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多黏菌素B联合其他抗菌药物治疗CRAB肺部感染临床效果的影响因素研究
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| 篇名： | 多黏菌素B联合其他抗菌药物治疗CRAB肺部感染临床效果的影响因素研究 |
| TITLE： | Study on the influential factors for clinical efficacy of polymyxin B combined with other antibiotics in the treat-ment of carbapenem-resistant Acinetobacter baumannii pulmonary infection |
| 摘要： | 目的 分析多黏菌素B联合其他抗菌药物用于耐碳青霉烯类鲍曼不动杆菌（CRAB）肺部感染临床效果的影响因素。方法回顾性收集我院2021年5月至2024年10月收治的CRAB肺部感染患者的临床资料，汇总其年龄、性别、入住科室、感染情况、基础疾病情况、机械通气情况、抗感染联合治疗方案、用药前24h的急性生理与慢性健康评分Ⅱ（APACHE-Ⅱ）评分等信息。根据治疗是否有效，将患者分为治疗有效组和治疗无效组，通过单因素分析和多因素Logistic回归分析确定影响临床疗效的独立因素。结果共纳入156例患者，其中108例治疗有效，治疗有效率为69.23%。单因素分析结果显示，两组患者的机械通气时间、用药前24h的APACHE-Ⅱ评分、并发症种类数、凝血功能异常比例、抗感染治疗疗程、用药前住院时间比较，差异均有统计学意义（P＜0.05）；多因素Logistic回归分析结果显示，用药前24h的APACHE-Ⅱ评分≥15分[OR＝2.965，95%CI（1.284，6.845），P＝0.020]、机械通气时间≥10d[OR＝3.577，95%CI（1.185，10.793），P＝0.037]和用药前住院时间≥14d[OR＝2.422，95%CI（1.036，5.654），P＝0.041]是治疗失败的独立危险因素，抗感染治疗疗程＞7d[OR＝0.445，95%CI（0.221，0.895），P＝0.043]是治疗有效的保护因素。结论多黏菌素B联合其他抗菌药物用于CRAB肺部感染的有效率小于70%；机械通气时间≥10d、用药前24h的APACHE-Ⅱ评分≥15分、用药前住院时间≥14d可能导致患者治疗失败，而抗感染治疗疗程＞7d则可能与治疗有效有关。 |
| ABSTRACT： | OBJECTIVE To analyze the influential factors for clinical efficacy of polymyxin B combined with other antibiotics in the treatment of carbapenem-resistant Acinetobacter baumannii （CRAB） pulmonary infection. METHODS A retrospective analysis was conducted on the clinical data of patients with CRAB pulmonary infection in our hospital from May 2021 to October 2024. Information such as age， gender， admitting department， infection status， underlying medical conditions， mechanical ventilation time， combination anti-infective treatment regimens， and the Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE-Ⅱ） score 24 h before medication was compiled. Based on the effectiveness of the treatment， patients were divided into treatment-effective group and treatment-ineffective group. Univariate analysis and multivariate Logistic regression analysis were employed to identify independent factors influencing clinical efficacy. RESULTS A total of 156 patients were included， and 108 patients were treated effectively， with an effective rate of 69.23%. The results of univariate analysis indicated that there were statistically significant differences between 2 groups in terms of the duration of mechanical ventilation time， APACHE-Ⅱ score 24 h before medication， the number of complication types， the proportion of abnormal coagulation function， anti-infective treatment course， and hospital stay before medication （P＜0.05）. The results of multivariate Logistic regression analysis showed that APACHE-Ⅱ score≥15 points 24 h before medication [OR＝2.965， 95%CI （1.284， 6.845）， P＝0.020]， mechanical 20251606） ventilation time≥10 d [OR＝3.577， 95%CI （1.185， 10.793）， P＝0.037] and hospital stay≥14 d before medication [OR＝2.422， 95%CI （1.036， 5.654）， P＝0.041] were independent 15120420253@139.com risk factors， and anti-infective treatment course＞7 d was a protective factor [OR＝0.445， 95%CI （0.221， 0.895）， P＝0.043]. CONCLUSIONS This study shows that the effective rate of polymyxin B combined with other antibiotics in the treatment of CRAB pulmonary infection is less than 70%. The mechanical ventilation time≥10 d， APACHE-Ⅱ score≥15 points 24 h before medication， and hospital stay≥14 d before medication may lead to treatment failure， whereas anti-infective treatment course＞7 d may be associated with treatment success. |
| 期刊： | 2025年第36卷第12期 |
| 作者： | 杜梅；谭瑞娟；王立丹；陈赫军；李翰泽；张媛媛 |
| AUTHORS： | DU Mei，TAN Ruijuan，WANG Lidan，CHEN Hejun，LI Hanze，ZHANG Yuanyuan |
| 关键字： | 多黏菌素B；抗菌药物；耐碳青霉烯类鲍曼不动杆菌；肺部感染；临床疗效；影响因素 |
| KEYWORDS： | polymyxin B； antibiotics； carbapenem-resistant Acinetobacter baumannii； pulmonary infection； clinical efficacy； |
| 阅读数： | 2 次 |
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