头孢他啶阿维巴坦与多黏菌素E对肾功能不全患者的疗效及预后比较

Comparison of the Efficacy and Prognosis of Ceftazidime-avibactam and Polymyxin E in Patients with Renal Insufficiency

关键词:  头孢他啶阿维巴坦  多黏菌素 E  碳青霉烯类耐药革兰阴性菌感染  肺部感染  安全性  预后

Key words:  Ceftazidime-avibactam  polymyxin E  carbapenem-resistant Gram-negative bacterial infection  pulmonary infection  safety  prognosis

摘要:

目的: 比较头孢他啶阿维巴坦(ceftazidime-avibactam,CAZ-AVI)与多黏菌素E (polymyxin E methane sulfonate sodium,CMS) 对肾功能不全患者碳青霉烯类耐药革兰阴性菌(carbapenem resistant gram-negative bacilli,CR-GNB)肺部感染的疗效、安全性及预后。方法:选择苏州市立医院收治的CR-GNB肺部感染合并肾功能不全的患者,分为CAZ-AVI组和CMS组,比较两组性别、年龄、合并症、SOFA评分、APACHE II评分、感染类型、感染部位等基础指标,并记录抗CR-GNB治疗疗程、是否联合治疗、联合治疗药物、细菌清除率、是否临床治愈、30天死亡率及不良反应等资料。结果:共纳入161例肾功能不全的CR-GNB肺部感染患者,其中CAZ-AVI组73例,CMS组88例,CAZ-AVI组联合药物治疗比例低于CMS组(76.70% vs. 97.72%,P<0.001),临床治愈率、病原菌清除率高于CMS组(56.1% vs. 36.4%,P=0.012；73.97% vs. 47.72%, P<0.001)。CAZ-AVI组30天死亡率为39.73%,低于CMS组的60.22%,差异有统计学意义(P=0.010)。CMS组不良反应率高于CAZ-AVI组(60.23% vs. 24.66%,P<0.001)。结论: CAZ-AVI及CMS对于肾功能不全患者CR-GNB肺部感染的治疗均具有良好效果。与CMS相比,CAZ-AVI 临床治愈率及细菌清除率高,安全性和预后较好。

Abstract:

ABSTRACT: OBJECTIVE To compare the efficacy, safety and prognosis of ceftazidime-avibactam (CAZ-AVI) and polymyxin E methane sulfonate sodium (CMS) in the treatment of carbapenem-resistant gram-negative bacilli (CR-GNB) pulmonary infection in patients with renal insufficiency. METHODS Patients with CR-GNB pulmonary infection and renal insufficiency admitted to Suzhou Municipal Hospital were selected and divided into the CAZ-AVI group and the CMS group. Basic indicators such as gender, age, comorbidities, SOFA score, APACHE II score, infection type and infection site were compared between the two groups. The treatment course for CR-GNB, whether combined treatment was used, combined treatment drugs, bacterial clearance rate, clinical cure rate, 30-day mortality rate and adverse reactions were recorded. RESULTS A total of 161 patients with CR-GNB pulmonary infection and renal insufficiency were included, including 73 in the CAZ-AVI group and 88 in the CMS group. The proportion of combined drug treatment in the CAZ-AVI group was lower than that in the CMS group (76.71% vs. 97.72%, P < 0.001). The clinical cure rate and pathogen clearance rate in the CAZ-AVI group were higher than those in the CMS group (56.1% vs. 36.4%, P = 0.012; 73.97% vs. 47.72%, P < 0.001). The 30-day mortality rate in the CAZ-AVI group was 39.73%, which was lower than 60.22% in the CMS group, and the difference was statistically significant (P = 0.010). The adverse reaction rate in the CMS group was higher than that in the CAZ-AVI group (60.23% vs. 24.66%, P < 0.001). CONCLUSION Both CAZ-AVI and CMS have good therapeutic effects on CR-GNB pulmonary infection in patients with renal insufficiency. Compared with CMS, CAZ-AVI has a higher clinical cure rate and bacterial clearance rate, and better safety and prognosis.