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头孢他啶阿维巴坦钠治疗碳青霉烯类耐药革兰氏阴性菌感染的疗效与安全性
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| 篇名： | 头孢他啶阿维巴坦钠治疗碳青霉烯类耐药革兰氏阴性菌感染的疗效与安全性 |
| TITLE： | Efficacy and safety of ceftazidime and avibactam sodium in the treatment of carbapenem-resistant organism infection |
| 摘要： | 目的 观察头孢他啶阿维巴坦钠（CAZ/AVI）治疗碳青霉烯类耐药革兰氏阴性菌（CRO）感染的疗效和安全性。方法回顾性收集2019年9月－2022年3月在苏州大学附属第二医院住院治疗的CRO感染患者的资料，根据治疗方案的不同分为对照组（48例）和观察组（48例）。对照组患者静脉滴注注射用硫酸多黏菌素B50万单位，q12h，其中肾功能不全或接受肾脏代替治疗（CRRT）者不进行剂量调整；观察组患者以微量泵持续静脉泵入注射用CAZ/AVI2.5g，q8h，持续2h，其中肾功能不全者根据肌酐清除率调整剂量，接受CRRT者不进行剂量调整。比较两组患者的临床疗效、微生物学疗效和治疗前后的体温、白细胞（WBC）、C反应蛋白（CRP）、降钙素原（PCT），记录其预后情况和不良反应发生情况；通过Logistic回归分析筛选影响疗效的因素。结果观察组患者的有效率、微生物清除率均显著高于对照组（P＜0.05）。治疗后，两组患者的体温、PCT、CRP均显著低于同组治疗前，且观察组CRP显著低于同期对照组（P＜0.05）；两组的康复出院、转普通病房、死亡患者比例及总不良反应发生率比较，差异均无统计学意义（P＞0.05）。使用CAZ/AVI、延长用药疗程可能实现临床获益（比值比分别为1.146、7.707，P＜0.05），肺部感染、接受CRRT可能是导致治疗失败的独立危险因素（比值比分别为0.182、0.236，P＜0.05）。结论CAZ/AVI治疗CRO感染的疗效和安全性均较好，适当延长用药疗程可能会获得更高的有效率，而肺部感染或接受CRRT可能会导致治疗失败。 |
| ABSTRACT： | OBJECTIVE To observe the efficacy and safety of ceftazidime and avibactam sodium （CAZ/AVI） in the treatment of carbapenem-resistant organism （CRO） infection. METHODS The information of patients with CRO infection admitted to the Second Affiliated Hospital of Soochow University from September 2019 to March 2022 was collected， and the patients were retrospectively divided into observation group （48 cases） and control group （48 cases） according to the treatment plan. The control group was given Polycolistin B sulfate for injection intravenously at a dose of 500 000 U every 12 hours； no dose adjustment was performed in patients with renal insufficiency or receiving continuous renal replacement therapy （CRRT）. The observation group was given continuous micropump of CAZ/AVI for injection intravenously at a dose of 2.5 g every 8 hours for 2 continous hours； among them， the patients with renal insufficiency received an adjusted dose based on creatinine clearance， and no dose adjustment was performed in patients receiving CRRT. The clinical efficacy and microbiological efficacy as well as body temperature， white blood cell （WBC）， C-reactive protein （CRP） and procalcitonin （PCT） before and after treatment were compared between 2 groups. The prognosis and the occurrence of adverse drug reactions were recorded. The factors influencing the clinical efficacy were screened by Logistic regression analysis. RESULTS The effective rate and microbial clearance rate of the observation group were significantly higher than the control group （P＜0.05）. After treatment， body temperature， PCT and CRP of 2 groups were significantly lower than before treatment， and CRP of the observation group was significantly lower than the control （No.SDFEYJLC2105） group （P＜0.05）. There was no statistically significant differencebetween the two groups in terms of rehabilitation discharge rate， the proportion of patients transferred to general wards，the proportion of dead patients， and the total incidence ofadverse drug reactions （P＞0.05）. CAZ/AVI and prolonging therapy duration were more likely to achieve clinical benefits （odds ratios of 1.146， 7.707，P＜0.05）， while lung infection and CRRT may be independent risk factors for treatment failure （odds ratios of 0.182， 0.236， P＜0.05）. CONCLUSIONS CAZ/AVI has good efficacy and safety in the treatment of CRO infection， the appropriate extension of antibacterial treatment time can achieve a higher clinical response rate， while lung infection or CRRT may lead to treatment failure. |
| 期刊： | 2023年第34卷第16期 |
| 作者： | 毛娇娇；曹国文；朱珠；陶宏；许峰 |
| AUTHORS： | MAO Jiaojiao，CAO Guowen，ZHU Zhu，TAO Hong，XU Feng |
| 关键字： | 头孢他啶阿维巴坦钠；碳青霉烯类耐药革兰阴性菌；感染；疗效；安全性 |
| KEYWORDS： | ceftazidime and avibactam sodium； carbapenem-resistant organism； infection； efficacy； safety |
| 阅读数： | 68 次 |
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