亚胺培南/西司他丁治疗急诊重症感染的效果研究
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摘要
目的探讨亚胺培南/西司他丁对于急诊重症感染的疗效。方法研究对象为2016年8月-2018年1月在医院收治急诊重症感染患者122例,采用随机数字法分为两组。对照组采用头孢菌素进行治疗,观察组采用亚胺培南/西司他丁进行治疗,观察两组患者细菌清除率、耐药菌发生率及临床治疗效果。结果观察组总有效率为85.25%,对照组为80.32%,差异无统计学意义。观察组鲍氏不动杆菌、肺炎克雷伯菌、大肠埃希菌及铜绿假单胞菌的清除率高于对照组(P<0.05)。两组患者金黄葡萄球菌、真菌、粪肠球菌及其他菌的清除率比较,差异无统计学意义。治疗前,两组患者C-反应蛋白(CRP)、降钙素原(PCT)水平比较差异无统计学意义。治疗后,与对照组相比,观察组患者CRP、PCT水平较低(P<0.05)。两组患者存活率比较差异无统计学意义。结论亚胺培南/西司他丁治疗急诊重症感染疗效显著,细菌清除率高,可抑制血清炎症因子水平,值得在急症重症感染患者中应用。
OBJECTIVE To observe the effect of imipenem-cilastatin on treatment of patients with acute severe infection. METHODS A total of 122 patients with acute severe infection who were treated in the hospital from Aug 2016 to Jan 2018 were enrolled in the study and randomly divided into two groups. The control group was treated with cephalosporins, while the observation group was treated with imipenem-cilastatin. The bacterial clearance rates, drug resistance rates and clinical curative effects were observed and compared between the two groups of patients. RESULTS The total effective rate was 85.25% in the observation group, 80.32% in the control group, and there was no significant difference. The clearance rates of Acinetobacter baumannii, Klebsiella pneumoniae, Escherichia coli and Pseudomonas aeruginosa were sighificantly higher in the observation group than in the control group(P<0.05). There were no significant differences in the clearance rates of Staphylococcus aureus, fungi, Enterococcus faecalis and other species of bacteria between the two groups of patients. There were no significant differences in the levels of C-reactive protein(CRP) and procalcitonin(PCT) between the two groups of patients before the treatment. The levels of CRP and PCT of the observation group were sighificantly lower than those of the control group after the treatment(P<0.05). There was no significant difference in the survival rate between the two groups of patients. CONCLUSION Imipenem-cilastatin can achieve remarkable effect on treatment of the patients with acute severe infection and inhibit the levels of serum inflammatory factors, with the bacterial clearance rate high, and it is worthy to be applied in the treatment of the patients with acute severe infection.
OBJECTIVE To observe the effect of imipenem-cilastatin on treatment of patients with acute severe infection. METHODS A total of 122 patients with acute severe infection who were treated in the hospital from Aug 2016 to Jan 2018 were enrolled in the study and randomly divided into two groups. The control group was treated with cephalosporins, while the observation group was treated with imipenem-cilastatin. The bacterial clearance rates, drug resistance rates and clinical curative effects were observed and compared between the two groups of patients. RESULTS The total effective rate was 85.25% in the observation group, 80.32% in the control group, and there was no significant difference. The clearance rates of Acinetobacter baumannii, Klebsiella pneumoniae, Escherichia coli and Pseudomonas aeruginosa were sighificantly higher in the observation group than in the control group(P<0.05). There were no significant differences in the clearance rates of Staphylococcus aureus, fungi, Enterococcus faecalis and other species of bacteria between the two groups of patients. There were no significant differences in the levels of C-reactive protein(CRP) and procalcitonin(PCT) between the two groups of patients before the treatment. The levels of CRP and PCT of the observation group were sighificantly lower than those of the control group after the treatment(P<0.05). There was no significant difference in the survival rate between the two groups of patients. CONCLUSION Imipenem-cilastatin can achieve remarkable effect on treatment of the patients with acute severe infection and inhibit the levels of serum inflammatory factors, with the bacterial clearance rate high, and it is worthy to be applied in the treatment of the patients with acute severe infection.
引文
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[15] Meraz-Munoz A,Gomez-Ruiz I,Correa-Rotter R,et al.Chronic kidney disease after acute kidney injury associated with intravenous colistin use in survivors of severe infections:a comparative cohort study[J].J Crit Care,2018,44:244-248.
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[17] 宋国强,卢火佺,陈墩顺,等.亚胺培南/西司他丁对重症肺炎患者血清CRP及降钙素原水平影响研究[J].中国生化药物杂志,2016,36(2):54-56.
[18] Mughini-Gras L,Schaapveld M,Kramers J,et al.Increased colon cancer risk after severe Salmonella infection[J].PLoS One,2018,13(1):e0189721.
[19] Fry W,McCafferty S,Gooday C,et al.Assessing the effect of piperacillin/tazobactam on hematological parameters in patients admitted with moderate or severe foot infections[J].Diabetes Ther,2018,9(1):219-228.
[20] Shukeri WFWM,Ralib AM,Abdulah NZ,et al.Sepsis mortality score for the prediction of mortality in septic patients[J].J Crit Care,2018,43:163-168.
[21] van der Galien HT,Loeffen EAH,Miedema KGE,et al.Predictive value of PCT and IL-6 for bacterial infection in children with cancer and febrile neutropenia[J].Support Care Cancer,2018,26(11):3819-3826.
[22] 李诗阳,王日兴,吕有凯,等.老年重症感染患者血清降钙素原与C-反应蛋白联合检测的临床价值[J].中国老年学杂志,2016,36(8):1960-1961.
[2] Moellering RC Jr.Tedizolid:a novel oxazolidinone for gram-positive infections[J].Clin Infect Dis,2014,58 (Suppl 1):S1-3.
[3] Pati NB,Doijad SP,Schultze T,et al.Enterobacter bugandensis:a novel enterobacterial species associated with severe clinical infection[J].Sci Rep,2018,8(1):5392.
[4] McLinden T,Moodie EEM,Hamelin AM,et al.Methadone treatment,severe food insecurity,and HIV-HCV co-infection:A propensity scorematching analysis[J].Drug Alcohol Depend,2018,185:374-380.
[5] 陈刚,徐永芳,徐长青,等.亚胺培南/西司他丁治疗重症医院获得性肺炎临床观察[J].中华医院感染学杂志,2016,26(7):1498-1499.
[6] 滕国杰,聂秀红,杨强,等.亚胺培南/西司他丁和美罗培南治疗机械通气患者痰分离铜绿假单胞菌的耐药风险差异[J].中国感染控制杂志,2016,15(6):397-400.
[7] Mandell LA,Wunderink RG,Anzueto A,et al.Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults[J].Clin Infect Dis,2007,44 (Suppl 2):S27-72.
[8] Wang G,Wu R,Guo F,et al.Effects of carbon dioxide pneumoperitoneum on the inflammatory response and bacterial translocation in intraabdominal infection[J].J Laparoendosc Adv Surg Tech A,2014,24(3):199-204.
[9] Knaus WA,Draper EA,Wagner DP,et al.APACHE II:a severity of disease classification system[J].Crit Care Med,1985,13(10):818-829.
[10] 宁永忠.细菌性感染性疾病的诊断分级[J].中华传染病杂志,2015,33(1):49-52.
[11] Tormes AK,De Bortoli MM,Junior RM,et al.Management of a severe cervicofacial odontogenic infection[J].J Contemp Dent Pract,2018,19(3):352-355.
[12] Goisque E,Launay E,Vrignaud B,et al.Suboptimal care and severe bacterial infection in the French Caribbean area[J].Arch Pediatr,2018,25(1):23-27.
[13] Murugananthan K,Subramaniyam S,Kumanan T,et al.Blood group AB is associated with severe forms of dengue virus infection[J].Virus Dis,2018,29(1):103-105.
[14] 邬弋,张毅,陆晓臻,等.急诊重症患者医院感染病原菌分布及影响因素分析[J].中华医院感染学杂志,2018,28(1):18-20.
[15] Meraz-Munoz A,Gomez-Ruiz I,Correa-Rotter R,et al.Chronic kidney disease after acute kidney injury associated with intravenous colistin use in survivors of severe infections:a comparative cohort study[J].J Crit Care,2018,44:244-248.
[16] Barber KE,Ortwine JK,Akins RL.Ceftazidime/avibactam:who says you can't teach an old drug new tricks[J].J Pharm Pharm Sci,2016,19(4):448-464.
[17] 宋国强,卢火佺,陈墩顺,等.亚胺培南/西司他丁对重症肺炎患者血清CRP及降钙素原水平影响研究[J].中国生化药物杂志,2016,36(2):54-56.
[18] Mughini-Gras L,Schaapveld M,Kramers J,et al.Increased colon cancer risk after severe Salmonella infection[J].PLoS One,2018,13(1):e0189721.
[19] Fry W,McCafferty S,Gooday C,et al.Assessing the effect of piperacillin/tazobactam on hematological parameters in patients admitted with moderate or severe foot infections[J].Diabetes Ther,2018,9(1):219-228.
[20] Shukeri WFWM,Ralib AM,Abdulah NZ,et al.Sepsis mortality score for the prediction of mortality in septic patients[J].J Crit Care,2018,43:163-168.
[21] van der Galien HT,Loeffen EAH,Miedema KGE,et al.Predictive value of PCT and IL-6 for bacterial infection in children with cancer and febrile neutropenia[J].Support Care Cancer,2018,26(11):3819-3826.
[22] 李诗阳,王日兴,吕有凯,等.老年重症感染患者血清降钙素原与C-反应蛋白联合检测的临床价值[J].中国老年学杂志,2016,36(8):1960-1961.