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中国临床药理学与治疗学 ›› 2024, Vol. 29 ›› Issue (2): 154-163.doi: 10.12092/j.issn.1009-2501.2024.02.005

• 药物治疗学 • 上一篇    下一篇

替加环素和多黏菌素B治疗重症患者耐碳青霉烯类肠杆菌科细菌肺炎的疗效和安全性分析

查 娴1,陈大宇2,邵 华1   

  1. 1东南大学附属中大医院药学部,南京  210009,江苏;
    2南京大学医学院附属鼓楼医院药学部,南京  210009,江苏

  • 收稿日期:2023-07-31 修回日期:2023-11-27 出版日期:2024-02-26 发布日期:2024-02-02
  • 通讯作者: 邵华,女,博士,主任药师,硕士生导师,研究方向:抗菌药物PK/PD与个体化给药。 E-mail: gycsh@163.com
  • 作者简介:查娴,女,本科,主管药师,研究方向:重症医学专业临床药学。 E-mail: zxyzx0702@163.com
  • 基金资助:
    江苏省药学会-奥赛康医院药学基金科研项目(A202107);南京药学会-常州四药医院药学科研基金项目(2020YX021)

Efficacy and safety analysis of tigecycline and polymyxin B in the treatment of carbapenem-resistant enterobacteriaceae pneumonia in critically ill patients

ZHA Xian1, CHEN Dayu2, SHAO Hua1   

  1. 1Department of Pharmacy, Zhongda Hospital Southeast University, Nanjing 210009, Jiangsu, China; 2Department of Pharmacy, Nanjing Drum Tower Hospital the Affiliated Hospital of Nanjing University, Nanjing 210009, Jiangsu, China
  • Received:2023-07-31 Revised:2023-11-27 Online:2024-02-26 Published:2024-02-02

摘要:

目的:比较替加环素和多黏菌素B治疗重症患者耐碳青霉烯类肠杆菌科细菌(CRE)肺炎的疗效和安全性。方法:回顾性分析2018年1月1日至2023年6月30日于我院重症医学科(ICU)接受替加环素或多黏菌素B治疗的CRE肺炎患者的临床资料。主要结局包括28 d全因病死率和28 d临床治愈率。次要结局包括ICU病死率、住院病死率、住院时间、ICU住院时间、微生物清除率、机械通气时间。采用Cox回归分析检验影响28 d临床治愈率的独立预测因素。结果:倾向性评分匹配后纳入83名患者,其中替加环素组54例,多黏菌素B组29例。替加环素组28 d全因病死率为31.5%(17/54),多黏菌素B组为37.9%(11/29),差异无统计学意义(P=0.554);替加环素组28 d临床治愈率为63%(34/54),显著高于多黏菌素B组的34.5%(10/29)(P=0.013)。两组的次要结局指标均无统计学差异。多因素回归分析发现,使用替加环素是28 d临床治疗有效的独立预测因素(HR:2.083,95%CI 1.018-4.263,P=0.045)。但替加环素组用药后活化部分凝血活酶时间、凝血酶原时间较多黏菌素B组显著延长(P=0.047;P=0.027),纤维蛋白原显著下降(P<0.001)。结论:替加环素组和多黏菌素组28 d全因病死率无显著差异;与多黏菌素B相比,替加环素可能与更高的28 d临床治愈率相关。同时需注意,替加环素可能增加凝血功能异常的风险。

关键词: 替加环素, 多黏菌素B, 肺炎, 耐碳青霉烯类肠杆菌科细菌

Abstract:

AIM: To compare the efficacy and safety of tigecycline with polymyxin B in the treatment of carbapenem resistant enterobacteriaceae (CRE) pneumonia in critically ill patients. METHODS: A retrospective analysis was performed on the clinical data of patients with CRE pneumonia who received tigecycline or polymyxin B therapy from January 1,2018 to Jun 30,2023 in the Intensive Care Unit (ICU). Primary outcomes included the 28-day all-cause mortality and clinical cure rate within 28days. Secondary outcomes included the ICU mortality, in-hospital mortality, the length of hospital stay and ICU stay, microbial eradication, duration of mechanical ventilation. Independent predictors affecting 28-day clinical cure rate were tested using Cox regression analyses. RESULTS: A total of 83 eligible patients were included in the final analysis after propensity score matching, 54 in the tigecycline group and 29 in the polymyxin B group. The 28-day all-cause mortality was 31.5% (17/54) in the tigecycline group and 37.9% (11/29) in the polymyxin B group, the difference was not statistically significant (P=0.554); the clinical cure rate was 63% (34/54) in the tigecycline group, which was significantly higher than that of the polymyxin B group of 34.5% (10/29) (P = 0.013). There were no statistical differences between the two groups in terms of secondary outcomes. Multivariate logistic regression analysis found that the use of tigecycline was an independent predictor of the 28-day clinical cure rate (HR 2.083, 95%CI 1.018-4.263, P = 0.045). However, activated partial thromboplastin time (APTT) and prothrombin time (PT) were significantly prolonged in the tigecycline group compared with the polymyxin B group (P=0.047; P=0.027), and fibrinogen (FIB) was significantly decreased (P < 0.001) after drug administration. CONCLUSION: There was no significant difference in 28-day all-cause mortality between the tigecycline and polymyxin groups; tigecycline might be associated with a higher 28-day clinical cure rate compared with polymyxin B. It should be noted that tigecycline may increase the risk of coagulation abnormalities.

Key words: tigecycline, polymyxin B, pneumonia, carbapenem-resistant enterobacteriaceae

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