摘要
目的了解硫酸多粘菌素B治疗多重耐药(Multidrug-resistant,MDR)的革兰阴性菌(Gram-negative bacteria,GNB)所致医院获得性肺炎的疗效,并讨论影响硫酸多粘菌素B疗效的可能因素。方法选取中国医科大学附属盛京医院呼吸科、重症监护室2019年6月-2021年6月诊治的40例确诊MDR革兰阴性菌所致HAP患者,根据患者的疗效分为临床有效组27例,以及临床无效组13例,比较两组患者的性别、年龄、机械通气情况、血管活性药物使用情况、APACHE Ⅱ评分、合并症、耐药菌分布情况、使用硫酸多粘菌素B的日剂量及使用时间以及与其他抗菌药物联用情况。对其中有意义的变量进行Logistic回归,探讨硫酸多粘菌素B疗效的影响因素。结果临床有效组与无效组的年龄、性别、合并症、APACHE II评分、耐药菌分布情况、硫酸多粘菌素的日剂量及与其他抗菌药物联用情况差异无统计学意义(P>0.05),临床有效组的硫酸多粘菌素B使用时间较无效组长,差异有统计学意义(P=0.022),临床无效组有更多的患者应用机械通气(P=0.010),且无效组应用血管活性药物患者更多,差异有统计学意义(P=0.009)。对两组患者中有统计学意义的指标进行多元逻辑回归分析,提示使用机械通气(B=1.928;OR=3.861;95%CI:1.005~47.058;P=0.049)及血管活性药物(B=2.401;OR=6.054;95%CI:1.630~74.748;P=0.014)与临床有效独立相关。结论硫酸多粘菌素B治疗多重耐药革兰阴性菌所致医院获得性肺炎具有较好的治疗效果,机械通气情况、血管活性药物使用情况是硫酸多粘菌素B临床疗效的独立相关因素。
Objective To study the efficacy of polymyxin B sulfate in the treatment of hospital-acquired pneumonia(HAP)caused by multidrug-resistant(MDR)gram-negative bacteria(GNB),and discuss the possible factors that affect the efficacy of polymyxin B sulfate.Methods Totally 40 patients with confirmed MDR HAP caused by Gram-negative bacteria in the Department of Respiration and Intensive Care Unit of Shengjing Hospital of China Medical University from June 2019 to June 2021 were selected and divided into clinically effective group with 27 cases and ineffective group with 13 cases according to the therapeutic efficacy in the patients.The gender,age,mechanical ventilation,vasoactive drug use,APACHE Ⅱ score,comorbidities,distribution of drug-resistant bacteria,daily dose and time of polymyxin B sulfate,and combined use with other antibiotics were compared,and logistic regression was performed on the meaningful variables to explore the influencing factors of the efficacy of polymyxin B sulfate.Results There was no significant difference in age,gender,comorbidities,APACHE II score,distribution of drug-resistant bacteria,daily dose of polymyxin sulfate or combination use with other antibiotics between clinically effective group and ineffective group(P>0.05).The time of polymyxin B sulfate use in the clinically effective group was longer than that in the ineffective group,which had a statistical difference(P=0.022),and more patients in the clinical ineffective group used mechanical ventilation(P=0.010),and more patients in the ineffective group used vasoactive drugs(P=0.009).Multivariate logistic regression analysis was performed on the indicators with statistical differences in the two groups of patients,which suggested that the use of mechanical ventilation(B=1.928;OR=3.861;95%CI:1.005~47.058;P=0.049)and vasoactive drugs(B=2.401;OR=6.054;95%CI:1.630~74.748;P=0.014)were independently related to clinical effectiveness.Conclusion Polymyxin B sulfate has a good therapeutic effect in the treatment of hospital-acquired pneumonia ca
作者
边明艳
张强
BIAN Ming-yan;ZHANG Qiang(Department of Geriatric Respiratory Medicine,Jinqiu Hospital,Shenyang 110016,China;Department of Pulmonary and Critical Care Medicine,Shengjing Hospital of China Medical University,Shenyang 110022,China)
出处
《实用药物与临床》
CAS
2022年第3期243-246,共4页
Practical Pharmacy and Clinical Remedies
关键词
多粘菌素B
多重耐药菌
革兰阴性菌
医院获得性肺炎
Polymyxin B
Multidrug-resistant bacteria
Gram-negative bacteria
Hospital-acquired pneumonia
