背景:多重耐药革兰氏阴性菌,过度使用抗菌剂和免疫抑制剂加剧了,是一个重大的健康威胁。
目的:研究硫酸粘菌素治疗耐碳青霉烯类革兰阴性杆菌肺炎的临床疗效和安全性,为临床诊断和治疗提供理论参考。
方法:回顾性分析2020年8月至2022年6月中国人民解放军北部战区总医院重症监护室收治的革兰阴性杆菌肺炎患者54例。经过细菌学培养,收集患者气道分泌物以确认革兰氏阴性杆菌的存在。根据使用的药物将患者分为实验组和对照组。研究组由28例患者组成,这些患者通过静脉注射硫酸多粘菌素联合其他药物,雾化,或静脉注射结合雾化,日剂量为1.5-3.0百万单位。对照组由26例患者组成,这些患者接受了标准剂量的其他抗生素(包括注射用舒巴坦钠,注射用头孢哌酮钠舒巴坦,替加环素,美罗培南,或vaborbactam)。
结果:在纳入研究组的28例患者中,26例患者表现出改善,两名患者治疗无效,一个病人死了,治疗有效率达92.82%。在对照组的26名患者中,18名患者好转,8例患者治疗无效,两个病人死了,治疗有效率54.9%,两组比较差异有统计学意义(P<0.05)。白细胞(WBC)的水平,降钙素原(PCT),两组患者治疗后C反应蛋白(CRP)水平均显著低于治疗前(P<0.05),和白细胞的水平,PCT,研究组患者的CRP水平明显低于对照组(P<0.05)。与治疗前相比,天冬氨酸转氨酶没有显著变化,肌酐,两组的肾小球滤过率,总胆红素、谷丙转氨酶治疗后下降(P<0.05),组间无差异。在临床效果良好的患者中,当吸入硫酸多粘菌素治疗时,序贯器官衰竭评估(SOFA)评分较低,和特定的抗生素治疗没有改善结局.脓毒症和脓毒性休克以及低SOFA评分是与良好临床结局相关的独立因素。
结论:硫酸多粘菌素对多重耐药革兰阴性杆菌肺炎等肺部感染患者的治疗效果显著,安全可靠。此外,小剂量静脉注射联合雾化吸入的给药途径具有较好的治疗效果和较低的不良反应,为临床用药提供新思路。
BACKGROUND: Multidrug-resistant Gram-negative bacteria, exacerbated by excessive use of antimicrobials and immunosuppressants, are a major health threat.
OBJECTIVE: To study the clinical efficacy and safety of colistin sulfate in the treatment of carbapenem-resistant Gram-negative bacilli-induced pneumonia, and to provide theoretical reference for clinical diagnosis and treatment.
METHODS: This retrospective analysis involved 54 patients with Gram-negative bacilli pneumonia admitted to intensive care unit of The General Hospital of the Northern Theater Command of the People\'s Liberation Army of China from August 2020 to June 2022. After bacteriological culture, the patients\' airway secretions were collected to confirm the presence of Gram-negative bacilli. The patients were divided into the experimental and control groups according to the medication used. The research group consisted of 28 patients who received polymyxin sulfate combined with other drugs through intravenous, nebulization, or intravenous combined with nebulization, with a daily dosage of 1.5-3.0 million units. The control group consisted of 26 patients who received standard dosages of other antibiotics (including sulbactam sodium for injection, cefoperazone sodium sulbactam for injection, tigecycline, meropenem, or vaborbactam).
RESULTS: Of the 28 patients included in the research group, 26 patients showed improvement, treatment was ineffective for two patients, and one patient died, with the treatment efficacy rate of 92.82%. Of the 26 patients in the control group, 18 patients improved, treatment was ineffective for eight patients, and two patients died, with the treatment efficacy rate of 54.9%; significant difference was observed between the two groups (P < 0.05). The levels of white blood cell (WBC), procalcitonin (PCT), and C-reactive protein (CRP) in both groups were significantly lower after treatment than before treatment (P < 0.05), and the levels of WBC, PCT, and CRP in the research group were significantly lower than those in the control group (P < 0.05). Compared with before treatment, there were no significant changes in aspartate aminotransferase, creatinine, and glomerular filtration rate in both groups, while total bilirubin and alanine aminotransferase decreased after treatment (P < 0.05) with no difference between the groups. In patients with good clinical outcomes, the sequential organ failure assessment (SOFA) score was low when treated with inhaled polymyxin sulfate, and specific antibiotic treatment did not improve the outcome. Sepsis and septic shock as well as a low SOFA score were independent factors associated with good clinical outcomes.
CONCLUSIONS: Polymyxin sulfate has a significant effect on the treatment of patients with multiple drug-resistant Gram-negative bacilli pneumonia and other infections in the lungs and is safe and reliable. Moreover, the administration route of low-dose intravenous injection combined with nebulization shows better therapeutic effects and lower adverse reactions, providing new ideas for clinical administration.