头孢他啶阿维巴坦治疗碳青霉烯类耐药铜绿假单胞菌感染的疗效与安全性分析

The efficacy and safety of ceftazidime avibactam versus polymyxin B for patients with carbapenem-resistant Pseudomonas aeruginosa infection

目的:在碳青霉烯类耐药铜绿假单胞菌感染患者中,比较头孢他啶阿维巴坦组与以多粘菌素B为基础的联合治疗的疗效和安全性。方法:回顾性分析2019年6月—2022年1月南京医科大学第一附属医院各ICU内碳青霉烯类耐药铜绿假单胞菌感染患者,依据治疗方式分为头孢他啶阿维巴坦组和多粘菌素B联合组,收集患者临床资料,包括性别、年龄、诊断、住院时间等基本信息,比较疗效指标,包括细菌清除率、28 d病死率等,以及肝肾功能不全等不良反应的发生率。结果:共纳入55例,其中头孢他啶阿维巴坦组25例,多粘菌素B联合组30例,两组之间基本指标、细菌清除率、28 d病死率、不良反应差异均无统计学意义,头孢他啶阿维巴坦组住院时间长于多粘菌素B联合组[49.0(34.0,78.0)vs.26.0(15.8,40.5),P=0.001],在抗生素联合应用方面较多粘菌素B联合组少。结论:与多粘菌素B相比,头孢他啶阿维巴坦在临床治愈、细菌清除率方面效果相似,不良反应方面无统计学差异,增加了临床用药的选择,有助于减轻公共卫生事业压力。

Objective:To evaluate the efficacy and safety of ceftazidime avibactam compared with polymyxin based combination therapy in patients with carbapenem resistant Pseudomonas aeruginosa infection.Methods:Retrospective analysis was carried out on the patients infected with carbapenem resistant Pseudomonas aeruginosa in the ICU of the First Affiliated Hospital of Nanjing Medical University between June 2019 and January 2022.They were divided into ceftazidime avibactam group and polymyxin B group.The clinical data of patients were collected,including basic information,such as gender,age,diagnosis,and length of stay.The comparative efficacy indicators included bacterial clearance rate,28-day mortality rate and the incidence of adverse reactions,such as liver and kidney dysfunction.Results:A total of 55 patients were included,including 25 patients in the ceftazidime avibactam group and 30 patients in the polymyxin B group.There was no statistically significant difference in basic indicators,bacterial clearance,28-day mortality,and adverse reactions between the two groups.The length of hospital stay in the ceftazidime avibactam group was longer than that in the polymyxin B group[49.0(34.0,78.0)vs.26.0(15.8,40.5),P=0.001],and ceftazidime avibactam group had fewer antibiotic combinations than polymyxin B group.Conclusion:Compared with polymyxin B,ceftazidime averbactam has similar effects in clinical cure and bacterial clearance,and there is no statistical difference in adverse reactions.Ceftazidime averbaltam increases the choice of clinical drugs and helps to reduce the pressure on public health.