多黏菌素B治疗儿童重症耐碳青霉烯革兰阴性杆菌感染用药分析
收稿日期: 2022-09-05
网络出版日期: 2023-08-10
基金资助
四川省中央引导地方科技发展专项项目(2021ZYD0105)
Drug analysis of polymyxin B in the treatment of severe carbapenem-resistant Gram-negative bacteria infection in children
Received date: 2022-09-05
Online published: 2023-08-10
目的 评价多黏菌素B治疗儿童耐碳青霉烯类革兰阴性杆菌(CRGNB)感染的疗效和安全性。方法 回顾性分析2020年7月—2021年12月儿科重症监护病房收治确诊或高度怀疑CRGNB感染并使用多黏菌素B抗感染患儿的临床资料。结果 纳入20例CRGNB患儿,男11例、女9例,中位年龄为3.4(0.6~8.9)岁,12例治愈,1例死亡。基础疾病以血液肿瘤系统疾病最多(30.0%)。感染标本检出主要为深部痰液或肺泡灌洗液(75.0%),其次为血液(10.0%)。耐碳青霉烯肺炎克雷伯菌为最常分离的微生物(35.0%,7/20),其次为耐碳青霉烯铜绿假单胞菌(30%,6/20);另有4例为多种CRGNB混合感染。所有患儿均采用多黏菌素B联合用药方式,以美罗培南为主(9例,45.0%),20例患儿均未观察到毒副反应。存在下呼吸道感染的15例患儿中,与单纯多黏菌素B静脉注射用药相比,增加局部雾化用药患儿的治愈率更高(P=0.002)。结论 多黏菌素B治疗儿童CRGNB感染的疗效和安全性值得肯定,但目前亟需更多、更大规模的临床研究做进一步探索和评估。
关键词: 多重耐药; 耐碳青霉烯革兰阴性杆菌; 多黏菌素B; 儿科重症监护病房
林良康 , 刘忠强 , 乔莉娜 , 李德渊 , 张海洋 . 多黏菌素B治疗儿童重症耐碳青霉烯革兰阴性杆菌感染用药分析[J]. 临床儿科杂志, 2023 , 41(8) : 578 -583 . DOI: 10.12372/jcp.2023.22e1184
Objective To evaluate the efficacy and safety of polymyxin B in the treatment of carbapenem-resistant Gram-negative bacteria (CRGNB) infection in children. Methods From July 2020 to December 2021, 32 cases of carbapenem-resistant Gram-negative bacteria infection in PICU with using polymyxin B were retrospectively analysed. Results 20 patients enrolled in the retrospective cohort, 11 males and 9 females, with a median age of 3.4 (0.6-8.9) years; 12 were cured and 1 died. The underlying diseases were most frequently haemato-oncological system diseases (30.0%). Infection specimens from 20 patients were mainly detected in sputum or bronchoalveolar lavage fluid (75%), followed by blood (10%). Carbapenem-resistant Klebsiella pneumoniae was the most frequently isolated organism (35.0%, 7/20), followed by carbapenem-resistant Pseudomonas aeruginosa with 30% (6/20). Another 4 cases were mixed infection of multiple carbapenem-resistant Gram-negative bacilli.. All children were treated with a polymyxin B combination, with meropenem as the mainstay (9 cases, 45.0%), and no adverse reactions were observed in 20 cases. Of the 15 children with lower respiratory tract infections, a higher cure rate was observed in children with the addition of topical nebulisation compared to the intravenous administration of polymyxin B alone (P=0.002).Conclusion The efficacy and safety of polymyxin B in the treatment of severe carbapenem-resistant Gram-negative bacterial infection in children is worthy of affirmation. However, more and large-scale clinical studies are urgently needed for further exploration and evaluation..
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