今日药学

2021, v.31(07) 548-552

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替加环素治疗成人危重症感染患者的疗效影响因素分析
Analysis of Influencing Factors of Tigecycline in the Treatment of Adult Patients with Critical Illness

宋静楠;李佳;翟嘉倩;唐朝霞;杨廉平;何秋毅;陈杰;陈孝;
SONG Jingnan;LI Jia;ZHAI Jiaqian;TANG Zhaoxia;Yang Lianping;HE Qiuyi;CHEN Jie;CHEN Xiao;Department of Pharmacy,the First Affiliated Hospital of Sun Yat-Sen University;Xin Hua College of Sun Yat-Sen University;Department of Intensive Care Unit,the First Affiliated Hospital of Sun Yat-Sen University;School of Public Health,Sun Yat-Sen University;

摘要(Abstract):

目的分析替加环素(Tigecycline)治疗成人危重症感染患者的疗效影响因素。方法回顾性分析广州某三甲综合医院2018年10月~2020年10月入住ICU并使用替加环素的病例资料,调查替加环素治疗重症感染的有效率,用单因素和多因素逐步Logistic回归分析影响疗效的危险因素,并用COX回归分析影响预后的危险因素。结果通过统一的纳入和排除标准筛选符合要求的病例共249例,替加环素治疗总有效率为79.92%,微生物清除率为47.48%。疗程和CRRT为疗效的影响因素,国产(海正力星)和进口替加环素的疗效无明显差异(P>0.05)。替加环素治疗有效的疗程应>5 d(AUC 0.713,95%CI:0.652~0.768)。替加环素治疗28 d的全因死亡率为18.88%,APACHEⅡ高评分、CRRT和肺部感染为独立的危险因素,延长疗程有利于降低死亡率。不良反应发生率为16.47%。结论替加环素可作为治疗危重症感染的选择之一,国产(海正力星)与进口(泰阁)替加环素均有较好疗效,适当延长疗程有利于改善临床结果。
OBJECTIVE To analyze the influencing factors of tigecycline in the treatment of critically ill adults. METHODS A retrospective study was performed in critically ill patients treated with tigecycline between October 2018 and October 2020 at a tertiary hospital in Guangzhou. The efficacy of tigecycline was investigated, and risk factors were identified via univariate and multivariate logistic regression analysis. Cox regression analysis was performed for identification of independent prognostic factor. RESULTS A total of 249 cases were screened out by the inclusion and exclusion criteria. The total effective rate of tigecycline treatment was 79.92% and the microbial clearance rate was 47.48%. Treatment course and CRRT were the influencing factors of the curative effect. The effective course of tigecycline therapy would be more than 5 days(AUC 0.713, 95% CI:0.652-0.768). There was no significant difference in the efficacy between the imported and domestic(Hai zheng li xing) groups(P>0.05). The all-cause mortality rate for treatment with tigecycline for 28 days was 18.88%. High APACHE Ⅱ scores, CRRT, and pneumonia were independent risk factors, and prolonged treatment was associated with reduced mortality. The rate of adverse reactions was 16.47%. CONCLUSION Tigecycline is a potential choice to treat severe infection in critically ill adults. Both imported and domestic(Hai zheng li xing) tigecycline have good efficacy and a longer duration of tigecycline treatment might be beneficial to improve the clinical outcomes.

关键词(KeyWords): 替加环素;危重症患者;感染;疗效;死亡率
tigecycline;critically ill patients;infection;efficacy;mortality

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基金项目(Foundation): 广东省临床用药研究基金(2020ZJ08)

作者(Author): 宋静楠;李佳;翟嘉倩;唐朝霞;杨廉平;何秋毅;陈杰;陈孝;
SONG Jingnan;LI Jia;ZHAI Jiaqian;TANG Zhaoxia;Yang Lianping;HE Qiuyi;CHEN Jie;CHEN Xiao;Department of Pharmacy,the First Affiliated Hospital of Sun Yat-Sen University;Xin Hua College of Sun Yat-Sen University;Department of Intensive Care Unit,the First Affiliated Hospital of Sun Yat-Sen University;School of Public Health,Sun Yat-Sen University;

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