广谱抗菌药物联合硝基咪唑类药物治疗腹腔感染的疗效:一项10年的真实世界队列研究

Efficacy of broad-spectrum antibiotics plus nitroimidazoles for abdominal infections:a decade-long realworld cohort study

目的:探讨广谱抗菌药物联合硝基咪唑类药物治疗腹腔感染的临床疗效。方法:回顾性分析2010年6月至2020年5月在单一中心接受广谱抗菌药物单用(BSA)或广谱抗菌药物联合硝基咪唑(NCBSA)类药物治疗的腹腔感染患者的临床数据。进行1∶1倾向评分匹配(PSM),以调整2组在年龄、性别、APACHEⅡ评分和SOFA评分方面的潜在差异。比较2组患者的临床有效率、住院时长和总住院费用。同时,根据疾病严重程度(APACHEⅡ评分)和是否进行腹腔手术来分析亚组疗效。结果:本研究共纳入149对倾向评分匹配的病例。两组临床有效率无统计学差异(P=0.236)。BSA组住院时间较短(18 d vs.27 d,P=0.001),住院费用较低(85185.7元vs.187898.3元,P<0.001)。但NCBSA组患者的体温和PCT高于BSA组(分别为P=0.007和P=0.045),NCBSA组的CRP和WBC值也较高,但两组之间没有显著差异(分别为P=0.105和P=0.170)。NCBSA组接受腹腔手术的患者更多(92例vs.38例),这表明NCBSA的感染和临床情况可能更严重。亚组分析显示,疾病的严重程度和患者术后是否合并感染不影响两组的治疗效果(P>0.05)。结论:广谱抗菌药物联合硝基咪唑类药物治疗腹腔感染的临床疗效与单独使用广谱抗菌药物相似,但是否在腹腔术后患者中联合使用硝基咪唑类仍需更多的临床证据。

OBJECTIVE To explore the clinical efficacy of broad-spectrum antibiotics plus nitroimidazoles for abdominal infection.METHODS The relevant clinical data were retrospectively reviewed for patients with abdominal infection on broadspectrum antibiotics(BSA)alone or broad-spectrum antibiotics plus nitroimidazole(NCBSA)at a single center from June 2010 to May 2020.One-to-one propensity score matching(PSM)was performed for adjusting the potential differences in age,gender,APACHEⅡscore and SOFA score of two groups.Clinical effective rate,hospitalization stay and total hospitalization expense were compared between two groups.Meanwhile,subgroup efficacy was analyzed according to disease severity(APACHEⅡscore)and whether or not abdominal surgery was performed.RESULTS A total of 149 propensity score-matched case pairs were included.No inter-group statistical difference existed in clinical effective rate(P=0.236).BSA group had shorter hospitalization stay(18 vs.27 day,P=0.001)and lower hospitalization expense(85185.7 vs.187898.3 yuan,P<0.001).However,body temperature and procalcitonin(PCT)were higher in NCBSA group than those in BSA group(P=0.007,P=0.045)and Creactive protein(CRP)and white blood cell(WBC)also were higher in NCBSA group.However,no significant inter-group differences existed(P=0.105,P=0.170).And more patients(92 vs.38)in NCBSA group underwent abdominal surgery.It implied that infection and clinical conditions were probably more severe in NCBSA group.Subgroup analysis revealed that severity of disease and an onset of postoperative co-infection did not affect therapeutic effect of two groups(P>0.05).CONCLUSION Clinical efficacy of broad-spectrum antibiotics plus nitroimidazoles for abdominal infection is similar to that of broad-spectrum antibiotics alone.And more clinical evidence is required for the necessity of combining nitroimidazoles in these conditions.