替加环素治疗血液疾病并发感染的疗效

doi:10.3877/cma.j.issn.1674-1358.2016.02.020

目的

探讨替加环素治疗血液疾病并发感染的疗效。

方法

本院2011年1月至2015年1月收治的血液疾病并发感染者共80例，按用药情况分为更换替加环素组（36例）和初始即联合其他抗菌药物组（44例）。两组患者治疗后进行疗效评价，治疗过程观察患者肝肾功能，同时记录其症状、体征的变化和药物不良反应等。

结果

80例患者中发生粒细胞缺乏者26例（32.50%），中性粒细胞缺乏时间为2～65 d，平均（18.5 ± 16.5）d。68例（85.00%）患者发热，发热持续时间1～52 d，平均（10.5 ± 8.5）d。共检测出41株菌株，其中27株（65.85%）革兰阴性菌、13株（31.71%）革兰阳性菌和1株（2.44%）真菌。1株肺炎克雷伯菌对替加环素耐药，耐药率为33.33%，1株凝固酶阴性葡萄球菌对替加环素耐药，耐药率为16.67%，其余菌株均对替加环素敏感。80例患者治愈2例，好转55例（总有效率为71.25%），无效13例，死亡10例。更换替加环素组和初始即联合其他抗菌药物组总有效率分别为72.22%和70.45%，总有效率差异无统计学意义（χ² = 0.265，P > 0.05）。不良反应轻，主要为消化道不适等症状。

结论

替加环素以抗菌谱广、抗菌活性强的特点，可作为血液疾病继发感染者替补方案或经验治疗的选择，具有良好的疗效和安全性。

关键词: 替加环素, 血液疾病, 感染

Objective

To investigate the effect of tigecycline in treatments on patients with blood disease complicated with infection.

Methods

Total of 80 cases with blood diseases and infection in our hospital from January 2011 to January 2015 were divided into changed tigecycline group (36 cases) and originally combined using tigecycline and other antibiotics group (44 cases). The curative efficiency, liver and rental function, symptom and adverse effects were determined, respectively.

Results

There were 26 (32.50%) cases with agranulocytosis for 2-65 d, with the mean time of (18.5 ± 16.5) d. While 68 (85.00%) cases were with fever; the fever time were 1-52 d, with the average of (10.5 ± 8.5) d. Total of 41 strains were detected, including 27 (65.85%) strains of Gram-negative bacteria, 13 strains (31.71%) of Gram-positive bacteria and 1 (2.44%) strain of fungi. One strain of Klebsiella pneumoniae and one strain of coagulase negative Staphylococcus were resistant against tigecycline, with the resistance rate as 33.33% and 16.67%, respectively. Total of 2 patients were cured and 55 cases were improved, with the total effective rate of 71.25%. The total effective rates of tigecycline group and originally combined using tigecycline and other antibiotics group were 72.22% and 70.45%, respectively, with no significant difference (χ² = 0.265, P > 0.05). Adverse reaction was mild due to mostly gastrointestinal symptoms.

Conclusions

Tigecycline, with wide antibiotic spectrum and high antimicrobial activities, could be used as a supplement treatment for patients with blood diseases and infection, with good curative effect and safety.

Key words: Tigecycline, Blood diseases, Infection

表1 病原菌分布及构成比

病原菌		株数	构成比（%）
革兰阴性菌		27	65.85
	鲍曼不动杆菌	9	21.95
	铜绿假单胞菌	7	17.07
	大肠埃希菌	4	9.76
	肺炎克雷伯菌	3	7.32
	洛菲不动杆菌	2	4.88
	嗜麦芽窄食单胞菌	2	4.88
革兰阳性菌		13	31.71
	凝固酶阴性葡萄球菌	6	14.63
	金黄色葡萄球菌	2	4.88
	表皮葡萄球菌	2	4.88
	屎肠球菌	1	2.44
	粪肠球菌	1	2.44
	溶血葡萄球菌	1	2.44
真菌		1	2.44
	热带假丝酵母菌	1	2.44
合计		41	100.00

表1 病原菌分布及构成比

病原菌		株数	构成比（%）
革兰阴性菌		27	65.85
	鲍曼不动杆菌	9	21.95
	铜绿假单胞菌	7	17.07
	大肠埃希菌	4	9.76
	肺炎克雷伯菌	3	7.32
	洛菲不动杆菌	2	4.88
	嗜麦芽窄食单胞菌	2	4.88
革兰阳性菌		13	31.71
	凝固酶阴性葡萄球菌	6	14.63
	金黄色葡萄球菌	2	4.88
	表皮葡萄球菌	2	4.88
	屎肠球菌	1	2.44
	粪肠球菌	1	2.44
	溶血葡萄球菌	1	2.44
真菌		1	2.44
	热带假丝酵母菌	1	2.44
合计		41	100.00

表2 不同组别患者替加环素治愈率比较

组别	例数	治愈（例）	好转（例）	无效（例）	死亡（例）	总有效率（%）
更换替加环素组	36	1	25	6	4	72.22
初始即联合其他抗菌药物组	44	1	30	7	6	70.45

表2 不同组别患者替加环素治愈率比较

组别	例数	治愈（例）	好转（例）	无效（例）	死亡（例）	总有效率（%）
更换替加环素组	36	1	25	6	4	72.22
初始即联合其他抗菌药物组	44	1	30	7	6	70.45

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Effect of tigecycline in treatments on patients with blood diseases complicated with infection

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Effect of tigecycline in treatments on patients with blood diseases complicated with infection