替加环素治疗耐碳青霉烯鲍曼不动杆菌感染的临床疗效
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杜云波

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R181.3+2

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广东省医学科研基金(A2012726)


ZHANG Peng, LI Shuyun, DU Yunbo,  LI Chaoliang, CHEN Yantang
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    摘要:

    目的了解替加环素单药或联合用药治疗耐碳青霉烯鲍曼不动杆菌(CRAB)感染的临床疗效。方法选择某院重症监护病房(ICU)2013年1月—2014年6月CRAB医院获得性肺炎(HAP)和血流感染者,分析替加环素的治疗效果。结果25例患者,其中肺部感染21例,血流感染、肺部感染合并血流感染各2例。其中13例为多重耐药鲍曼不动杆菌(MDRAB),10例为泛耐药鲍曼不动杆菌(XDRAB)。25株CRAB对替加环素的敏感率为84%。使用替加环素后患者白细胞计数、C反应蛋白(CRP)和降钙素原(PCT)均呈逐渐下降趋势(均P<0.01)。临床有效率为68.00%(17/25),细菌清除率66.67%(14/21),30 d病死率为28.00%(7/25);其中21例肺部感染患者的临床有效率为76.19%(16/21),2例血流感染患者1例有效,2例肺部感染合并血流感染者死亡。结论替加环素对于CRAB HAP具有良好疗效,对血流感染的疗效不确切,仍需增大样本量进一步研究。

    Abstract:

    ObjectiveTo evaluate clinical efficacy of tigecycline alone or in combination with other antimicrobials in treating infection caused by carbapenemresistant  Acinetobacter baumannii(CRAB). MethodsPatients with hospitalacquired pneumonia (HAP) and/or bloodstream infection in the intensive care unit of a hospital between January 2013 and June 2014 were selected, efficacy of tigecycline treatment was analyzed. ResultsOf 25 patients with CRAB infection, 21 were with HAP, 2 with bloodstream infection, and 2 with both HAP and bloodstream infection.  13 cases were multidrugresistant Acinetobacter baumannii (MDRAB), 10 cases were  extensively drugresistant Acinetobacter baumannii (XDRAB). The susceptibility rate of 25 CRAB isolates to tigecycline was 84%. After treated with tigecycline, white blood cell count(WBC),  Creactive protein (CRP), and procalcitonin (PCT) all significantly decreased (all P<0.01). The clinical effective rate, bacterial clearance rate, and 30day mortality were 68.00% (17/25), 66.67%(14/21), and 28.00% (7/25) respectively; effective rate of 21 cases of HAP was 76.19% (16/21),  1 case of bloodstream infection was effective, 2 cases of HAP combined bloodstream infection died. ConclusionTigecycline is effective in the treatment of HAP caused by CRAB, but the therapeutic effect on bloodstream remains uncertain, further research is needed.

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张鹏,李淑芸,杜云波,等.替加环素治疗耐碳青霉烯鲍曼不动杆菌感染的临床疗效[J]. 中国感染控制杂志,2016,15(6):380-383. DOI:10.3969/j. issn.1671-9638.2016.06.004.
ZHANG Peng, LI Shuyun, DU Yunbo, et al. ZHANG Peng, LI Shuyun, DU Yunbo,  LI Chaoliang, CHEN Yantang[J]. Chin J Infect Control, 2016,15(6):380-383. DOI:10.3969/j. issn.1671-9638.2016.06.004.

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  • 收稿日期:2015-09-18
  • 最后修改日期:2015-11-12
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  • 在线发布日期: 2016-06-30
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