替加环素治疗碳青霉烯类抗生素耐药肺炎克雷伯菌所致医院获得性肺炎的疗效观察

doi:10.3969/j.issn.1671-7171.2018.10.002

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摘要【目的】探讨替加环素治疗碳青霉烯类抗生素耐药肺炎克雷伯菌(CRKP)所致医院获得性肺炎(HAP)的疗效与安全性。【方法】对本院2010年9月至2013年3月收治的22例痰或肺泡灌洗液培养提示CRKP感染的 HAP患者,使用替加环素治疗,疗程至少5 d。回顾性分析患者的临床疗效、细菌学疗效以及不良反应。【结果】22例患者中,临床痊愈6例(27.27%),4例显效,有效率为45.45%(10/22);细菌清除12例,清除率为54.55%(12/22)。高剂量组和低剂量组临床有效率及细菌清除率比较差异无统计学意义(χ²=1.473,P=0.225;χ²=0.321,P=0.571);联用碳青霉烯类抗生素组和联用非碳青霉烯类抗生素组的临床有效率及细菌清除率比较差异无统计学意义(χ²=0.028,P=0.867;χ²=0.566,P=0.452)。22例患者中2例(9.1%)出现恶心、呕吐,经对症处理后症状消失,未停药;2例出现转氨酶水平升高,经护肝治疗后降至正常,未停药;治疗过程中2例出现二重感染,1例(9.1%)出现铜绿假单胞菌感染,1例(9.1%)出现嗜麦芽窄食假单胞菌,根据药敏选择联合用药,未发生严重不良事件。【结论】替加环素可作为CRKP感染所致医院获得性肺炎的一种治疗选择,但尚需要积累更多临床经验,尤其迫切需要大样本前瞻性研究,以探讨常规剂量及高剂量治疗的疗效及安全性。

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	谭建龙
	刘志光
	谢良伊
	张卫东

关键词 ：克雷伯菌, 肺炎/药物作用, 药用制剂

Abstract：【Objective】To retrospectively analyze the efficacy and safety of Tigecycline in treatment of hospital associated pneumonia(HAP) caused by carbapenem-resistant Klebsiella(CRKP). 【Methods】 From September 2010 to March 2013, 22 patients with HAP infected by CRKP through sputum or alveolar lavage fluid culture were admitted to our hospital. Tegacycline was used for at least 5 days. Clinical efficacy, bacteriological efficacy and adverse reactions were retrospectively analyzed. 【Results】Among the 22 patients, 6 cases (27.27%) were cured, 4 cases were effective, the effective rate was 45.45% (10 / 22), and the clearance rate of bacteria was 54.55% (12 / 22). There was no significant difference in the clinical effective rate and bacterial clearance rate between the high dose group and the low dose group(χ²=0.028,P=0.867;χ²=0.566,P=0.452). There was no significant difference in the clinical effective rate and bacterial clearance rate between the carbapenem antibiotics group and the non-carbapenem antibiotic group(χ²=0.028,P=0.867;χ²=0.566,P=0.452). Of the 22 patients, 2 (9.1%) developed nausea and vomiting, and the symptoms disappeared after symptomatic treatment,the drug was not stopped. In the course of treatment, there were 2 cases of double infection, 1 case (9.1%) of Pseudomonas aeruginosa and 1 case (9.1%) of Pseudomonas maltophilia, and according to drug sensitivity, no serious adverse events occurred. 【Conclusion】Tegacycline can be used as a therapeutic option for HAP caused by CRKP infection. However, it is necessary to accumulate more clinical experience, especially for a large sample of prospective studies to explore the efficacy and safety of conventional and high dose therapy.

Key words： Klebsiella pneumoniae/DE Pharmaceutical Preparations

收稿日期: 2017-12-26

PACS:

R563.11

基金资助:湖南省卫生计生委科研计划课题项目(B2016006);湖南省人民医院仁术基金(2013-34)

通讯作者: **Email:700816@sina.com

引用本文:

谭建龙, 刘志光, 谢良伊, 张卫东. 替加环素治疗碳青霉烯类抗生素耐药肺炎克雷伯菌所致医院获得性肺炎的疗效观察[J]. 医学临床研究, 2018, 35(10): 1877-1879.
TAN Jian-long, LIU Zhi-guang, XIE Liang-yi, et al. Efficacy and Safety of Tigecycline in Treatment of Hospital Associated Pneumonia(HAP) Caused by Carbapenem-resistant Klebsiella(CRKP). JOURNAL OF CLINICAL RESEARCH, 2018, 35(10): 1877-1879.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2018.10.002 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2018/V35/I10/1877

[1] Yigit H, Queenan AM, Anderson GJ,et al. Novel carbapenem-hydrolyzing beta-lactamase, KPC-1, from a carbapenem-resistant strain of Klebsiella pneumoniae[J].Antimicrob Agents Chemother,2001,45(4):1151-1161.
[2] 胡付品, 朱德妹, 汪复, 等. 2014年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志, 2015,15(5):401-410.
[3] 王辉,俞云松,王明贵,等. 替加环素体外药敏试验操作规程专家共识[J].中华检验医学杂志,2013.36(7):584-587.
[4] 《抗菌药物临床试验技术指导原则》写作组. 抗菌药物临床试验技术指导原则[J].中国临床药理学杂志, 2014,9:844-856.
[5] 秦又发, 吴雷, 朱永坤, 等. 替加环素联合头孢哌酮-舒巴坦治疗广泛耐药鲍曼不动杆菌医院获得性肺炎临床疗效观察[J].中国感染与化疗杂志, 2015,15(5):430-433.
[6] 刘元明, 王茂筠, 梁宗安. 替加环素成功治疗肺感染广泛耐药肺炎克雷伯菌一例[J].中国呼吸与危重监护杂志, 2014,13(5):521-522.
[7] 谭建龙, 张卫东, 柳威, 等. 替加环素治疗多或泛耐药鲍曼不动杆菌肺炎的疗效观察[J].中国呼吸与危重监护杂志, 2013,12(6):581-585.[8] 陈虎, 雷旦生,童先丽.肝癌术后广泛耐药肺炎克雷伯菌血流感染1例[J] .中国感染与化疗杂志. 2016,16(1):80-82.
[9] Balandin MB, Fernández SI, Pintado GV, et al. Tigecycline therapy for infections due to carbapenemase-producing Klebsiella pneumoniae in critically ill patients[J].Scand J Infect Dis,2014,46(3):175-180.
[10] Sbrana F, Malacarne P, Viaggi B, et al. Carbapenem-sparing antibiotic regimens for infections caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae in intensive care unit[J].Clin Infect Dis,2013,56(5):697-700.
[11] Burkhardt O, Rauch K, Kaever V, et al. Tigecycline possibly underdosed for the treatment of pneumonia: a pharmacokinetic viewpoint[J].Int J Antimicrob Agents,2009,34(1):101-102.
[12] Ramirez J, Dartois N, Gandjini H, et al. Randomized phase 2 trial to evaluate the clinical efficacy of two high-dosage tigecycline regimens versus imipenem-cilastatin for treatment of hospital-acquired pneumonia[J].Antimicrob Agents Chemother,2013,57(4):1756-1762.