摘要
目的探讨高剂量替加环素为基础的联合治疗方案对多重耐药革兰阴性细菌感染患者的疗效及安全性。方法回顾性分析2021年1月至2021年12月本院以替加环素为基础的联合治疗方案治疗的158例多重耐药革兰阴性细菌感染患者的临床资料。按替加环素使用剂量分为高剂量组(负荷剂量200 mg,维持剂量100 mg q12h)78例和推荐剂量组(负荷剂量100 mg,维持剂量50 mg q12h)80例,观察2组患者使用替加环素的疗效、肝肾功能及凝血功能变化。结果推荐剂量组和高剂量组临床有效率分别为61%(49/80)和77%(60/78),组间有显著差异(P<0.05);中性粒细胞百分比及降钙素原(PCT)水平均比治疗前显著降低(P<0.01),且高剂量组PCT水平降低更显著(P<0.05)。2组治疗后天冬氨酸转氨酶、丙氨酸转氨酶、直接胆红素、间接胆红素和血肌酐水平与治疗前比较均无显著差异(P>0.05)。2种剂量均能够显著升高国际标准化比值、降低纤维蛋白原浓度、延长活化部分凝血活酶时间(P<0.05),组间比较无显著差异(P>0.05);对凝血酶原时间、D-二聚体及血小板计数无显著影响(P>0.05)。结论高剂量替加环素治疗多重耐药革兰阴性细菌感染较推荐剂量具有更高治疗有效率,对患者肝肾功能无明显影响,两种剂量均可诱导凝血功能障碍。
AIM To study the efficacy and safety of high-dose tegacycline-based combination therapy in patients with multi-drug resistant Gram-negative bacterial infection.METHODS The clinical data of 158 patients with multidrug-resistant Gram-negative bacterial infection treated by the combined therapy based on tegacyclin in our hospital from January 2021 to December 2021 were analyzed retrospectively.According to the dose of tegacyclin,78 patients were divided into high-dose group(loading dose 200 mg,maintenance dose 100 mg q12h)and 80 patients in recommended-dose group(loading dose 100 mg,maintenance dose 50 mg q12h).The efficacy of tegacyclin,liver and kidney function and coagulation function of the two groups were observed.RESULTS The clinical response rates of the recommended-dose group and the high-dose group were 61%(49/80)and 77%(60/78),respectively,with significant difference between groups(P<0.05);the levels of neutrophil ratio and procalcitonin were significantly lower than those before treatment(P<0.01),and the level of PCT in the high-dose group was significantly lower(P<0.05).There were no significant diferences in the levels of aspartate aminotransferase,alanine aminotransferase,direct bilirubin,indirect bilirubin and serum creatinine between the two groups after treatment(P>0.05).Both doses could significantly increase international normalized ratio value,reduce fibrinogen concentration and prolong activated partial thromboplastin time(P<0.05),with no significant difference between groups(P>0.05),and had no significant fect on the levels of prothrombin time,D-dimer and platelet count(P>0.05).CONCLUSION High dose of tegacycline in the treatment of multidrug-resistant Gram-negative bacterial infection is more effective than recommended dose with no significant effect on liver and kidney function,and both doses can induce coagulation dysfunction.
作者
陈丽娟
朱蕻潮
吴晓丽
杨康群
秦海艳
孙俊
CHEN Li-juan;ZHU Hong-chao;WU Xiao-li;YANG Kang-qun;QIN Hai-yan;SUN Jun(Department of Pharmacy,the Afiliated Huaian NO.1 People's Hospital of Nanjing Medical University,Huaian JIANGSU 223300,China;Department of Nuclear Medicine,the Affiliated Huaian NO.1 People's Hospital of Nanjing Medical University,Huaian JIANGSU 223300,China)
出处
《中国新药与临床杂志》
CAS
CSCD
北大核心
2023年第9期581-586,共6页
Chinese Journal of New Drugs and Clinical Remedies
关键词
替加环素
革兰阴性菌
治疗结果
血液凝固
安全
tigecycline
Gram-negative bacteria
treatment outcome
blood coagulation
safety
