多黏菌素B治疗ICU耐碳青霉烯类革兰阴性杆菌感染患者的效果

doi:10.6040/j.issn.1671-7554.0.2024.0040

摘要/Abstract

摘要： 目的探讨静脉用多黏菌素B治疗重症监护室(intensive care unit, ICU)耐碳青霉烯类革兰阴性杆菌感染患者的效果和安全性。方法回顾性分析2022年1月至2023年12月于山东大学第二医院ICU住院治疗期间确诊为耐碳青霉烯类革兰阴性菌感染、且接受静脉多黏菌素B治疗的69例住院患者的临床资料。根据患者临床结局分为临床有效组和临床无效组,分析两组患者一般资料、临床疗效以及药物的安全性。对其中有统计学意义的变量进行Logistic回归,探讨影响多黏菌素B疗效的因素。结果临床有效组与临床无效组的年龄、性别、耐药菌类型、是否行肾脏替代治疗、用药前的白细胞、降钙素原及胆红素的差异无统计学意义。临床有效组的硫酸多黏菌素B使用时间较临床无效组长(P<0.05),临床有效组急性生理与慢性健康状况(acute physiology and chronic health evaluation II, APACHEII)评分较临床无效组低(P<0.05),临床无效组有更多的患者应用机械通气(P<0.05),且应用血管活性药物的患者更多(P<0.05)。两组患者用药前的白介素6、肌酐、尿素氮及估计肾小球滤过率之间的差异有统计学意义(P<0.05)。Logistic回归分析结果提示是否应用血管活性药物(β=-0.256,OR=0.128,95%CI:0.029~0.574,P=0.007)及入ICU时的APCHEII评分(β=-1.515,OR=0.220,95%CI:0.060~0.809,P=0.023)与临床疗效独立相关。肝功能损伤的比例为20.83%(10/48)。结论多黏菌素B治疗多重耐药革兰阴性杆菌所致医院获得性感染具有较好的临床效果,入ICU时的APACHEII评分及血管活性药物使用情况是多黏菌素B临床疗效的独立相关因素。

关键词: 多黏菌素B, 耐碳青霉烯类革兰阴性杆菌, 重症监护室, 疗效, 安全性

Abstract: Objective To investigate the efficacy and safety of intravenous polymyxin B in the treatment of patients infected with carbapenem-resistant gram-negative bacteria in intensive care unit(ICU). Methods Clinical data of 69 hospitalized patients diagnosed with carbapenem-resistant Gram-negative bacillus infections and treated with intravenous polymyxin B during their hospitalization in the ICU of The Second Hospital of Shandong University from January 2022 to December 2023 were retrospectively analyzed. According to their clinical outcomes, the patients were divided into clinically effective group and clinically ineffective group, and the general data, clinical efficacy and safety of the drugs were analyzed. The statistically significant variables were subjected to Logistic regression to explore the factors affecting the efficacy of polymyxin B. Results There were no significant differences in age, sex, type of drug-resistant bacteria, use of continuous renal replacement therapy, white blood cell, procalcitonin, and bilirubin before treatment between the clinically effective group and the clinically ineffective group. The treatment time of clinically effective group was longer than that of clinically ineffective group(P<0.05). The acute physiology and chronic health evaluation II(APACHEII)score of the clinically effective group was lower than that of the clinically ineffective group(P<0.05). More patients in the clinically ineffective group were treated with mechanical ventilation and vasoactive drugs(both P<0.05). The difference of interleukin-6, creatinine, urea nitrogen, and estimated glomerular filtration rate before treatment between the two groups were statistically significant(P<0.05). Logistic regression analysis showed whether vasoactive drugs were used(β=-0.256,OR=0.128,95%CI: 0.029-0.574,P=0.007)and APACHEII score at ICU admission(β=-1.515, OR=0.220,95%CI: 0.060-0.809,P=0.023)were independently correlated with clinical efficacy. The proportion of liver injury was 20.83%(10/48). Conclusion Polymyxin B has a good therapeutic effect on hospital-acquired infections caused by multidrug-resistant Gram-negative bacteria. APACHEII score at ICU admission and vasoactive drug are independent factors related to the clinical efficacy of polymyxin B.

Key words: Polymyxin B, Carbapenem-resistant Gram-negative bacteria, Intensive care unit, Clinical efficacy, Safety

中图分类号:

R574

孙晓丹,杨创. 多黏菌素B治疗ICU耐碳青霉烯类革兰阴性杆菌感染患者的效果[J]. 山东大学学报 (医学版), 2024, 62(7): 72-77.

SUN Xiaodan, YANG Chuang. Clinical efficacy of polymyxin B in treatment of patients infected with carbapenem resistant Gram-negative bacteria in intensive care unit[J]. Journal of Shandong University (Health Sciences), 2024, 62(7): 72-77.

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