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碳青霉烯类联合舒巴坦延长输注治疗广泛耐药菌所致呼吸机相关性肺炎的疗效

[Efficacy of extended-infusion of carbapenem plus sulbactam for ventilator-associated pneumonia caused by extensive drug-resistant ].

作者信息

Wang X, Hu Y, Que C L, Zhang H, Huang J J, Cao J, Jin Z, Wang G F, Zhang W

机构信息

Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing 100034, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2017 Oct 17;97(38):2996-3000. doi: 10.3760/cma.j.issn.0376-2491.2017.38.010.

Abstract

To evaluate the efficacy of extended-infusion of carbapenem plus sulbactam for ventilator-associated pneumonia caused by extensive drug-resistant (XDRAB). Clinical data of patients with ventilator-associated pneumonia caused by XDRAB who were treated with extended-infusion carbapenem plus sulbactam or tigecycline-based therapy in Peking University First Hospital from January 2015 to December 2016 were collected and reviewed in this retrospective study. Twenty-one patients were treated with extended-infusion carbapenem plus sulbactam, and 20 other patients received tigecycline combined with other antibiotics. The general status of the patient, microbiological eradication rate, superinfection rate, new microorganism colonization rate, clinical resolution rate on the third day, clinical cure rate and mortality during treatment were compared between the two groups. The two groups shared similar characteristics except that patients in the carbapenem group were younger. Microbiological eradication was not observed. Superinfections occurred in 1 patients (4.8%) in the carbapenem group and 0 patients in the tigecycline group (=1.000), the occurrences of new microorganisms colonization were 14.3% and 25.0% respectively (=0.638). Clinical cure were achieved in 57.1% of the patients in the carbapenem group and 50.0% of the patients in the tigecycline group (=0.647), the clinical resolution rates on the third day were 52.4% and 45.0% respectively (=0.636). The mortality during treatment was 9.5% in carbapenem group, and 20.0% in tigecycline group (=0.612). No serious adverse drug reactions occurred. Ventilator-associated pneumonia caused by XDRAB treated with either extended-infusion carbapenem plus sulbactam or tigecycline-based therapy has a similar clinical outcome.

摘要

评估碳青霉烯类药物联合舒巴坦延长输注治疗广泛耐药鲍曼不动杆菌(XDRAB)所致呼吸机相关性肺炎的疗效。本回顾性研究收集并分析了2015年1月至2016年12月期间在北京大学第一医院接受碳青霉烯类药物联合舒巴坦延长输注治疗或替加环素治疗的XDRAB所致呼吸机相关性肺炎患者的临床资料。21例患者接受碳青霉烯类药物联合舒巴坦延长输注治疗,另外20例患者接受替加环素联合其他抗生素治疗。比较两组患者的一般情况、微生物清除率、二重感染发生率、新微生物定植率、第3天的临床缓解率、临床治愈率及治疗期间的死亡率。除碳青霉烯类药物组患者年龄较轻外,两组患者的特征相似。未观察到微生物清除情况。碳青霉烯类药物组有1例患者(4.8%)发生二重感染,替加环素组无患者发生二重感染(P = 1.000),新微生物定植发生率分别为14.3%和25.0%(P = 0.638)。碳青霉烯类药物组57.1%的患者临床治愈,替加环素组50.0%的患者临床治愈(P = 0.647),第3天的临床缓解率分别为52.4%和45.0%(P = 0.636)。碳青霉烯类药物组治疗期间的死亡率为9.5%,替加环素组为20.0%(P = 0.612)。未发生严重药物不良反应。碳青霉烯类药物联合舒巴坦延长输注治疗或替加环素治疗XDRAB所致呼吸机相关性肺炎的临床结局相似。

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