大剂量替加环素联合多黏菌素治疗多重耐药鲍曼不动杆菌肺炎疗效及安全性分析

Efficacy and safety of high-dose tigecycline combined with polymyxin in treatment of multidrug resistance acinetobacter baumannii pneumonia

目的分析大剂量替加环素联合多黏菌素治疗多重耐药鲍曼不动杆菌(MDR-AB)肺炎的疗效及安全性。方法前瞻性研究,纳入平煤神马医疗集团总医院2021年5月—2023年5月收治的86例MDR-AB患者,随机将患者分为两组,各43例。对照组采用常规剂量替加环素+多黏菌素治疗,观察组采用大剂量替加环素+多黏菌素治疗,持续用药10 d。治疗后评估两组疗效,测定两组细菌清除情况。记录两组临床指标(退热时间、咳嗽消失时间、肺部啰音消失时间、细菌转阴时间);治疗期间观察并记录不良反应发生情况。结果观察组治疗总有效率和细菌清除率高于对照组(P<0.05),观察组退热时间、咳嗽及肺部啰音消失时间、细菌转阴时间均短于对照组(P<0.05),组间不良反应发生率比较差异无统计学意义(P>0.05)。结论大剂量替加环素联合多黏菌素治疗MDR-AB肺炎可提高疗效,患者各主要症状更好更快缓解,病原菌清除率提高,且不会增加药物使用安全性风险。

Objective To analyze the efficacy and safety of high-dose tigecycline combined with polymyxin in the treatment of multidrug resistance acinetobacter baumannii(MDR-AB)pneumonia.Methods A prospective cohort study included 86 patients with MDR-AB who were admitted to the hospital from May 2021 to May 2023.According to the random number table,the patients were divided into the control group and the observation group,43 patients in each group.The control group was treated with conventional dose of tigecycline and polymyxin,and the observation group was treated with high-dose of tigecycline+polymyxin for 10 days.After treatment,the efficacy of the two groups was evaluated,and the bacterial clearance of the two groups was measured.The clinical indicators(antipyretic time,cough disappearance time,lung rale disappearance time,and bacterial clearance time)of the two groups were recorded.Adverse reactions were observed and recorded during treatment.Results The total effective rate and bacterial clearance rate of observation group were higher than control group,with statistical significant differences(P<0.05).The time for fever relief,cough disappearance,lung rale disappearance,and bacterial negative conversion in observation group were shorter than control group,with statistical significant differences(P<0.05).There was no statistical significant difference in the incidence of adverse reactions between the groups(P>0.05).Conclusion High dose tigecycline combined with polymyxin can improve the efficacy in the treatment of MDR-AB pneumonia.The main symptoms of patients can be better and faster alleviated,and the clearance rate of pathogens can be improved,without increasing the safety risk of drug use.