头孢他啶阿维巴坦治疗耐碳青霉烯类革兰阴性杆菌感染致脑室炎的文献分析

Literature Analysis of Ceftazidime/Avibactam in the Treatment of Ventriculitis Caused by Carbapenem-Resistant Gram-Negative Bacilli Infection

目的:探讨头孢他啶阿维巴坦(CAZ/AVI)治疗耐碳青霉烯类革兰阴性杆菌(CRGNB)感染致脑室炎的疗效,为临床合理用药提供参考。方法:检索中国知网、维普期刊、万方数据库、PubMed、Embase等数据库中关于CAZ/AVI治疗CRGNB感染致脑室炎的研究,收集患者性别、年龄、诊断、合并感染、手术操作、病原学结果、脑脊液生化指标、药物治疗方案及预后情况等信息并进行统计分析,检索时限均为建库起至2023年4月30日。结果:共纳入文献13篇,均为案例报道,涉及有效病例18例。其中,男性11例(61.11%),女性5例(27.78%),未描述2例(11.11%);年龄2.5~69岁。感染菌株以耐碳青霉烯类肺炎克雷伯菌(CRKP)(10例,55.56%)为主,其次为耐碳青霉烯类铜绿假单胞菌(CRPA)(7例,38.89%);感染类型以混合感染为主,表现为颅内感染合并血流感染或肺部感染。主要药物治疗方案为CAZ/AVI静脉滴注联合鞘内或脑室内注射给药,平均疗程为(34.12±18.29)天。10例报道了细菌培养转阴结果,细菌平均转阴时间(8.20±5.78)天,临床治愈率为94.44%。除未描述的研究外,CAZ/AVI治疗过程中均无不良反应发生。结论:CAZ/AVI对于CRGNB感染致脑室炎具有一定的临床疗效,但仅限于个案报道,尚需更多临床研究进一步证实。

Objective:To investigate the efficacy of ceftazidime/avibactam(CAZ/AVI)in the treatment of ventriculitis caused by carbapenem-resistant Gram-negative bacilli(CRGNB),and to provide reference for clinical rational drug use.Methods:The data of patients with ventriculitis caused by CRGNB infection treated with CAZ/AVI were retrieved from CNKI,VIP,Wanfang,PubMed and Embase.The information of patients'sex,age,diagnosis,concurrent infection,surgical procedures,etiological results,biochemical index in cerebrospinal fluid,drug therapy and prognosis were collected and analyzed statistically.The retrieval period was from the establishment of the database to April 30,2023.Results:A total of 13 articles were included,all of them were case reports,involving 18 valid cases.Among them,11 cases were male(61.11%),5 cases were female(27.78%),2 cases with unspecified gender(11.11%);the age ranged from 2.5 to 69 years.Carbapenem-resistant Klebsiella pneumoniae(CRKP)was the main pathogen(10 cases,55.56%),followed by carbapenem-resistant Pseudomonas aeruginosa(CRPA)(7 cases,38.89%).The main type of infection was mixed infection,which was intracranial infection combined with bloodstream infection or pulmonary infection.The main medical regimen was intravenous infusion of CAZ/AVI combined with intrathecal or intraventricular injection administration,with a mean duration of(34.12±18.29)days.The negative results of bacterial culture were reported in 10 cases.The average time to obtain negative bacterial result was(8.20±5.78)days.The clinical cure rate was 94.44%.Except for undescribed reports,no adverse effects occurred during treatment with CAZ/AVI.Conclusion:CAZ/AVI is effective in the treatment of ventriculitis caused by CRGNB infection,but it is limited to case reports.More clinical studies are needed to confirm it.