多黏菌素B治疗危重症儿童多重耐药革兰阴性菌感染的疗效观察

The Efficacy Observation of Polymyxin B in Multiple Drug-Resistant Gram-Negative Bacterial Infections in Critically Ill Children

目的:评估多黏菌素B治疗危重症儿童多重耐药革兰阴性菌感染的疗效,并探讨其影响多黏菌素B疗效的可能因素。方法:选取某院重症监护室2020年2月~2022年6月诊治的26例危重症多重耐药革兰阴性菌感染患儿,根据患者的疗效分为临床有效组(n=14)和临床无效组(n=12)。比较两组患者的性别、年龄、小儿危重病例评分、合并疾病、病原菌、治疗时间、机械通气情况以及与其他抗菌药物联用情况。对其中有意义的变量进行多因素Logistic回归分析,探讨影响多黏菌素B疗效的可能因素。结果:临床有效组与无效组的性别、年龄、小儿危重病例评分、合并疾病、病原菌以及与其他抗菌药物联用情况比较均无统计学差异(P>0.05)。临床有效组的多黏菌素B使用时间较无效组更长(P=0.000),临床无效组有更多的患儿应用机械通气(P=0.034)。Logistic回归分析果结提示治疗时间(OR:2.606,95%CI:1.346~5.046,P=0.004)是影响多黏菌素B治疗危重症儿童多重耐药革兰阴性菌感染临床疗效的可能因素。结论:多黏菌素B治疗危重症儿童多重耐药革兰阴性菌感染具有较好的治疗效果,治疗时间是影响多黏菌素临床疗效的可能因素。

Objective:The aim of this study was to assess the efficacy of polymyxin B in multiple drugresistant Gram-negative bacterial infections in critically ill children and discuss the potential factors affecting the efficacy of polymyxin B.Methods:A total of 26 pediatric patients with multiple drug-resistant Gramnegative bacterial infections who were admitted to the intensive care unit between February 2020 and June 2022 were selected for this study.The study assigned the patients into two groups based on their clinical response:a group of 14 cases with response and a group of 12 cases without response.Various factors between the two groups were compared in the study,including gender,age,pediatric risk of mortality(PRISM)scores,coexisting diseases,pathogens,treatment duration,mechanical ventilation status,and concomitant use of other antimicrobial agents.Logistic regression was performed on variables with statistical significance to explore the factors affecting the efficacy of polymyxin B.Results:No statistically significant differences were found in gender,age,pediatric risk of mortality scores,coexisting diseases,pathogens,and concomitant use of other antimicrobial agents between the responsive and non-responsive groups(P>0.05).However,the duration of polymyxin B use was longer in the responsive group than in the non-responsive group(P=0.000),and a higher number of children in the non-responsive group required mechanical ventilation(P=0.034).Logistic regression analysis was conducted to identify potential factors affecting the clinical efficacy of polymyxin B in multiple drug-resistant Gram-negative bacterial infections in critically ill children.The analysis suggested that treatment duration(OR:2.606,95%CI:1.346~5.046,P=0.004)was a significant factor.Conclusion:Polymyxin B is effective in multiple drug-resistant Gram-negative bacterial infections in critically ill children.The duration of treatment is a potential factor that affects the clinical efficacy of polymyxin B.