多西环素、阿奇霉素和氯霉素治疗重症恙虫病患者的临床疗效。
Clinical outcomes of doxycycline, azithromycin and chloramphenicol for the treatment of patients with severe scrub typhus.
机构信息
State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China.
State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, P. R. China; School of Public Health, Anhui Medical University, Hefei, P. R. China.
出版信息
Int J Antimicrob Agents. 2022 Oct;60(4):106647. doi: 10.1016/j.ijantimicag.2022.106647. Epub 2022 Aug 4.
BACKGROUND
Previous studies have evaluated treatment efficacy of various antibiotics for patients with mild-to-moderate scrub typhus (ST). However, the efficacy of different antibiotics for treating severe ST remains uncertain.
METHODS
A retrospective study of patients with severe ST was undertaken in China. The treatment efficacy rates of doxycycline, azithromycin and chloramphenicol were compared, using treatment failure and time to defervescence as primary outcomes.
RESULTS
In total, 876 patients with severe ST who initially received doxycycline, azithromycin or chloramphenicol were recruited. The treatment failure rate did not differ significantly between patients receiving doxycycline and patients receiving azithromycin (6.0% vs 11.4%; P=0.109). However, a higher treatment failure rate was observed for chloramphenicol compared with doxycycline (14.6% vs 6.0%; P=0.004). No significant difference in time to defervescence was observed between patients receiving doxycycline, azithromycin or chloramphenicol. Further subgroup analysis revealed a higher risk of treatment failure for chloramphenicol compared with doxycycline in patients with acute kidney injury, pneumonia and shock; and a higher risk of treatment failure for azithromycin compared with doxycycline in patients with meningitis. Significant correlation was found between azithromycin resistance and meningitis (P=0.009), and between chloramphenicol resistance and acute respiratory distress syndrome (ARDS) (P<0.001) using Cramer's V correlation coefficient. Multi-variate Cox regression analysis revealed significant associations between time to defervescence and presence of ARDS, shock, myocarditis, meningitis and acute kidney injury.
CONCLUSION
Azithromycin and doxycycline were found to have significant therapeutic effects in patients with severe ST. In contast, chloramphenicol was less efficacious for the treatment of these patients.
背景
之前的研究已经评估了各种抗生素治疗轻度至中度恙虫病（ST）患者的疗效。然而，不同抗生素治疗严重 ST 的疗效仍不确定。
方法
在中国进行了一项严重 ST 患者的回顾性研究。以治疗失败和退热时间作为主要结局，比较了多西环素、阿奇霉素和氯霉素的疗效。
结果
共纳入 876 例初始接受多西环素、阿奇霉素或氯霉素治疗的严重 ST 患者。接受多西环素和阿奇霉素治疗的患者治疗失败率无显著差异（6.0%比 11.4%；P=0.109）。然而，与多西环素相比，氯霉素的治疗失败率更高（14.6%比 6.0%；P=0.004）。接受多西环素、阿奇霉素或氯霉素治疗的患者退热时间无显著差异。进一步的亚组分析显示，在有急性肾损伤、肺炎和休克的患者中，氯霉素的治疗失败风险高于多西环素；在有脑膜炎的患者中，阿奇霉素的治疗失败风险高于多西环素。采用 Cramer's V 相关系数发现，阿奇霉素耐药与脑膜炎之间存在显著相关性（P=0.009），氯霉素耐药与急性呼吸窘迫综合征（ARDS）之间存在显著相关性（P<0.001）。多变量 Cox 回归分析显示，退热时间与 ARDS、休克、心肌炎、脑膜炎和急性肾损伤的存在显著相关。
结论
阿奇霉素和多西环素对严重 ST 患者均具有显著疗效。相比之下，氯霉素对这些患者的治疗效果较差。
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