替加环素或米诺环素联合头孢哌酮钠舒巴坦钠治疗多重耐药鲍曼不动杆菌的临床疗效比较

叶友胜; 余菲; 张琳

doi:10.13201/j.issn.1009-5918.2021.04.007

替加环素或米诺环素联合头孢哌酮钠舒巴坦钠治疗多重耐药鲍曼不动杆菌的临床疗效比较

- 合肥市第一人民医院重症医学科(合肥, 230061)
基金项目:
合肥市重点学科建设资助项目(No:合卫科教[2019]160号)

合肥市名医工作室资助项目(No:合人才[2019]1号)

详细信息

通讯作者: 张琳,E-mail:2005202zhl@sina.com

中图分类号: R453

收稿日期: 2021-01-04

Clinical therapeutic effect comparision of tigecycline or minocycline combined with cefoperazone-sulbactam in the treatment of multidrug-resistant acinetobacter baumannii infection

- Department of Intensive Care Unit, the First Hospital of Hefei, Hefei, 230061, China

More Information

Corresponding author: ZHANG Lin, E-mail: 2005202zhl@sina.com

Received Date: 04 January 2021

摘要

摘要: 目的:探讨不同抗生素方案治疗多重耐药鲍曼不动杆菌的临床疗效差异。方法:研究选取我院2018年1月—2020年11月收治的110例多重耐药鲍曼不动杆菌感染患者,按随机分组方法分为A、B、C 3组,各采用不同的抗感染方案:A组使用头孢哌酮钠舒巴坦钠,B组在A组用药方案上联合使用替加环素,C组在A组用药方案上联合米诺环素。通过观察CPIS评分、PCT、CRP、IL-6、机械通气时间、ICU入住时间及不良反应情况等,比较3组患者临床疗效差异。结果:实际入选92例,A组36例,B组29例,C组27例。3组患者治疗前指标比较差异无统计学意义,治疗1周后的B组在CPIS评分、PCT、CRP、机械通气时间、ICU入住时间方面均优于A组及C组(C组CRP除外),差异有统计学意义。C组与A组比较在CRP、机械通气时间方面差异有统计学意义。不良反应方面,B组的消化道症状及C组的皮疹症状与A组比较,差异有统计学意义,两组不良反应处理后很快好转。结论:针对多重耐药鲍曼不动杆菌,头孢哌酮钠舒巴坦钠联合替加环素疗效比单用头孢哌酮钠舒巴坦钠或联合米诺环素效果要好,推荐使用头孢哌酮钠舒巴坦钠联合替加环素。
- 鲍曼不动杆菌 /
- 多重耐药 /
- 替加环素 /
- 米诺环素 /
- 头孢哌酮钠舒巴坦钠
Abstract: Objective: To investigate the differences in clinical efficacy of different antibiotic regimens in the treatment of multidrug-resistant acinetobacter baumannii.Methods: The study selected 110 patients with multidrug-resistant acinetobacter baumannii infection in our hospital from Jan 2018 to Nov 2020, and divided them into three groups(A, B, and C) according to the random grouping method. A total of 92 cases were actually selected. Anti-infection aspect: group A used Cefoperazone sodium and sulbactam sodium alone, group B combined with tigecycline, group C combined with minocycline. By observing CPIS score, PCT, CRP, IL-6, duration of mechanical ventilation, ICU stay duration, and adverse reactions, the differences in clinical efficacy of the three groups of patients were compared.Results: There was no significant difference in the indicators of the three groups before treatment. One week after treatment, group B was better than the other two groups in terms of CPIS score, PCT, CRP, duration of mechanical ventilation, and ICU stay duration(except for CRP in group C). The difference was statistically significant. There were statistically significant differences between group C and group A in terms of CRP and duration of mechanical ventilation. In terms of adverse reactions, the gastrointestinal symptoms of group B and the rash symptoms of group C were different from those of group A. The adverse reactions of the two improved quickly after treatment.Conclusion: For multidrug-resistant acinetobacter baumannii, Cefoperazone sodium and sulbactam sodium combined with tigecycline has a better effect than using it alone or combined with minocycline. Cefoperazone sodium and sulbactam sodium combined with tigecycline is recommended.
- acinetobacter baumannii /
- multidrug resistance /
- tigecycline /
- minocycline /
- cefoperazone sodium and sulbactam sodium

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参考文献(15)

[1]	Medina E,Pieper DH.Tackling Threats and Future Problems of Multidrug-Resistant Bacteria[J].Curr Top Microbiol Immunol,2016,398:3-33.
[2]	Zak-Doron Y,Dishon Benattar Y,Pfeffer I,et al.The Association Between Empirical Antibiotic Treatment and Mortality in Severe Infections Caused by Carbapenem-resistant Gram-negative Bacteria:A Prospective Study[J].Clin Infect Dis,2018,67(12):1815-1823.
[3]	Paul M,Daikos GL,Durante-Mangoni E,et al.Colistin alone versus colistin plus meropenem for treatment of severe infections caused by carbapenem-resistant Gram-negative bacteria:an open-label,randomised controlled trial[J].Lancet Infect Dis,2018,18(4):391-400.
[4]	Qin Y,Zhang J,Wu L,et al.Comparison of the treatment efficacy between tigecycline plus high-dose cefoperazone-sulbactam and tigecycline monotherapy against ventilator-associated pneumonia caused by extensively drug-resistant Acinetobacter baumannii[J].Int J Clin Pharmacol Ther,2018,56(3):120-129.
[5]	Tan Y,Zhou K,Tang X,et al.Bacteremic and non-bacteremic pneumonia caused by Acinetobacter baumannii in ICUs of South China:A Clinical and Microbiological Study[J].Sci Rep,2017,7(1):15279.
[6]	Sjovall F,Alobaid AS,Wallis SC,et al.Maximally effective dosing regimens of meropenem in patients with septic shock[J].J Antimicrob Chemother,2018,73(1):191-198.
[7]	陈佰义,何礼贤,胡必杰,等.中国鲍曼不动杆菌感染诊治与防控专家共识[J].中国医药科学,2012,2(8):3-8.
[8]	汪加朋,徐化强,汪文国.肺部感染患者多重耐药菌的耐药性分析[J].中国卫生标准管理,2019,10(3):44-46.
[9]	Stelmasiak M,Slotwnski R.Infection-induced innate antimicrobial response disorders:from signaling pathways and their modulation to selected biomarkers[J].Cent Eur J Immunol,2020,45(1):104-116.
[10]	Guisasola MC,Alonso B,Bravo B,et al.An overview of cytokines and heat shock response in polytraumatized patients[J].Cell Stress Chaperones,2018,23(4):483-489.
[11]	Lee CR,Lee JH,Park M,et al.Biology of Acinetobacter baumannii:Pathogenesis,Antibiotic Resistance Mechanisms,and Prospective Treatment Options[J].Front Cell Infect Microbiol,2017,7:55.
[12]	胡付品,郭燕,朱德妹,等.2019年CHINET三级医院细菌耐药监测[J].中国感染与化疗杂志,2020,20(3):233-243.
[13]	张可,蔡文伟,许秋然.替加环素和头孢哌酮钠舒巴坦钠治疗多重耐药鲍曼不动杆菌肺炎的比较研究[J].中华危重症医学杂志(电子版),2016,9(2):116-119.
[14]	Oliva A,Cipolla A,Vullo V,et al.Clinical and in vitro efficacy of colistin plus vancomycin and rifampin against colistin-resistant Acinetobacter baumannii causing ventilator-associated pneumonia[J].New Microbiol,2017,40(3):205-207.
[15]	王宇航,蔡芸.鲍曼不动杆菌对多黏菌素类抗菌药物耐药现状及机制研究进展[J].中国抗生素杂志,2019,44(9):1015-1019.