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头孢他啶/阿维巴坦联合阿米卡星治疗CRE感染重症肺炎的疗效与安全性分析
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| 篇名： | 头孢他啶/阿维巴坦联合阿米卡星治疗CRE感染重症肺炎的疗效与安全性分析 |
| TITLE： | Efficacy and safety analysis of ceftazidime/avibactam combined with amikacin in the treatment of severe pneumonia caused by CRE infection |
| 摘要： | 目的 探讨头孢他啶/阿维巴坦（CAZ/AVI）联合阿米卡星（AMK）治疗碳青霉烯类耐药肠杆菌（CRE）感染重症肺炎的临床疗效与安全性。方法采用回顾性队列研究方法，选取2022年1月－2024年12月在徐州医科大学附属医院重症监护病房（ICU）确诊为CRE感染重症肺炎的患者240例为研究对象，分为联合组（CAZ/AVI联合AMK，n＝136）和对照组（单用CAZ/AVI，n＝104）。比较两组患者的28d病死率、临床疗效、机械通气时间、ICU住院时间、感染性指标[C反应蛋白（CRP）、降钙素原（PCT）、白细胞介素6（IL-6）、白细胞计数（WBC）及中性粒细胞百分比（N%）]、急性生理学和慢性健康状况评价Ⅱ（APACHEⅡ）评分及不良反应发生率。同时根据病情严重程度、机械通气状态及基础肾功能进行亚组分析。结果联合组患者28d病死率显著低于对照组（20.6%vs.34.6%，P＝0.022），临床有效率显著高于对照组（80.1%vs.65.4%，P＝0.004），机械通气时间及ICU住院时间均显著短于对照组（[7.2±2.4）dvs.（10.4±3.6）d、（10.5±3.1）dvs.（13.7±3.8）d；P＜0.01]。治疗7d后，联合组患者CRP、PCT、IL-6、WBC、N%以及APACHEⅡ评分较治疗前显著下降，且降幅均显著大于对照组（P＜0.01）。两组患者不良反应总发生率比较，差异无统计学意义（11.8%vs.13.5%，P＝0.690）。亚组分析显示，在高危（APACHEⅡ评分≥15分）及接受机械通气的患者中，联合组患者28d病死率及撤机时间显著低/短于对照组（P＜0.05），而慢性肾功能不全患者经剂量调整后，联合组和对照组患者不良反应总发生率无显著差异（P＞0.05）。结论CAZ/AVI联合AMK方案在CRE感染重症肺炎患者中较单用CAZ/AVI方案具有更优的抗感染疗效，且安全性良好；该联合方案在高危以及接受机械通气的患者中的生存获益更显著，危重症患者可能是主要获益人群。 |
| ABSTRACT： | OBJECTIVE To evaluate the efficacy and safety of ceftazidime/avibactam （CAZ/AVI） combined with amikacin （AMK） in the treatment of carbapenem-resistant Enterobacteriaceae （CRE） severe pneumonia. METHODS A retrospective cohort study was conducted on 240 patients diagnosed with severe pneumonia caused by CRE infection in the intensive care unit （ICU） of the Affiliated Hospital of Xuzhou Medical University from January 2022 to December 2024. The patients were divided into a combination group （CAZ/AVI combined with AMK， n＝136） and a control group （CAZ/AVI alone， n＝104）. The 28-day mortality rate， clinical efficacy，mechanical ventilation time， ICU stay， infectious markers [C-reactive protein （CRP）， procalcitonin （PCT）， interleukin-6 （IL-6）， white blood cell count （WBC）， and neutrophil percentage （N%）]， Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE Ⅱ） scores， and total incidence of adverse reactions were compared between two groups of patients. At the same time， subgroup analysis was conducted based on the severity of the condition， mechanical ventilation status， and baseline renal function. RESULTS The 28-day mortality rate of patients in the combination group was significantly lower than that in the control group （20.6% vs. 34.6%， P＝0.022）， and the clinical effective rate was significantly higher than that in the control group （80.1% vs. 65.4%， P＝0.004）. The mechanical ventilation time and ICU hospitalization time in the combination group were significantly shorter than those in the control group （[ 7.2±2.4） days vs. （10.4±3.6） days， （10.5±3.1） days vs. （13.7±3.8） days； P＜0.01].After 7 days of treatment， the CRP， PCT， IL-6， WBC， N% and APACHE Ⅱ scores of patients in the combination group significantly decreased compared to before treatment， and the decrease was significantly greater than that of the control group （P＜0.01）. There was no statistically significant difference in the total incidence of adverse reactions between the two groups of patients （11.8% vs. 13.5%， P＝0.690）. Subgroup analysis showed that among high-risk （APACHE Ⅱ score≥15） and mechanically ventilated patients， the 28-day mortality rate and weaning time of the combination group were significantly lower/ shorter than those of the control group （P＜0.05）， while there was no significant difference in the total incidence of adverse reactions between the combination group and the control group after dose adjustment in patients with chronic renal insufficiency （P＞0.05）. CONCLUSIONS The CAZ/AVI combined with AMK regimen has better anti-infective efficacy and good safety in patients with severe pneumonia caused by CRE infection compared to the CAZ/AVI regimen alone； the survival benefits of this joint regimen are more significant in high-risk and mechanically ventilated patients， with critically ill patients being the main beneficiaries. |
| 期刊： | 2025年第36卷第21期 |
| 作者： | 张天棋；陈碧；张灿堂 |
| AUTHORS： | ZHANG Tianqi，CHEN Bi，ZHANG Cantang |
| 关键字： | 头孢他啶/阿维巴坦；阿米卡星；碳青霉烯类耐药肠杆菌；重症肺炎；联合治疗 |
| KEYWORDS： | ceftazidime/avibactam； amikacin； carbapenem-resistant Enterobacteriaceae； severe pneumonia； combination therapy |
| 阅读数： | 3 次 |
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