替加环素不同治疗方案对ICU泛耐药鲍曼不动杆菌肺部感染的临床效果对比观察#br#

目的 对不同替加环素治疗方案对重症监护室(ICU)泛耐药鲍曼不动杆菌肺部感染的临床疗效和安全性进行对比分析，为替加环素的合理用药提供临床依据。方法 回顾性分析我院ICU 2014年1月-2017年6月使用替加环素治疗的62例泛耐药鲍曼不动杆菌肺部感染的临床资料，其中29例患者单独使用替加环素治疗，33例患者使用替加环素联合头孢哌酮/舒巴坦治疗，其疗程均超过7d，采用t检验或χ²检验对两组患者的临床特征、炎症指标、临床疗效、微生物清除率及不良反应等指标进行比较。结果 替加环素单独用药组和联合用药组在性别、年龄、疾病严重程度及加倍剂量应用替加环素病例数均无统计学差异(P＞ 0.05)，联合用药组的临床有效率(21/33, 63.6%)高于单独用药组(11/29, 37.9%)(χ²=4.084, P＜0.05)。其中，患者APACHEⅡ评分≤15分的临床有效率70%(14/20)高于APACHEⅡ评分＞15分的42.9%(18/42)(χ²=3.997, P＜0.05)；接受替加环素加倍剂量的临床有效率69.6%(16/23)高于常规剂量的41.0%(16/39)(χ²=4.719, P＜0.05)。替加环素单独用药组和联合用药组患者治疗后PCT、WBC和CRP水平与治疗前相比均显著降低(P＜0.05)，且联合用药组的PCT水平下降更为明显(P＜0.05)。两组微生物学清除率(31.0% vs 38.7%)、不良反应发生率(13.8% vs 15.2%)均无统计学差异(P＞0.05)。临床疗效相关影响因素的logistic回归分析，也表明联合用药组疗效优于单独用药组，且用药前患者APACHE评分，CRP值，剂量加倍对临床疗效均存在影响。结论 替加环素联合头孢哌酮/舒巴坦治疗ICU泛耐药鲍曼不动杆菌肺部感染有较好的临床疗效，替加环素是否加倍剂量以及患者APACHEⅡ评分的高低可能影响其治疗效果，且不增加不良反应的发生率，值得在临床进一步推广。

Comparison of different therapeutic regimens of tigecycline in the treatment of ICU patients with pneumonia caused by extensively drug resistant Acinetobacter baumannii#br#

To compare the clinical efficacy and safety of the different treatment regimens of tigecycline for the ICU patients with pneumonia caused by extensively drug resistant Acinetobacter baumannii, and provide the clinical evidence for the rational use of tigecycline. Methods The clinical data collected from 62 ICU patients with pneumonia caused by extensively drug resistant Acinetobacter baumannii from January 2014 to June 2017 were analyzed retrospectively. Among them, 29 patients were treated with tigecycline alone, and the rest 33 patients were received tigecycline combined with cefoperazone/sulbactam. Antibiotic treatments were all more than seven days. t-test or chi-square test were used to analyze the data between the two groups including clinical characteristics, inflammatory index, clinical cure rates, microbiological eradication rate and adverse drug reactions.Results There were no significant differences in gender, age, disease severity and the number cases of high dose between the tigecycline alone group and the combination group (P>0.05). The clinical cure rate in the combination group (21/33, 63.6%) was higher than that in the alone group (11/29, 37.9%) (P<0.05). The clinical cure rate in patients with APACHEⅡ score ≤15 (14/20, 70%) was higher than that in patients with APACHEⅡscore>15(18/42, 42.9%) (P<0.05). The clinical cure rate in the high dose group (16/23, 69.6%) was higher than that in the standard dose group (16/39, 41.0%) (P<0.05). The levels of PCT, WBC, and CRP after therapy in both two groups were decreased obviously (all P<0.05), but PCT decreased more significantly in the combination group (P<0.05). Microbiological eradication rates (31.0% vs 38.7%) and adverse drug reactions (13.8% vs 15.2%) among two groups were of no significant difference (P>0.05). The logistic regression analysis also suggests that combination group is superior to the alone group. The levels of APACHE score, CRP value, and high dose therapy indicated some impact on the clinical efficacy. Conclusion Tigecycline combined with cefoperazone/sulbactam can achieve good clinical therapeutic effect on ICU pneumonia caused by extensively drug resistant Acinetobacter baumannii, without the increasing adverse reaction rates. The APACHEⅡ score and high dose of tigecycline may affect the clinical efficacy. This combined treatment is safe and is worthy of being promoted in this