摘要
目的评价万古霉素联合抗假单胞菌的β-内酰胺类(A组)、哌拉西林他唑巴坦/舒巴坦(B组)、头孢曲松(C组)三种抗菌药物方案治疗术后中枢神经系统感染(CNSIs)的疗效与安全性,为不同程度CNSIs的抗菌药物合理选择提供参考。方法抽取2019年6月-2020年12月于某三甲医院发生术后CNSIs患者49例,监测三种抗感染方案治疗前后患者体温、血常规、脑脊液、降钙素原、微生物等检查指标,并观察不良反应发生情况。结果49例患者均治疗有效,其中A组显效率最高(43.33%);治疗7 d后三组患者体温、血常规均降低(P<0.05),而A组体温恢复至正常值(37.3℃以下)所需的时间最长;三组患者治疗后脑脊液中白细胞、多核细胞比例、蛋白定量较治疗前均降低(P<0.01),其中A组脑脊液白细胞降幅最大(P<0.01),且该组患者治疗后脑脊液葡萄糖水平较治疗前升高(P<0.05);治疗中共观察到16例次药物不良反应,其中14例次发生在A组,主要表现为药物热和白细胞减少。结论万古霉素联合抗假单胞菌的β-内酰胺类治疗中重度CNSI疗效最佳,但安全性稍差,需密切监测其血药浓度及肾功能。哌拉西林及头孢曲松治疗CNSIs疗效可靠且安全性较好,可作为轻中度CNSIs及降阶梯治疗的优选方案。
OBJECTIVE To evaluate the efficacy and safety of three antimicrobial regimens including vancomycin combined withβ-lactam antibiotics against pseudomonas(group A),piperacillin tazobactam/sulbactam(group B)and ceftriaxone(group C)in the patients with postoperative central nervous system infections(CNSIs),so as to provide reference for the rational use of antimicrobial agents for different degrees of CNSIs.METHODS From Jun 2019 to Dec 2020,49 patients with postoperative CNSIs in a grade A tertiary hospital were enrolled.The temperature,blood routine,cerebrospinal fluid,procalcitonin,microorganisms and other indexes of the three different anti-infection regimens before and after treatment were detected,and the occurrence of adverse reactions was monitored.RESULTS All 49 patients were treated effectively,and patients in the group A showed the highest effective rate of 43.33%.Body temperature and blood routine indexes among the three groups decreased after 7 days of treatment(P<0.05),but patients in the group A took the longest time to return to normal(below 37.3℃)temperature.After treatment,the WBC,multinucleated cells ratio and protein quantity in cerebrospinal fluid of the three groups were lower than before(P<0.01);the decrease of WBC in cerebrospinal fluid of group A was the greatest(P<0.01),and the glucose level was higher than that before treatment(P<0.05).A total of 16 adverse drug reactions were observed in the treatment groups,14 of which occurred in the group A,mainly drug fever and leukopenia.CONCLUSION The optimal efficacy of vancomycin combined with anti-pseudomonasβ-lactam antibiotics in the treatment of moderate and severe CNSIs is the best,but their safety is slightly poor.It is necessary to monitor plasma concentration of vancomycin and patients′renal function.Piperacillin and ceftriaxone are effective and safe in the treatment of CNSIs,which can be optimal treatment for mild to moderate CNSIs and step-down therapy.
作者
钟询龙
江绮云
王兆涛
张时真
陀泳华
王若伦
ZHONG Xun-long;JIANG Qi-yun;WANG Zhao-tao;ZHANG Shi-zhen;TUO Yong-hua;WANG Ruo-lun(The Second Affiliated Hospital of Guangzhou Medical University,Guangzhou,Guangdong 510260,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2022年第24期3715-3720,共6页
Chinese Journal of Nosocomiology
基金
广东省中医药局面上项目(20221242)
广州市中医药和中西医结合科技项目(20222A011017)。
关键词
中枢神经系统感染
万古霉素
哌拉西林
头孢曲松
疗效评价
不良反应
术后感染
Central nervous system infections
Vancomycin
Piperacillin
Cefatriaxone
Curative effect evaluation
Adverse reactions
Postoperative infection
