的例数进行统计分析。结果 3组患者治疗后临床疗效比较无统计学差异,轮换组未痊愈患者肺泡灌洗液检测出的E.coli对头孢三代(头孢噻肟、头孢曲松)和碳青霉烯类药物(亚胺培南、美罗培南、厄他培南)的耐药率与其他2组比较有显著性差异(轮换组的耐药率显著低于其他2组,P<0.05)。治疗后舒普生组、美平组、轮换组未痊愈患者肺泡灌洗液分别检出ESBLs-E.coli 63,66,53例,舒普生组与美平组比较差异无统计学意义,轮换组检出例数与其他2组比较均有显著性差异(轮换组检出率显著低于其他2组,P<0.05)。治疗后舒普生组、美平组、轮换组未痊愈患者肺泡灌洗液分别检出CR-E.coli 7,8,2例,舒普生组与美平组比较差异无统计学意义,轮换组检出例数与其他2组比较均有显著性差异(轮换组检出率显著低于其他2组,P<0.05)。结论 使用头孢哌酮/舒巴坦与美罗培南治疗感染ESBLs-E.coli肺炎患者的临床疗效无显著性差异,使用头孢哌酮/舒巴坦与美罗培南轮换性治疗可有效降低ESBLs-E.coli和CR-E.coli的发生率。

OBJECTIVE To observe the clinical effiacy of cefoperazone/sulbactam and meropenem in the treatment of pneumonia caused by extended spectrum β-lactamase producing Escherichia coli(ESBLs-E.coli) and ratational treatment reduces the incidence of ESBLs-E.coli and carbapenem resistant E.coli(CR-E.coli). METHODS From June 2019 to June 2021, a total of 419 patients with moderate pulmonary infection by ESBLs-E.coli were selected in the department of respiratory medicine,Shanghai Neuromedical Center, and they were divided into three groups according to visiting sequence and antibiotic application based on conventional treatment: the sulperazon group with 104 cases received cefoperazone/sulbactam continuously treated for 14 d, the meropenem group with 127 cases received meropenem continuously treated for 14 d, and the rotation group with 188cases first received cefoperazone/sulbactam treated for 7 d, and then received meropenem for 7 d. The three groups of patients had the same treatment plan except for the different use of antibacterial drugs. After 14 d, the clinical efficacy of the three groups of patients was observed, and the alveolar lavage fluid of all patients who were not cured after treatment was collected for bacterial culture identification and drug sensitivity analysis for three consecutive days. The number of patients with ESBLs-E.coli and CR-E-coli cultured from the alveolar lavage fluid after treatment was statistically analyzed. RESULTS There was no significant difference in treatment efficacy between every two groups in three groups. Compared with after treatment, the E.coli resistance rate in rotation group of cephalosporin Ⅲ(cefotaxime, ceftriaxone) and carbapenems(imipenem,meropenem and ertapenem) were significantly different from that in sulperazon group and meropenem group(the drug resistance rate of rotation group were significantly lower than other 2 groups, P<0.05). After treatment, ESBLs-E.coli was detected in alveolar lavage fluid of patients in 63, 66 and 53 cases in the sulpersen group, meropenem group and rotation group who were not cured. There was significant difference between rotation and sulperazon or meropenem(the rotation was significantly lower than sulperazon or meropenem group, P<0.05), and there was no significant difference between sulperazon and meropenem group;CR-E.coli was 7, 8, 2 cases in alveolar lavage fluid of sulperazon, meropenem and rotation group after treatment,respectively;there was significant difference between rotation and sulperazon or meropenem group(the rotation was significantly lower than sulperazon or meropenem group, P<0.05);there was no significant difference between sulperazon and meropenem.CONCLUSION There is no significant difference in the clinical efficacy between cefoperazone/sulbactam and meropenem rotation therapy for the pneumonia patients infected by ESBLs-E.coli, but the antibiotic rotation of above two antibiotic can effectively curb the production of ESBLs-E.coli and CR-E.coli.