CAJ | 학술논문

目的评价替加环素治疗血液病继发感染的疗效及安全性.方法将85例血液病继发感染的住院患者分为经验和目标治疗两组.对无微生物学依据,经抗感染治疗3～5d疗效不佳,更换替加环素治疗者,为经验治疗组;一旦获得微生物学证据,及时更换替加环素治疗者为目标治疗组.替加环素的用法:首剂100 mg,维持50 mg,1次/12 h,疗程2～4周.结果 85例患者,除11例发生血流感染,2例发热原因不明外,最常见的感染部位为下呼吸道.共分离出45株菌株,以嗜麦芽窄食单胞菌为主(占40％),产超广谱β-内酰胺酶(ESBLS)+的多药耐药革兰氏阴性杆菌占15.6％.球菌5株,其中耐甲氧西林金黄色葡萄球菌(MRSA)+的金黄色葡萄球菌3株,屎肠球菌2株.替加环素治疗的临床有效率为72.9％,对鲍曼不动杆菌、产ESBLS+的革兰氏阴性杆菌、嗜麦芽窄食单胞菌清除率分别为85％、70％、55％.经验治疗组与目标治疗组疗效相当.替加环素治疗肺部感染、继发血流感染有效率分别为71％及45.5％,中性粒细胞绝对值＜0.2×109/L者,有效率明显降低(45％与81.5％,P=0.003).不良反应轻,主要为消化道不适症状.结论替加环素可作为血液病患者继发多药耐药菌感染一个新的治疗选择.对常规抗感染疗效不佳者,替加环素的经验治疗可提高疗效.
목적 평개체가배소치료혈액병계발감염적료효급안전성.방법 장85례혈액병계발감염적주원환자분위경험화목표치료량조.대무미생물학의거,경항감염치료3～5d료효불가,경환체가배소치료자,위경험치료조;일단획득미생물학증거,급시경환체가배소치료자위목표치료조.체가배소적용법:수제100 mg,유지50 mg,1차/12 h,료정2～4주.결과 85례환자,제11례발생혈류감염,2례발열원인불명외,최상견적감염부위위하호흡도.공분리출45주균주,이기맥아착식단포균위주(점40％),산초엄보β-내선알매(ESBLS)+적다약내약혁란씨음성간균점15.6％.구균5주,기중내갑양서림금황색포도구균(MRSA)+적금황색포도구균3주,시장구균2주.체가배소치료적림상유효솔위72.9％,대포만불동간균、산ESBLS+적혁란씨음성간균、기맥아착식단포균청제솔분별위85％、70％、55％.경험치료조여목표치료조료효상당.체가배소치료폐부감염、계발혈류감염유효솔분별위71％급45.5％,중성립세포절대치＜0.2×109/L자,유효솔명현강저(45％여81.5％,P=0.003).불량반응경,주요위소화도불괄증상.결론 체가배소가작위혈액병환자계발다약내약균감염일개신적치료선택.대상규항감염료효불가자,체가배소적경험치료가제고료효.
Objective To evaluate the efficacy and safety of tigecycline in treating secondary infections of patients with hematological diseases.Methods A total of 85 cases of hematological patients with secondary infections were classified into empirical and targeted therapy groups.Empirical therapy group was composed of patients receiving tigecycline as an alternative due to ineffective anti-infection treatment for 3-5 days in the absence of microbiological evidence while those taking tigecycline based on microbiological evidence belonged to targeted therapy group.Dosage regimen of tigecycline:loading dose 100 mg,50 mg every 12 hours as maintenance therapy for 2-4 weeks.Results Among them,except for 11 cases of bloodstream infections and 2 cases of fever for unknown reasons,the most common site for infection was lower respiratory tract.Among 45 isolated bacterial strains,Stenotrophomonas maltophilia (40％) was the most commonly seen while extended spectrum beta-lactamases (ESBLS) + multidrug resistant gram negative bacilli 15.6％.Among 5 bacterial strains,there were 3 methicillin-resistant Staphylococcus aureus + golden staphylococci strains and 2 excrement enterococci.The total effective rate of tigecycline was 72.9％.And the bacterial clearance rates of acinetobacter baumannii,ESBLS + gram-negative bacillus and stenotrophomonas maltophilia were 85％,70％ and 55％ respectively.The effect of tigecycline was equivalent for two groups.Pneumonia patients obtained an effective rate of 71％,compared to those with bloodstream infections (54.5％).For patients whose absolute neutrophil counts were less than 0.2 × 109/L,the effective rate decreased obviously (45％ vs 81.5％,P =0.003).Adverse reaction was mild due to mostly gastrointestinal symptoms.Conclusion Tigecycline is a new treatment choice in treating secondary multidrug resistant infections of patients with hematological diseases.Empirical therapy of tigecycline may improve the therapeutic efficacy of patients non-responding favorably to conventional anti-infectives.