一项基于实践的观察性研究，旨在确定与使用高剂量替加环素治疗重症患者继发性腹膜炎相关的因素。

A practice-based observational study identifying factors associated with the use of high-dose tigecycline in the treatment of secondary peritonitis in severely ill patients.

作者信息

Maseda Emilio, Suárez-de-la-Rica Alejandro, Anillo Víctor, Salgado Patricia, Tamayo Eduardo, García-Bernedo Carlos A, Ramasco Fernando, Villagrán María-José, López-Tofiño Araceli, Giménez María-José, Granizo Juan-José, Hernández-Gancedo Carmen, Aguilar Lorenzo, Gilsanz Fernando

机构信息

Emilio Maseda, Anesthesiology and Surgical Critical Care Department. Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.

出版信息

Rev Esp Quimioter. 2015 Feb;28(1):47-53.

PMID:25690145

Abstract

INTRODUCTION

Based on tigecycline linear pharmacokinetic/pharmacodynamics, dose increases have been advocated to maximise activity especially when severe infections with high bacterial load and/or multidrug resistance are suspected. This practice-based observational study explored factors associated with tigecycline administration (100 mg/12h, 200 mg loading dose) in severely ill patients with complicated intra-abdominal infection (cIAI) admitted to four Surgical Critical Care Units (SCCUs).

METHODS

Medical records of all consecutive adult patients with cIAI and controlled infection source requiring surgery and admission for ≥ 48 h to SCCU were reviewed and divided into patients treated with a regimen including tigecycline (tigecycline group) and those that not (control group). A logistic regression model was performed using "tigecycline administration" (dependent variable) and variables showing differences (p ≤ 0.1) in bivariate analyses (independent variables).

RESULTS

One hundred and twenty one patients were included. In the tigecycline group, higher percentage of patients (vs. controls) presented colon as surgical site (66.7% vs. 41.8%, p = 0.006), nosocomial infection (55.6% vs. 26.9%, p = 0.001), mechanical ventilation (48.1% vs. 28.4%, p = 0.025), chronic renal replacement therapy (40.7% vs. 19.4%, p =0.008), septic shock (72.2% vs. 46.3%, p = 0.004), and higher values of SAPS II (48.0 ± 15.0 vs. 39.6 ± 15.5, p = 0.003), SOFA at admission (7.0 ± 3.3 vs. 5.5 ± 3.7, p = 0.020), lactate-24h (2.5 ± 2.8 vs. 1.6 ± 0.9, p = 0.029) and CRP-72 h (207.4 ± 87.9 vs. 163.7 ± 76.8, p = 0.021). In the multivariate analysis (R2 = 0.187, p < 0.001) nosocomial infection (OR = 7.721; 95%CI = 2.193, 27.179; p = 0.001), colon as infection site (OR = 4.338; 95%CI = 1.432, 13.145; p = 0.009) and CRP-72 h (OR = 1.009 per-unit; 95%CI = 1.002, 1.016; p = 0.012) were associated with tigecycline administration.

CONCLUSIONS

In severely ill patients with cIAI, high-dose tigecycline administration was associated with nosocomial origin of cIAI and colon as source infection site.

摘要

引言

基于替加环素的线性药代动力学/药效学，有人主张增加剂量以最大化其活性，尤其是在怀疑存在高细菌载量和/或多重耐药的严重感染时。这项基于实践的观察性研究探讨了入住四个外科重症监护病房（SCCU）的复杂性腹腔内感染（cIAI）重症患者接受替加环素治疗（100mg/12小时，200mg负荷剂量）的相关因素。

方法

回顾了所有因cIAI且感染源得到控制而需要手术并入住SCCU≥48小时的成年连续患者的病历，并将其分为接受包含替加环素方案治疗的患者（替加环素组）和未接受该方案治疗的患者（对照组）。使用“替加环素给药”（因变量）和在双变量分析中显示出差异（p≤0.1）的变量（自变量）进行逻辑回归模型分析。

结果

共纳入121例患者。在替加环素组中，与对照组相比，更高比例的患者手术部位为结肠（66.7%对41.8%，p = 0.006）、发生医院感染（55.6%对26.9%，p = 0.001）、接受机械通气（48.1%对28.4%，p = 0.025）、接受慢性肾脏替代治疗（40.7%对19.4%，p = 0.008）、发生感染性休克（72.2%对46.3%，p = 0.004），并且急性生理与慢性健康状况评分系统II（SAPS II）值更高（48.0±15.0对39.6±15.5，p = 0.003）、入院时序贯器官衰竭评估（SOFA）评分更高（7.0±3.3对5.5±3.7，p = 0.020）、24小时乳酸水平更高（2.5±2.8对1.6±0.9，p = 0.029）以及72小时C反应蛋白（CRP）水平更高（207.4±87.9对163.7±76.8，p = 0.021）。在多变量分析中（R2 = 0.187，p < 0.001），医院感染（比值比[OR]=7.721；95%置信区间[CI]=2.193，27.179；p = 0.001）、结肠作为感染部位（OR = 4.338；95%CI = 1.432，13.145；p = 0.009）和72小时CRP（每单位OR = 1.009；95%CI = 1.002，1.016；p = 0.012）与替加环素给药相关。