天津医药

天津医药 ›› 2022, Vol. 50 ›› Issue (1): 88-93.doi: 10.11958/20211589

• 临床研究 • 上一篇    下一篇

以多黏菌素B为基础联合治疗耐碳青霉烯革兰阴性菌脓毒症的临床疗效分析

王静，辛绍斌，孙强，马旺，齐勇，王永明，申翔   

  1. 天津市人民医院重症医学科（邮编300121）
  • 收稿日期:2021-07-08 修回日期:2021-09-08 出版日期:2022-01-15 发布日期:2022-01-19
  • 通讯作者: 王静 E-mail:tjwjing@sina.com

Clinical efficacy of polymyxin B combination therapy in the treatment of carbapenem-resistant gram-negative bacteria sepsis 

WANG Jing, XIN Shaobin, SUN Qiang, MA Wang, QI Yong, WANG Yongming, SHEN Xiang   

  1.  Department of Critical Care Medicine, Tianjin Union Medical Center, Tianjin 300121, China
  • Received:2021-07-08 Revised:2021-09-08 Published:2022-01-15 Online:2022-01-19
  • Contact: Jing WANG E-mail:tjwjing@sina.com

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摘要：

摘要：目的　探讨以多黏菌素B为基础联合其他抗生素治疗耐碳青霉烯革兰阴性菌（CR-GNB）脓毒症患者的临床疗效。方法　回顾性分析48例使用多黏菌素B为基础联合其他抗生素治疗CR-GNB感染的脓毒症患者的临床相关资料。（1）按照标本采集送检时间至开始使用多黏菌素B时间分组，分为早期组（≤7 d，30例）和推迟组（＞7 d，18例）。（2）按照多黏菌素B治疗的持续用药时间分组，分为≤7 d组（16例）和＞7 d组（32例）。（3）按照多黏菌素B联合其他抗生素治疗的用药方案不同分组，分为替加环素组（23例）、碳青霉烯组（9例）和其他药物组（哌拉西林他唑巴坦、头孢哌酮舒巴坦、环丙沙星、依替米星等，16例）。比较各组患者细菌总清除率、治疗有效率、28 d病死率的差异。结果　（1）早期组治疗后细菌总清除率（76.7% vs. 44.4%，χ2=5.107，P＜0.05）和治疗有效率（73.3% vs. 44.4%，χ2=4.006，P＜0.05）均高于推迟组，28 d病死率比较差异无统计学意义（30.0% vs. 38.9%，χ2=0.400，P＞0.05）。（2）治疗持续时间＞7 d组治疗后细菌总清除率（78.1% vs. 37.5%，χ2=7.696，P＜0.01）、治疗有效率（75.0% vs. 37.5%，χ2=6.400，P＜0.05）、28 d病死率（21.9% vs. 56.3%，χ2=5.672，P＜0.05）较≤7 d组明显改善。（3）多黏菌素B联合治疗用药方案中，替加环素组、碳青霉烯组和其他药物组之间的细菌总清除率（69.6% vs. 66.7% vs. 56.3%，χ2=0.823）、治疗有效率（69.6% vs. 55.6% vs. 56.3%，χ2=1.051），28 d病死率（26.1% vs. 33.3% vs. 43.8%，χ2=1.390）的比较，差异无统计学意义（均P＞0.05）。结论　对于CR-GNB感染致脓毒症患者，多黏菌素B应早期、足疗程地与其他抗感染药物联合使用，以利于患者获益更多。

关键词: 脓毒症, 多黏菌素B, 耐碳青霉烯革兰阴性菌, 联合治疗, 临床疗效

Abstract: Abstract: Objective　To investigate the clinical efficacy of polymyxin B based combination therapy on patients with carbapenem-resistant gram-negative bacterial (CR-GNB) sepsis. Methods　Clinical data of 48 patients with sepsis who used polymyxin B as the basis for combination therapy of CR-GNB infection were retrospectively analyzed. (1) According to the time from specimen collecting for inspection to the start of the use of polymyxin B, patients were divided into the early group (≤7 days, n=30) and the delayed group (＞7 days, n=18). (2) According to the duration of polymyxin B therapy, patients were divided into the ≤ 7 days group (n=16) and the ＞7 days group (n=32). (3) According to the different combination of polymyxin B-based therapy, patients were divided into the tegacyclin group (n=23), the carbapenem group (n=9) and the other drug groups (piperacillin tazobactam, cefoperazone sulbactam, ciprofloxacin and etimicin, n=16). The total bacterial clearance rate, effective rate and 28-d mortality were compared between groups. Results (1) The total bacterial clearance rate (76.7% vs. 44.4%, χ2=5.107, P＜0.05) and the efficacy rate (73.3% vs. 44.4%, χ2=4.006, P＜0.05) after therapy were higher in the early group than those in the delayed group. There was no significant difference in the 28-day mortality between the two groups (30.0% vs. 38.9%, χ2=0.400, P＞0.05). The total bacterial clearance rate (78.1% vs. 37.5%, χ2=7.696, P＜0.01), efficacy rate (75.0% vs. 37.5%, χ2= 6.400, P＜0.05) and 28-day mortality (21.9% vs. 56.3%, χ2=5.672, P＜0.05) were significantly improved in the therapy duration ＞7-day group compared with the therapy duration ≤ 7-day group. (3) In the combination therapy of polymyxin B, total bacterial clearance rate (69.6% vs. 66.7% vs. 56.3%, χ2=0.823), efficacy rate (69.6% vs. 55.6% vs. 56.3%, χ2=1.051) and 28-day mortality (26.1% vs. 33.3% vs. 43.8%, χ2=1.390) showed no significant difference between the tegacyclin group, the carbapenem group and the other drug groups (all P＞0.05). Conclusion　Polymyxin B should be used in combination with other anti-infective drugs in the early stage and sufficient course of therapy for patients with CR-GNB infected sepsis.

Key words: sepsis, polymyxin B, carbapenem-resistant Gram-negative bacteria, combination therapy, clinical efficacy