替加环素在重症患者经验性抗感染治疗中的临床疗效

摘要

Objective To observe the therapeutic effect of tigecycline on empirical antibiotic treatment of criti-tally ill patients,and provide the evidence for rational use of tigecycline in prophylaxis and treatment of multi-drug re-sistant bacteria infection and improving the prognosis of patients. Methods A total of 30 critially ill patients admitted to Intensive Care Unit ( ICU) of our hospital from July 2013 to December 2014 were treated with tigecycline. The changes of the temperature,white blood cells ( WBC) counts and procalcitonin ( PCT) value before and after treatment of tigecycline were compared,and the prognosis and the incidence of complications were observed. Results The course of tigecycline treatment were 8. 5 (6~12) d. There were 21 patients with clinically success (the infection symp-toms and signs improved partially or completely),9 patients with clinically failed ( the infection symptoms and signs had no improvement or deteriorated). The mortality at 28 d after treatment was 20% (6/30). Only 2 patients were complicated with elevated hepatic enzymes. The APACHE Ⅱ scores of patients with clinically success before and after treatment were 16. 05±8. 18 and 8. 61±5. 50 ( P <0. 001 ),and SOFA scores were 6. 76±5. 18 and 2. 67±2. 52 (P<0. 001) respectively,WBC ( × 109/L) were 15. 46±5. 73 and 8. 81±3. 44(P <0. 001),and PCT (ng/mL) were 4. 88±5. 73 and 0. 37±0. 35(P<0. 01) respectively. The time of temperature recovered to normal was 7 (5 ~10) d. Conclusion Empirically antibiotic treatment with tigecycline in the critically ill patients,who were suspected of infection with multidrug resistant bacteria,could promote the success rate of anti-infection therapy and then improve the prognosis.%目的 观察替加环素对重症患者经验性抗感染治疗的效果,为临床合理使用替加环素防治多重耐药菌感染及改善患者预后提供依据. 方法 选择2013年7月至2014年12月在我院ICU给予替加环素治疗的重症患者30例,比较替加环素治疗前后患者的体温、白细胞( WBC)及降钙素原( PCT)等临床感染指标及临床预后和并发症的发生率的变化. 结果 患者应用替加环素的总疗程为8. 5(6 ~12) d,临床成功(感染症状和体征部分或完全改善) 21 例,临床失败(感染症状和体征无改善或恶化) 9 例,替加环素治疗28 d后的死亡率为20% (6/30),并发转氨酶升高2 例. 替加环素治疗临床成功患者用药前后 APACHEⅡ和 SOFA 评分分别为(16. 05±8. 18 vs. 8. 61±5. 50,P<0. 001)和(6. 76±5. 18 vs. 2. 67±2. 52,P <0. 001),WBC ( × 109/L)和 PCT (ng/mL)分别为(15. 46±5. 73 vs. 8. 81±3. 44,P<0. 001)和(4. 88±5. 73 vs. 0. 37±0. 35,P<0. 01),患者体温完全恢复正常时间为7(5~10) d. 结论 对可疑MDR病原菌感染的重症患者使用替加环素经验性治疗能够提高临床抗感染的成功率,进而可能改善重症患者的预后.