摘要
目的观察以头孢哌酮-舒巴坦（C／S）联合米诺环素为主的方案治疗广泛耐药的鲍曼不动杆菌（XDRAB）感染的效果。方法采用前瞻、单中心研究方法，纳入2009年北京协和医院重症医学科病房（ICU）内感染XDRAB的重症患者，以C／S联合米诺环素作为初始治疗，无效时可联合亚胺培南-西司他丁，观察疗程天数及临床有效率和微生物学清除率。结果101例入选患者中的77例符合最终分析，年龄（69±20）岁，男49例，女28例。基线APACHEⅡ评分（15±5）分。感染部位分别为肺部61例、血流5例、腹腔3例、皮肤软组织2例和多部位感染6例，其中23例为混合细菌感染。7例在方案基础上联合亚胺培南-西司他丁。治疗疗程（16±4）d，最终痊愈21例、显效27例、进步26例、无效3例，临床有效率62．3％（48／77），微生物学清除率46．8％（36／77）。影响疗效的独立因素为存在影响感染清除的基础疾病（OR=5．3，P=0．020），迁延感染（OR=3．8，P=0．029），混合感染（0R=3．5，P=0．032）及感染性休克（OR=2．5，P=0．037）。结论C／S联合米诺环素为主的方案治疗XDRAB感染的重症患者有一定的临床疗效，但细菌清除率较低。
Objective To explore the effects of cefoperazone-sulbactam （C/S） plus minocycline on extensively drug resistant Acinetobacter baumannii （XDRAB） infections in critically ill patients. Methods For this prospective and single-center trial, a total of 101 patients with infection due to XDRAB received the primary therapy of C/S plus minocycline. Combined use of imipenem-cilastatin was considered when primary therapy failed. Results Among them, 77 patients were evaluated. There were 49 males and 28 females with a mean age of （69 ± 20） years. The Acute Physiology and Chronic Health Evaluation （APACHE） I] score was 15 ± 5. Among whom 61 had hospitalacquired pneumonia （n = 61 ）, primary bacteremia （n = 5）, intraabdominal infection （ n = 3 ）, skin and soft tissue infection （SSTI） （ n = 2 ） and muhiple sites infection （n = 6 ）. Twenty-three patients had mixed bacterial infections. Combined use of imipenem- cilastatin therapy was administered in 7 patients. The treatment duration was （ 16 ± 4） days. The outcomes were cure （n = 21 ）, marked improvement （ n = 27）, improvement （ n = 26） and ineffectiveness （ n = 3 ）. The overall effective rate was 62. 3% （48/77）and the microbiological clearance rate 46. 8% （36/77）. The independent factors of decreased efficacy were underlying co-morbidity of impaired ability for infection control （ OR = 5.3, P = 0. 020）, prolonged infection （ OR = 3.8, P = 0. 029 ）, coinfecting organism （ OR = 3.5, P = 0. 032） and septic shock （ OR = 2. 5, P = 0. 037 ）. Conclusions The combined regimen of C/S and minocycline is efficacious in the treatment of infections caused by XDRAB. But it has a lower rate of microbiological eradication.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2012年第40期2847-2850,共4页
National Medical Journal of China
