替加环素治疗儿童术后多重耐药菌感染的疗效及安全性

发布时间：2018-03-09 07:22

  本文选题：替加环素　切入点：超说明书用药　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的:由于多重耐药菌和泛耐药菌的出现,临床医生开始应用替加环素。本文探讨了替加环素在危重患儿术后多重耐药菌感染中应用的疗效及安全性。研究方法:回顾性分析2012年3月至2016年5月浙江大学医学院附属儿童医院外科重症监护室(SICU)收住的外科术后严多重耐药菌感染应用替加环素22例患儿的临床数据。研究结果:(1)22例患儿(年龄45天-11岁)均为外科术后病人,其中先天性心脏病心内直视术后18例,大面积Ⅲ度烧伤2例,肠切除吻合术后1例,颅脑外科术后1例。入 ICU 的 SOFA 评分为 5.7±3.8,PRISMⅢ评分 10.6± 6.3。(2)22例患儿均为超说明书用药,最常见是呼吸机相关性肺炎12例(54.5%)。(3)应用替加环素的情况:经验用药2例,目标治疗20例。(4)应用替加环素前细菌学培养阳性20例,2例病人培养结果阴性;共分离出48株耐药菌,最常见为鲍曼不动杆菌37株。(5)所有患儿应用替加环素的负荷量1.5mg/kg,维持量1-1.2mg/kg Q12H,疗程为4天-22天。(6)临床有效率86.4%,死亡4例,仅1例死于感染未控制;所有患儿未观察到替加环素相关的不良反应。结论:替加环素治疗外科术后病情危重和多重耐药菌感染的患儿是临床有效,并具有良好的安全性和耐受性。
[Abstract]:Objective: due to the emergence of multidrug resistant bacteria and pan-resistant bacteria, The efficacy and safety of tigicycline in the treatment of multidrug resistant bacterial infections in critically ill children after operation were investigated. Methods: from March 2012 to May 2016, Zhejiang University, Zhejiang Province, was retrospectively analyzed. Clinical data of 22 children with severe multidrug resistant bacterial infection after surgery received by the Surgical intensive Care Unit (ICU) of affiliated Children's Hospital, Medical College. There were 18 cases of congenital heart disease after open heart surgery, 2 cases of large area third degree burn, 1 case of intestinal resection and anastomosis and 1 case of craniocerebral surgery. The SOFA score of ICU was 5. 7 卤3. 8 and 10. 6 卤6. 3. 2%. The most common cases were 12 cases of ventilator-associated pneumonia (n = 12) with tegacycline: 2 cases were treated by experience, 20 cases were treated with target, 20 cases were positive by bacteriological culture before tegacyclin, and 2 cases were negative in culture, 48 strains of drug-resistant bacteria were isolated. The most common was Acinetobacter baumannii (37 strains). All the children were treated with tegicycline at a dose of 1.5 mg / kg and a maintenance dose of 1-1.2 mg / kg Q12H. The course of treatment was 4 days to 22 days. 6) the clinical effective rate was 86.4%, 4 cases died, only 1 case died of uncontrolled infection. Conclusion: tigicycline is effective and safe in the treatment of severe and multidrug resistant bacterial infections after surgery.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.5
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本文编号：1587527