替加环素治疗多重耐药菌肺部感染的疗效分析

发布时间：2018-06-09 17:03

  本文选题：替加环素 + 多重耐药　； 参考：《南昌大学》2017年硕士论文

【摘要】：目的:通过回顾性观察替加环素治疗多重耐药菌肺部感染的临床疗效,为肺部多重耐药菌感染的合理治疗提供依据。方法:收集2013年1月-2016年7月期间在南昌大学第二附属医院住院,诊断肺部感染,两次以上细菌培养提示多重耐药革兰氏阴性杆菌感染(排外铜绿假单胞菌),使用替加环素治疗5天以上的患者资料,从临床和病原学两方面综合分析其疗效,并应用SPSS 22.0软件进行统计学分析。结果:1.入选患者92例,其中男性患者73例,给药时间平均为9.7±4.3天。2.患者用药后体温下降,用药第3天、第5天、第7天的平均体温分别与用药第1天的平均体温比较,P0.05,差异有统计学意义。WBC、N%、CRP、PCT四组感染指标用药后较用药前明显下降,P0.05,差异有统计学意义。分别以WBC=10×1 09/L、N%=70%、CRP=10mg/L、PCT=0.5ug/L作为截断点,比较炎症指标在治疗后转为正常的比率,VAP组低于HAP组,但差异无统计学意义。以PCT=0.5ug/L作为截断点评估降钙素原在肺炎诊断中的敏感性,VAP组(81.7%)高于HAP组(57.9%),P0.05,差异有统计学意义。3.入组92例患者总体临床有效率47.8%,各组临床有效率:CAP患者组临床有效率为100%,HAP(63.2%)VAP(42.3%)患者组,P=0.10,差异无统计学意义。≥75岁的高龄组(38.5%)低于75岁的非高龄组(51.5%),P=0.26,差异无统计学意义;APACHE Ⅱ评分≤15分组(54.2%)高于APACHE Ⅱ评分15分的患者组(28.0%),P0.05,差异有统计学意义;肾功能正常组(55.6%)高于肾功能损害(31.0%)的患者组,P0.05,差异有统计学意义;肝功能正常组、无低蛋白血症组均高于肝功能损害、低蛋白血症患者组,差异无统计学意义。4.使用替加环素前培养出耐药菌257株,其中以多重耐药鲍曼不动杆菌为主(56.8%),耐药菌株大部分对替加环素敏感,总体病原菌清除率67.4%,多重耐药鲍曼不动杆菌病原菌清除率58.7%。18.5%的患者在住院期间死亡。结论:1.替加环素对多重耐药菌或泛耐药菌所致的肺部感染有一定的疗效,在没有多粘菌素抗感染药物可供选择的情况下,以替加环素为主的联合抗菌方案仍为较好的选择。2.APACHE Ⅱ评分、肾功能损害影响替加环素的临床疗效。
[Abstract]:Objective: to observe the clinical effect of tigicycline in the treatment of multidrug resistant bacteria (MDR) pulmonary infection. Methods: from January 2013 to July 2016, the patients were hospitalized in the second affiliated Hospital of Nanchang University to diagnose pulmonary infection. Two or more times of bacterial culture suggested that multidrug resistant gram-negative bacilli (Pseudomonas aeruginosa, excluding Pseudomonas aeruginosa), which were treated with tegacycline for more than 5 days, were treated with tegicycline for more than 5 days. The clinical and etiological effects were analyzed comprehensively. SPSS 22.0 software was used for statistical analysis. The result is 1: 1. 92 patients were enrolled, 73 of them were male, the average administration time was 9.7 卤4.3 days. The body temperature of the patients decreased after medication, the third day, the fifth day, The mean body temperature on the 7th day was significantly lower than that on the 1st day (P 0.05), and the difference was statistically significant. The ratio of inflammation to normal in VAP group was lower than that in HAP group, but there was no significant difference between VAP group and HAP group. The sensitivity of procalcitonin in the diagnosis of pneumonia in VAP group was 81.7% higher than that in HAP group (P 0.05). The difference was statistically significant. The overall clinical effective rate of 92 patients in the group was 47.8. The clinical effective rate of each group was 100 HAPN 63.22 and VAPP 42.3. There was no significant difference between the two groups (P = 0.10). The aged group 鈮，

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