联合多黏菌素类药物治疗对头孢他啶/阿维巴坦耐药的耐碳青霉烯类革兰阴性菌感染的临床疗效

Clinical efficacy of polymyxin combination in the treatment of ceftazidime/avibactam-resistant carbapenem-resistant Gram-negative bacteria infection

目的初步评估联合多黏菌素类药物治疗对头孢他啶/阿维巴坦(CZA)耐药(即CZA纸片扩散法的抑菌圈直径≤22 mm)的耐碳青霉烯类革兰阴性菌(CR-GNB)感染患者的临床疗效。方法纳入2021年6月—2023年5月就诊于某院并联合使用多黏菌素类药物治疗对CZA耐药的CR-GNB感染的住院患者;按照CZA纸片扩散法药物敏感性结果,将患者分为CZA抑菌圈直径为20~22 mm组和CZA抑菌圈直径<20 mm组,观察两组患者抗感染治疗的临床疗效和安全性。结果共纳入75例患者,其中CZA抑菌圈直径为20~22 mm组患者41例,CZA抑菌圈直径<20 mm组患者34例。两组患者一般资料比较,差异均无统计学意义(均P>0.05);两组患者选用的多黏菌素类药物品种、剂量及联合用药方案比例均相近,差异均无统计学意义(均P>0.05);两组间不同种类CR-GNB分离株的菌株数和CZA抑菌圈直径比较,差异均具有统计学意义(均P<0.05)。两组患者抗感染的临床有效率、微生物学清除率、28天病死率和出院病死率比较,差异均无统计学意义(均P>0.05)。两组患者应用多黏菌素类药物治疗前后的肾脏安全性指标变化差异均无统计学意义(均P>0.05)。结论联合多黏菌素类药物治疗对CZA耐药的CR-GNB感染患者的临床疗效和微生物学疗效约为50%;联合多黏菌素类药物治疗CZA抑菌圈直径<20 mm与CZA抑菌圈直径为20~22 mm菌株感染的疗效一致,但尚需纳入更大的临床样本量进一步验证。

Objective To preliminarily evaluate the clinical efficacy of polymyxin combination treatment in patients with ceftazidime/avibactam(CZA)-resistant(inhibition zone diameter of CZA measured by disc diffusion method was≤22 mm)carbapenem-resistant Gram-negative bacteria(CR-GNB)infection.Methods Hospitalized patients who received polymyxin combination for the treatment of CZA-resistant CR-GNB infection in a hospital from June 2021 to May 2023 were included in the study.According to the antimicrobial susceptibility results of CZA by disc diffusion method,patients were divided into CZA inhibition zone diameter 20-22 mm group and CZA inhibition zone dia-meter<20 mm group.Clinical efficacy and safety of anti-infection treatment in the two groups of patients were observed.Results A total of 75 patients were enrolled,including 41 patients with CZA inhibition zone diameter 20-22 mm and 34 patients with CZA inhibition zone diameter<20 mm.The general data between the two groups of patients were not statistically different(all P>0.05).The proportion of the types,dosage and combination regimens of polymyxins between the two groups of patients were not statistically different(all P>0.05).The number of bacterial strains and the diameter of CZA inhibition zone of different types of CR-GNB isolates between the two groups were all statistically different(all P<0.05).Clinical effective rate,microbiological clearance rate,28-day mortality,and discharge mortality between the two groups of patients were not statistically different(all P>0.05).Changes in renal safety indexes between the two groups of patients before and after treatment with polymyxins were not statistically different(all P>0.05).Conclusion Clinical and microbiological efficacy of combination treatment with polymyxins for CZA-resistant CR-GNB infected patients is approximately 50%.The efficacy of polymyxin combination in the treatment of infection caused by strains with inhibitory zone diameter<20 mm is consistent with those with diameter of 20-22 mm,but further validation with a larger size of clinical specimens is needed.