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

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.%[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 ad-verse 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 differ-ence 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%)devel-oped 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.