头孢他啶/阿维巴坦治疗碳青霉烯耐药的肺炎克雷伯菌肺部感染效果观察

Efficacy of ceftazidime/avibactam on carbapenem-resistant Klebsiella pneumoniae pulmonary infection

目的探讨头孢他啶/阿维巴坦治疗碳青霉烯耐药的肺炎克雷伯菌肺部感染的效果及安全性。方法2020年1月—2022年1月郑州大学第一附属医院诊治碳青霉烯耐药的肺炎克雷伯菌肺部感染患者76例,其中采用头孢他啶/阿维巴坦(2.5 g/次,1次/8 h)治疗者36例为观察组,采用多黏菌素B(75万u,1次/12 h)治疗者40例为对照组,2组均联合使用碳青霉烯类抗生素,常规行机械通气、液体复苏、抗凝、肾脏替代治疗等对症支持治疗。比较2组治疗第5天总有效率,治疗前及治疗第5天Murray肺损伤评分、急性生理学和慢性健康状况评估Ⅱ(APACHEⅡ)评分、序贯器官衰竭评估(SOFA)评分、白细胞计数、C反应蛋白、降钙素原及免疫球蛋白IgA、IgG、IgM水平。观察2组治疗期间肺损伤、应激性溃疡、轻度肝损伤等不良反应发生情况,记录机械通气时间、ICU住院时间及病死率。结果治疗第5天,观察组治疗总有效率(94.4%)高于对照组(75.0%)(χ^(2)=7.559,P=0.006),Murray肺损伤评分[1.47(1.37,1.58)分]、APACHEⅡ评分[8.46(7.93,9.04)分]、SOFA评分[(4.12±0.51)分]、白细胞计数[12.25(11.83,12.73)×10^(9)/L]、C反应蛋白[6.91(5.91,7.45)mg/L]、降钙素原水平[2.16(2.10,2.23)μg/L]及病死率(2.8%)均低于对照组[2.08(1.86,2.25)分、12.75(12.08,13.39)分、(5.78±0.65)分、14.31(13.72,14.80)×10^(9)/L、20.62(17.73,23.29)mg/L、4.07(4.02,4.11)μg/L、20.0%](P<0.05),IgA[(2.74±0.15)g/L]、IgG[(11.08±0.71)g/L]、IgM[1.33(1.30,1.36)g/L]水平均高于对照组[(2.29±0.26)、(10.26±0.72)、1.05(0.99,1.10)g/L](P<0.05),机械通气时间[(10.81±2.28)d]、ICU住院时间[(13.56±2.22)d]均短于对照组[(14.94±2.80)、(18.12±3.13)d](t=-6.986,P<0.001;t=-7.382,P<0.001),不良反应发生率(8.3%)与对照组(10.0%)比较差异无统计学意义(χ^(2)<0.001,P>0.999)。结论头孢他啶/阿维巴坦治疗碳青霉烯耐药的肺炎克雷伯菌肺部感染可有效改善病情,减轻机体炎性反应,增强免疫功能,缩短机械通气时间,降低病死率,安全性好。

Objective To investigate the efficacy and safety of ceftazidime-avibactam in the treatment of carbapenem-resistant Klebsiella pneumoniae(CRKP)pulmonary infection.Methods From January 2020 to January 2022,76 patients with CRKP pulmonary infection were diagnosed and treated in the First Affiliated Hospital of Zhengzhou University,among whom 36 patients received ceftazidime-avibactam(2.5 g/8 h)(observation group),and 40patients received polycolistin B(750000 u/12 h)(control group),besides the administration of carbapenem antibiotics and the symptomatic supportive treatment such as mechanical ventilation,fluid resuscitation,anticoagulation and renal replacement in two groups.The effective rate by day 5 after treatment,and Murray Lung Injury Score,Acute Physiology and Chronic Health Evaluation II,sequential organ failure score,white blood cell count,C-reactive protein,procalcitonin,IgA,IgG and IgM before treatment and by day 5 after treatment were compared between two groups.The adverse reactions such as lung injury,stress ulcer and minor liver injury were observed in two groups during treatment,and the length of ventilator use,length of ICU stay and mortality were recorded.Results By day 5 after treatment,the effective rate was higher in observation group(94.4%)than that in control group(75.0%)(χ^(2)=7.559,P=0.006),the Murray Lung Injury Score,Acute Physiology and Chronic Health EvaluationⅡ,sequential organ failure score,white blood cell count,C-reactive protein,procalcitonin and mortality were lower in observation group[1.47(1.37,1.58),8.46(7.93,9.04),4.12±0.51,12.25(11.83,12.73)×10^(9)/L,6.91(5.91,7.45)mg/L,2.16(2.10,2.23)μg/L,2.8%]than those in control group[2.08(1.86,2.25),12.75(12.08,13.39),5.78±0.65,14.31(13.72,14.80)×10^(9)/L,20.62(17.73,23.29)mg/L,4.07(4.02,4.11)μg/L,20.0%](P<0.05),the levels of IgA,IgG and IgM were higher in observation group[(2.74±0.15),(11.08±0.71),1.33(1.30,1.36)g/L]than those in control group[(2.29±0.26),(10.26±0.72),1.05(0.99,1.10)g/L](P<0.05),the length of ventilator use and length of ICU stay were shorter in observation group[(10.81±2.28),(13.56±2.22)d]than those in control group[(14.94±2.80),(18.12±3.13)d](t=-6.986,P<0.001;t=-7.382,P<0.001),and there were no significant differences in the incidence of adverse reactions between two groups(8.3%vs.10.0%)(χ^(2)<0.001,P>0.999).Conclusion Ceftazidime/avibactam is effective and safe in the treatment of CRKP pulmonary infection,reduce the inflammatory reaction,enhance the immune function,shorten the length of ventilator use and lower the mortality.