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静脉注射死菌苗(W 株)治疗革兰氏阴性菌败血症的疗效和安全性。

Efficacy and Safety of Injection Sepsivac® (Heat-killed Mycobacterium W) in Gram-negative Sepsis administered via an Intravenous Route.

机构信息

Department of Critical Care Medicine, Fortis Escorts Heart Institute, Delhi, India; Corresponding Author.

出版信息

J Assoc Physicians India. 2023 May;71(5):11-12. doi: 10.5005/japi-11001-0221.

Abstract

BACKGROUND

As an immunomodulator, the mycobacterium w (Mw) has improved outcomes for patients suffering from severe sepsis. The traditional route of administration for Mw is intradermal (ID), which is limited to administering 0.1 mL per injection (Inj). The intravenous (IV) route can be an alternative to ID.

AIMS AND OBJECTIVES

To evaluate the safety and efficacy of Inj Sepsivac® IV in gram-negative sepsis.

MATERIALS AND METHODS

Present retrospective observational study was conducted in an intensive care unit (ICU) of tertiary care hospital. The study included 30 consecutive patients with presumed gram-negative sepsis within 48 hours of the first organ dysfunction. Patients received Inj Sepsivac® 0.3 mL diluted in 100 mL normal saline to be given as slow IV infusions over at least 15 minutes, every day for 3 consecutive days. Efficacy was assessed by recording the change in vital parameters, sequential organ failure assessment (SOFA) score, and laboratory investigations. Safety was evaluated by the occurrence of allergic reactions including anaphylaxis, the site of infection, and secondary infection. Each patient was followed up for 14 days from the day of enrolment.

RESULTS

Mean age of patients with gram-negative sepsis was 62.67 ± 12.77 years with male preponderance (63.3%). Pneumonia (40.1%) and intraabdominal infections (26.7%) were the most common etiologies of sepsis. A significant improvement in all the vitals and mean SOFA scores was observed from day 2 onward. More than half of the patients required ventilator support [17 (56.7%)], and mortality was observed in 7 (25%) patients. None was reported to have a secondary infection. Laboratory parameters improved and oxygen requirement was reduced postday 4 till the end of treatment from baseline.

CONCLUSION

The IV route of administration was found to be efficacious and safe and allow ease of administration in treating gram-negative sepsis. Further large multicentric randomized trials are required to confirm our findings.

摘要

背景

分枝杆菌 w(Mw)作为一种免疫调节剂,改善了严重脓毒症患者的预后。Mw 的传统给药途径是皮内(ID),每次注射限制为 0.1 毫升(Inj)。静脉内(IV)途径可以替代 ID。

目的和目标

评估 IV 途径给予 Inj Sepsivac®治疗革兰氏阴性脓毒症的安全性和疗效。

材料和方法

本回顾性观察研究在一家三级护理医院的重症监护病房(ICU)进行。该研究纳入了 30 例在首次器官功能障碍后 48 小时内确诊为革兰氏阴性脓毒症的连续患者。患者接受 Inj Sepsivac®0.3 毫升,用 100 毫升生理盐水稀释,以至少 15 分钟的速度缓慢静脉输注,每天 3 次,连续 3 天。通过记录生命体征、序贯器官衰竭评估(SOFA)评分和实验室检查的变化来评估疗效。通过过敏反应(包括过敏反应)的发生、感染部位和继发感染来评估安全性。每位患者从入组之日起随访 14 天。

结果

革兰氏阴性脓毒症患者的平均年龄为 62.67 ± 12.77 岁,男性居多(63.3%)。肺炎(40.1%)和腹腔内感染(26.7%)是脓毒症最常见的病因。从第 2 天开始,所有生命体征和平均 SOFA 评分均显著改善。超过一半的患者需要呼吸机支持[17(56.7%)],7 例(25%)患者死亡。无一例报告继发感染。从第 4 天开始,实验室参数改善,氧需求减少,直至治疗结束。

结论

IV 给药途径被发现是有效和安全的,并允许在治疗革兰氏阴性脓毒症时易于管理。需要进一步的大型多中心随机试验来证实我们的发现。

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