Page 87 - 《中国药房》2023年4期

多黏菌素B治疗血液系统恶性肿瘤伴CRKP-BSI的临床观察
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李 纳 1， 2， 3＊ ，刘 楠 1， 2， 3 ，张爱玲 1， 2， 3 ，李 丽 ，万鼎铭 ，张晓坚 1， 2， 3 # （1.郑州大学第一附属医院药学部，郑州
450052；2.河南省精准临床药学重点实验室，郑州 450052；3.河南省精准临床药学应用与转化工程研究中心，
郑州 450052；4.郑州大学第一附属医院血液科，郑州 450052）

中图分类号 R978.1 文献标志码 A 文章编号 1001-0408（2023）04-0461-06
DOI 10.6039/j.issn.1001-0408.2023.04.15

摘 要 目的 分析多黏菌素 B 治疗血液系统恶性肿瘤伴耐碳青霉烯类肺炎克雷伯菌（CRKP）-血流感染（BSI）的有效性和安全
性。方法 回顾性分析2019年9月－2021年6月于我院接受至少3 d多黏菌素B治疗的血液系统恶性肿瘤伴CRKP-BSI患者的资
料。所有患者初始均采用以多黏菌素B+替加环素+碳青霉烯类药物为基础的三联治疗方案。结果 共纳入10例患者，血培养检
出 11 株 CRKP，其中 10 株 CRKP 产肺炎克雷伯菌碳青霉烯酶（KPC），1 株 CRKP 同时产 KPC 和金属 β-内酰胺酶；9 株对黏菌素敏
感，7株对替加环素敏感，5株对阿米卡星敏感，2株对复方磺胺甲噁唑敏感。所有患者均伴有中性粒细胞减少，平均持续时间为
（14.1±6.4）d；均表现为发热、寒颤、乏力。经治疗后，有6例患者治愈出院，4例患者因感染性休克治疗无效死亡；所有患者未发生
多黏菌素B相关的严重不良事件。结论 多黏菌素B可作为血液系统恶性肿瘤伴CRKP-BSI患者的治疗用药，治疗期间均未发生
多黏菌素B相关的严重不良事件。
关键词 多黏菌素B；耐碳青霉烯类肺炎克雷伯菌；血液系统恶性肿瘤；血流感染；疗效；安全性

Clinical observation of polymyxin B in the treatment of CRKP-BSI in patients with hematological
malignancies
LI Na 1， 2， 3 ，LIU Nan 1， 2， 3 ，ZHANG Ailing 1， 2， 3 ，LI Li ，WAN Dingming ，ZHANG Xiaojian 1， 2， 3 （1. Dept. of
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Pharmacy， the First Affiliated Hospital of Zhengzhou University， Zhengzhou 450052， China；2. Henan
Provincial Key Laboratory of Precision Clinical Pharmacy， Zhengzhou 450052， China；3. Henan Provincial
Precision Clinical Pharmacy Application and Transformation Engineering Research Center， Zhengzhou 450052，
China；4. Dept. of Hematology， the First Affiliated Hospital of Zhengzhou University， Zhengzhou 450052，
China）

ABSTRACT OBJECTIVE To analyze the efficacy and safety of polymyxin B in the treatment of carbapenem-resistant Klebsiella
pneumoniae （CRKP）-bloodstream infection （BSI） in patients with hematologic malignancies. METHODS The medical records of
patients with hematologic malignancies with CRKP-BSI who received polymyxin B for at least 3 days in our hospital from
September 2019 to June 2021 were retrospectively analyzed. All patients were initially treated with a triple therapy namely
polymyxin B+tigecycline+carbapenems for anti-infection therapy. RESULTS A total of 10 patients were enrolled as the study
subjects. Eleven strains of CRKP were cultured in blood， including 10 strains of CRKP produced Klebsiella pneumoniae
carbapenemase（KPC） and 1 strain of CRKP produced both KPC and metal-beta-lactamase； 9 strains were sensitive to colistin， 7
strains were sensitive to tigecycline， 5 strains were sensitive to amikacin and 2 strains were sensitive to compound
sulfamethoxazole. All patients were accompanied by neutropenia， with an average duration of （14.1±6.4） days. They were all
characterized by fever， chills and fatigue. After treatment， 6 patients were cured and discharged， 4 patients died of ineffective
treatment of septic shock. No serious adverse events related to polymyxin B occurred in all patients. CONCLUSIONS Polymyxin B
can be used as a therapeutic drug for CRKP-BSI in patients with hematological malignancies. No serious adverse event related to
polymyxin B occurs during the treatment.
KEYWORDS polymyxin B； carbapenem-resistant Klebsiella pneumoniae； hematologic malignancy； bloodstream infection；
therapeutic efficacy； safety

随着碳青霉烯类药物在临床广泛和（或）不合理使
Δ 基金项目 重大新药创制科技重大专项（No.2020ZX09201009） 用，耐碳青霉烯类肺炎克雷伯菌（carbapenem-resistant
＊第一作者 主管药师，硕士。研究方向：临床药学、药动学。电 Klebsiella pneumoniae，CRKP）不断出现，患者一旦感染，
话：0371-66295644。E-mail：linafun08@126.com
# 通信作者 主 任 药 师 。 研 究 方 向 ：医 院 药 学 。 电 话 ：0371- 可选择的治疗药物有限，给临床抗感染治疗带来了巨大
[1]
66295644。E-mail：zhxj0524@sina.com 挑战 。血液系统恶性肿瘤患者是CRKP感染的高危人

中国药房 2023年第34卷第4期 China Pharmacy 2023 Vol. 34 No. 4 · 461 ·