替加环素对NICU碳青霉烯耐药菌致院内获得性肺炎抗感染疗效的回顾性分析
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摘要
目的探讨替加环素对NICU碳青霉烯耐药菌感染的院内获得性肺炎患者的抗感染疗效,为神经重症的抗感染治疗提供理论依据。方法回顾性分析2015年5月至2018年11月在我科重症加护病房(NICU)确诊碳青霉烯类耐药细菌感染的院内获得性肺炎患者131例临床资料。依据痰细菌培养结果分为鲍曼不动杆菌阳性组和肺炎克雷伯杆菌阳性组。依据抗感染治疗方案分为3组:替加环素与美罗培南联合治疗组;替加环素与亚胺培南西司他丁钠联合治疗组;替加环素与头孢哌酮舒巴坦联合治疗组。采用χ2检验或t检验分析各组患者的一般情况,临床有效率、微生物清除率以及炎症指标变化。采用Logistic回归分析观察与临床疗效相关的危险因素。结果①在鲍曼不动杆菌阳性组中替加环素与美罗培南联合治疗组的临床有效率为63.64%,与其他两组比较有显著差异(P<0.05)。在肺炎克雷伯杆菌阳性组中3种联合治疗方案的临床有效率无明显差异(P>0.05);②在鲍曼不动杆菌阳性组和肺炎克雷伯杆菌阳性组中各组微生物清除率均无明显差异(P>0.05);③给予3种不同替加环素联合抗感染治疗后各组患者白细胞数量、降钙素原、C反应蛋白等炎症标记物较抗感染治疗前均显著下降(P<0.05);④Logistic回归分析发现性别、气管插管/气管切开、治疗前降钙素原、治疗前C反应蛋白对临床有效率产生显著影响(P<0.05)。结论 NICU碳青霉烯耐药菌感染的院内获得性肺炎患者给予替加环素联合治疗具有较好的抗感染疗效。在我科NICU泛耐药菌菌种以鲍曼不动杆菌为主,以替加环素与美罗培南联合具有显著抗感染疗效。
Objective To provide theoretical evidences,we analyzed the effect of tigecycline on the anti-infection treatment of the patients with hospital-acquired pneumonia caused by carbapenem-resistant bacteria in the Neurosurgical Intensive Care Unit( NICU) in our hospital. Methods The clinical data of 131 NICU patients with hospital-acquired pneumonia caused by carbapenem-resistant bacteria from May 2015 to November 2018 were analyzed retrospectively. According to the results of sputum bacterial culture,they were divided into an extensively drug-resistant Acinetobacter baumannii positive group and an extensively drugresistant Klebsiella pneumoniae positive group. Then the patients received the following three anti-infective treatments,respectively: tigecycline combined with meropenem,tigecycline combined with imipenem-cilastatin sodium,and tigecycline combined with cefoperazone/sulbactam. Then Student' s t test or chi-square test were used to analyze the data among the three treated groups including the clinical characteristics, clinical efficiency,microbiological eradication rate and inflammatory markers. Logistic regression analysis was used to determine the risk factors related to the clinical cure rate. Results ①Compared with the other two groups,the clinical efficiency of the group of tigecycline combined with meropenem was the most highest in the extensively drug resistant Acinetobacter baumannii positive group( 63. 64%, P < 0. 05). There were no significant differences in the clinical efficiencies of the three treatment groups in the extensively drug resistant Klebsiella pneumoniae positive group( P>0.05). ②There were no significant differences in the microbiological eradication rates of the three treatment groups in both extensively drug resistant Klebsiella pneumoniae positive group and Acinetobacter baumannii positive group( P > 0. 05). ③ Compared with the inflammatory markers before antiinfective treatments,the inflammatory markers of all the groups,such as white blood cell count,C reaction protein and procalcitonin,were significantly decreased after anti-infectice treatments( P<0.05). ④The results of Logistic regression analysis showed that the markers,such as gender,tracheal intubation/tracheotomy,the values of C reaction protein and procalcitonin,before anti-infective treatments,had a significant impact on the clinical efficiency( P < 0. 05). Conclusion Tigecycline combined treatments can achieve better clinical therapeutic effects on the NICU patients with hospital-acquired pneumonia caused by carbapenem-resistant bacterias. Acinetobacter baumannii is the main extensively drug-resistant strain in our NICU. Treatment of tigecycline combined with meropenem has a significant anti-infective effect on the patients with hospital-acquired pneumonia caused by the extensively drug resistant Acinetobacter baumannii.
Objective To provide theoretical evidences,we analyzed the effect of tigecycline on the anti-infection treatment of the patients with hospital-acquired pneumonia caused by carbapenem-resistant bacteria in the Neurosurgical Intensive Care Unit( NICU) in our hospital. Methods The clinical data of 131 NICU patients with hospital-acquired pneumonia caused by carbapenem-resistant bacteria from May 2015 to November 2018 were analyzed retrospectively. According to the results of sputum bacterial culture,they were divided into an extensively drug-resistant Acinetobacter baumannii positive group and an extensively drugresistant Klebsiella pneumoniae positive group. Then the patients received the following three anti-infective treatments,respectively: tigecycline combined with meropenem,tigecycline combined with imipenem-cilastatin sodium,and tigecycline combined with cefoperazone/sulbactam. Then Student' s t test or chi-square test were used to analyze the data among the three treated groups including the clinical characteristics, clinical efficiency,microbiological eradication rate and inflammatory markers. Logistic regression analysis was used to determine the risk factors related to the clinical cure rate. Results ①Compared with the other two groups,the clinical efficiency of the group of tigecycline combined with meropenem was the most highest in the extensively drug resistant Acinetobacter baumannii positive group( 63. 64%, P < 0. 05). There were no significant differences in the clinical efficiencies of the three treatment groups in the extensively drug resistant Klebsiella pneumoniae positive group( P>0.05). ②There were no significant differences in the microbiological eradication rates of the three treatment groups in both extensively drug resistant Klebsiella pneumoniae positive group and Acinetobacter baumannii positive group( P > 0. 05). ③ Compared with the inflammatory markers before antiinfective treatments,the inflammatory markers of all the groups,such as white blood cell count,C reaction protein and procalcitonin,were significantly decreased after anti-infectice treatments( P<0.05). ④The results of Logistic regression analysis showed that the markers,such as gender,tracheal intubation/tracheotomy,the values of C reaction protein and procalcitonin,before anti-infective treatments,had a significant impact on the clinical efficiency( P < 0. 05). Conclusion Tigecycline combined treatments can achieve better clinical therapeutic effects on the NICU patients with hospital-acquired pneumonia caused by carbapenem-resistant bacterias. Acinetobacter baumannii is the main extensively drug-resistant strain in our NICU. Treatment of tigecycline combined with meropenem has a significant anti-infective effect on the patients with hospital-acquired pneumonia caused by the extensively drug resistant Acinetobacter baumannii.
引文
1赵鹤进,宋晓光.耐碳青霉烯类肠杆菌科细菌的临床分布及其耐药性研究[J].实验与检验医学,2017,35(1):105-107.
2张弨,翟所迪,单爱莲.替加环素的药代动力学/药效学评价和剂量选择研究现状[J].中国临床药理学杂志,2016,32(20):1914-1917.
3 Zhanel GG,Karlowsky JA,Rubinstein E,et al.Tigecycline:a novel glycylcycline antibiotic[J].Expert Rev Anti Infect Ther,2006,4(1):9-25.
4 Ni W,Han Y,Zhao J,et al.Tigecycline treatment experience against multidrug-resistant acinetobacter baumannii infections:a systematic review and meta-analysis[J].Int J Antimicrob Agents,2016,47(2):107-116.
5余敏,王勤鹰,顾勤,等.NICU患者替加环素联合治疗多药耐药菌感染的临床研究[J].中华医院感染学杂志,2014,24(24):6086-6088.
6抗菌药物临床试验技术指导原则写作组.抗菌药物临床试验技术指导原则[J].中国临床药理学杂志,2014,30(9):844-859.
7薛菊兰,王向荣,罗丽华,等.神经内科重症监护病房医院感染目标监测分析[J].中国消毒学杂志.2018,35(9):714-715.
8周高雅,向光红,唐佳宇,等.神经内科重症监护病房医院获得性肺炎病原菌分布及耐药性分析[J].医学信息,2018,31(11):121-123.
9王带媚,赵二义,钟敬波,等.神经内科重症监护病房医院获得性肺炎多重耐药菌感染的病原学分布及耐药性分析[J].中南药学,2018,16(12):1785-1788.
10李双,张广庆,刘玉才.替加环素不同治疗方案对ICU泛耐药鲍曼不动杆菌肺部感染的临床效果对比观察[J].中国抗生素杂志,2018,24(2):139-145.
11杨雪,刘琳,张湘燕.耐碳青霉烯类肺炎克雷伯杆菌的耐药机制及治疗策略研究进展[J].医学研究生学报,2018,31(4):430-434.
12 Chinese XDR Consensus Working Group,Guan X,He L,et al.Laboratory diagnosis,clinical management and infection control of the infections caused by extensively drug-resistant Gram-negative bacilli:a Chinese consensus statement[J].Clin Microbiol Infect,2016,22(Suppl 1):s15-s25.
13陈佰义,何礼贤,胡必杰,等.中国鲍曼不动杆菌感染诊治与防控专家共识[J].中华医学杂志,2012,92(2):76-85.
14金晶,吴伟平,林德.替加环素联合9种抗菌药物对碳青霉烯耐药细菌的抗菌作用[J].中国卫生检验杂志,2018,28(11):1281-1284.
15赵华,吴健,杨爱祥,等.以替加环素为基础的联合用药治疗多耐药和泛耐药鲍曼不动杆菌感染医院获得性肺炎的临床研究[J].临床和实验医学杂志,2015,14(24):2103-2105.
16粟时颖,黄瑞珠,施东萍,等.替加环素治疗耐碳青霉烯类鲍曼不动杆菌肺炎疗效的回顾性研究[J].药物流行病学杂志,2018,27(7):429-432.
17刘培培,赵江.替加环素和头孢哌酮钠舒巴坦钠治疗多重耐药鲍曼不动杆菌肺炎的对比研究[J].药物与临床,2019,16(1):24-27.
18李佳慧,陈华乐,张能华,等.替加环素单药及与5种抗菌药物联用对耐碳青霉烯类鲍曼不动杆菌的体外抑菌及生物膜清除作用研究[J].中国抗生素杂志,2018,43(2):121-126.
19陈爱凤,沈晓强,丁士标,等.替加环素治疗碳青霉烯类耐药肺炎克雷伯菌肺炎的临床疗效及预后分析[J].浙江医学,2018,40(3):258-265.
20王佳,骆霞,王林海,等.替加环素联合头孢哌酮舒巴坦钠治疗多重/泛耐药鲍曼不动杆菌致肺炎的Meta分析[J].临床药物治疗杂志,2017,15(1):38-42.
2张弨,翟所迪,单爱莲.替加环素的药代动力学/药效学评价和剂量选择研究现状[J].中国临床药理学杂志,2016,32(20):1914-1917.
3 Zhanel GG,Karlowsky JA,Rubinstein E,et al.Tigecycline:a novel glycylcycline antibiotic[J].Expert Rev Anti Infect Ther,2006,4(1):9-25.
4 Ni W,Han Y,Zhao J,et al.Tigecycline treatment experience against multidrug-resistant acinetobacter baumannii infections:a systematic review and meta-analysis[J].Int J Antimicrob Agents,2016,47(2):107-116.
5余敏,王勤鹰,顾勤,等.NICU患者替加环素联合治疗多药耐药菌感染的临床研究[J].中华医院感染学杂志,2014,24(24):6086-6088.
6抗菌药物临床试验技术指导原则写作组.抗菌药物临床试验技术指导原则[J].中国临床药理学杂志,2014,30(9):844-859.
7薛菊兰,王向荣,罗丽华,等.神经内科重症监护病房医院感染目标监测分析[J].中国消毒学杂志.2018,35(9):714-715.
8周高雅,向光红,唐佳宇,等.神经内科重症监护病房医院获得性肺炎病原菌分布及耐药性分析[J].医学信息,2018,31(11):121-123.
9王带媚,赵二义,钟敬波,等.神经内科重症监护病房医院获得性肺炎多重耐药菌感染的病原学分布及耐药性分析[J].中南药学,2018,16(12):1785-1788.
10李双,张广庆,刘玉才.替加环素不同治疗方案对ICU泛耐药鲍曼不动杆菌肺部感染的临床效果对比观察[J].中国抗生素杂志,2018,24(2):139-145.
11杨雪,刘琳,张湘燕.耐碳青霉烯类肺炎克雷伯杆菌的耐药机制及治疗策略研究进展[J].医学研究生学报,2018,31(4):430-434.
12 Chinese XDR Consensus Working Group,Guan X,He L,et al.Laboratory diagnosis,clinical management and infection control of the infections caused by extensively drug-resistant Gram-negative bacilli:a Chinese consensus statement[J].Clin Microbiol Infect,2016,22(Suppl 1):s15-s25.
13陈佰义,何礼贤,胡必杰,等.中国鲍曼不动杆菌感染诊治与防控专家共识[J].中华医学杂志,2012,92(2):76-85.
14金晶,吴伟平,林德.替加环素联合9种抗菌药物对碳青霉烯耐药细菌的抗菌作用[J].中国卫生检验杂志,2018,28(11):1281-1284.
15赵华,吴健,杨爱祥,等.以替加环素为基础的联合用药治疗多耐药和泛耐药鲍曼不动杆菌感染医院获得性肺炎的临床研究[J].临床和实验医学杂志,2015,14(24):2103-2105.
16粟时颖,黄瑞珠,施东萍,等.替加环素治疗耐碳青霉烯类鲍曼不动杆菌肺炎疗效的回顾性研究[J].药物流行病学杂志,2018,27(7):429-432.
17刘培培,赵江.替加环素和头孢哌酮钠舒巴坦钠治疗多重耐药鲍曼不动杆菌肺炎的对比研究[J].药物与临床,2019,16(1):24-27.
18李佳慧,陈华乐,张能华,等.替加环素单药及与5种抗菌药物联用对耐碳青霉烯类鲍曼不动杆菌的体外抑菌及生物膜清除作用研究[J].中国抗生素杂志,2018,43(2):121-126.
19陈爱凤,沈晓强,丁士标,等.替加环素治疗碳青霉烯类耐药肺炎克雷伯菌肺炎的临床疗效及预后分析[J].浙江医学,2018,40(3):258-265.
20王佳,骆霞,王林海,等.替加环素联合头孢哌酮舒巴坦钠治疗多重/泛耐药鲍曼不动杆菌致肺炎的Meta分析[J].临床药物治疗杂志,2017,15(1):38-42.