Lü X C, Cai G L, Xu Q H
Department of Intensive Care Unit, Zhejiang Hospital, Hangzhou 310013, China.
Zhonghua Yi Xue Za Zhi. 2016 Feb 23;96(7):535-8. doi: 10.3760/cma.j.issn.0376-2491.2016.07.009.
To evaluate the efficacy of tigecycline for treatment of ventilator-associated pneumonia in critically ill elderly patients.
Data of critically ill elderly patients with ventilator-associated pneumonia treated with tigecycline in the intensive care unit was collected from June 2011 to March 2014 in this retrospective study, to evaluated the clinical efficacy of tigecycline.
A total of 79 patients (83.5% male) were included, the mean age was 84 years old (rang, 65 years to 100 years old). Acinetobacter baumannii (39.1%), Pseudomonas aeruginosa (35.0%) and Klebsiella pneumonia (23.8%) were the most common pathogens.All patients were treated with tigecycline, 54.4% combined with other antimicrobial agents, 35.4% treated with double dose of tigecycline, and the mean course of antibiotic treatment was 9 days (range, 2 days to 22 days). After treatment, clinical success were recorded in 44 patients (55.7%), clinical failure were recorded in 29 patients, clinical uncertainty were recorded in 6 patients.28 days after treatment, patients' overall mortality was 39.0%.The clinical success rates were associated with acute physiology and chronic health evaluation (APACHE) Ⅱ score less than 15 (the clinical success rates were 72.2% and 41.9% in patients with APACHE Ⅱ score<15 and APACHE Ⅱ score≥15, respectively; P=0.007); treated with double dose of tigecycline (71.4% vs 47.1%, P=0.037) or combination regimens were also had significant difference (67.4% vs 41.7%, P=0.022).
Treatment of tigecycline combined with other antimicrobial agents and double dose of tigecycline may both can improve clinical efficacy in critically ill elderly patients with ventilator-associated pneumonia.
评估替加环素治疗老年危重症患者呼吸机相关性肺炎的疗效。
本回顾性研究收集了2011年6月至2014年3月在重症监护病房接受替加环素治疗的老年危重症呼吸机相关性肺炎患者的数据，以评估替加环素的临床疗效。
共纳入79例患者（男性占83.5%），平均年龄84岁（范围65岁至100岁）。鲍曼不动杆菌（39.1%）、铜绿假单胞菌（35.0%）和肺炎克雷伯菌（23.8%）是最常见的病原体。所有患者均接受替加环素治疗，54.4%联合其他抗菌药物，35.4%接受双倍剂量替加环素治疗，抗生素治疗的平均疗程为9天（范围2天至22天）。治疗后，44例患者（55.7%）记录为临床成功，29例患者记录为临床失败，6例患者记录为临床不确定。治疗28天后，患者的总死亡率为39.0%。临床成功率与急性生理与慢性健康状况评分系统（APACHE）Ⅱ评分小于15相关（APACHEⅡ评分<15和APACHEⅡ评分≥15的患者临床成功率分别为72.2%和41.9%；P=0.007）；接受双倍剂量替加环素治疗（71.4%对47.1%，P=0.037）或联合治疗方案也有显著差异（67.4%对41.7%，P=0.022）。
替加环素联合其他抗菌药物及双倍剂量替加环素治疗均可提高老年危重症呼吸机相关性肺炎患者的临床疗效。
