Page 74 - 《中国药房》2023年16期

头孢他啶阿维巴坦钠治疗碳青霉烯类耐药革兰氏阴性菌感染的

疗效与安全性
Δ

毛娇娇 ，曹国文，朱 珠，陶 宏，许 峰（苏州大学附属第二医院药学部，江苏 苏州 215004）
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中图分类号 R978.1+1 文献标志码 A 文章编号 1001-0408（2023）16-1984-05
DOI 10.6039/j.issn.1001-0408.2023.16.12

摘 要 目的 观察头孢他啶阿维巴坦钠（CAZ/AVI）治疗碳青霉烯类耐药革兰氏阴性菌（CRO）感染的疗效和安全性。方法 回顾
性收集 2019 年 9 月－2022 年 3 月在苏州大学附属第二医院住院治疗的 CRO 感染患者的资料，根据治疗方案的不同分为对照组
（48 例）和观察组（48 例）。对照组患者静脉滴注注射用硫酸多黏菌素 B 50 万单位，q12 h，其中肾功能不全或接受肾脏代替治疗
（CRRT）者不进行剂量调整；观察组患者以微量泵持续静脉泵入注射用CAZ/AVI 2.5 g，q8 h，持续2 h，其中肾功能不全者根据肌酐
清除率调整剂量，接受CRRT者不进行剂量调整。比较两组患者的临床疗效、微生物学疗效和治疗前后的体温、白细胞（WBC）、C
反应蛋白（CRP）、降钙素原（PCT），记录其预后情况和不良反应发生情况；通过Logistic回归分析筛选影响疗效的因素。结果 观
察组患者的有效率、微生物清除率均显著高于对照组（P＜0.05）。治疗后，两组患者的体温、PCT、CRP均显著低于同组治疗前，且
观察组CRP显著低于同期对照组（P＜0.05）；两组的康复出院、转普通病房、死亡患者比例及总不良反应发生率比较，差异均无统
计学意义（P＞0.05）。使用 CAZ/AVI、延长用药疗程可能实现临床获益（比值比分别为 1.146、7.707，P＜0.05），肺部感染、接受
CRRT可能是导致治疗失败的独立危险因素（比值比分别为0.182、0.236，P＜0.05）。结论 CAZ/AVI治疗CRO感染的疗效和安全
性均较好，适当延长用药疗程可能会获得更高的有效率，而肺部感染或接受CRRT可能会导致治疗失败。
关键词 头孢他啶阿维巴坦钠；碳青霉烯类耐药革兰阴性菌；感染；疗效；安全性

Efficacy and safety of ceftazidime and avibactam sodium in the treatment of carbapenem-resistant
organism infection
MAO Jiaojiao，CAO Guowen，ZHU Zhu，TAO Hong，XU Feng（Dept. of Pharmacy， the Second Affiliated
Hospital of Soochow University， Jiangsu Suzhou 215004， China）

ABSTRACT OBJECTIVE To observe the efficacy and safety of ceftazidime and avibactam sodium （CAZ/AVI） in the treatment
of carbapenem-resistant organism （CRO） infection. METHODS The information of patients with CRO infection admitted to the
Second Affiliated Hospital of Soochow University from September 2019 to March 2022 was collected， and the patients were
retrospectively divided into observation group （48 cases） and control group （48 cases） according to the treatment plan. The control
group was given Polycolistin B sulfate for injection intravenously at a dose of 500 000 U every 12 hours； no dose adjustment was
performed in patients with renal insufficiency or receiving continuous renal replacement therapy （CRRT）. The observation group
was given continuous micropump of CAZ/AVI for injection intravenously at a dose of 2.5 g every 8 hours for 2 continous hours；
among them， the patients with renal insufficiency received an adjusted dose based on creatinine clearance， and no dose adjustment
was performed in patients receiving CRRT. The clinical efficacy and microbiological efficacy as well as body temperature， white
blood cell （WBC）， C-reactive protein （CRP） and procalcitonin （PCT） before and after treatment were compared between 2
groups. The prognosis and the occurrence of adverse drug reactions were recorded. The factors influencing the clinical efficacy were
screened by Logistic regression analysis. RESULTS The effective rate and microbial clearance rate of the observation group were
significantly higher than the control group （P＜0.05）. After treatment， body temperature， PCT and CRP of 2 groups were
significantly lower than before treatment， and CRP of the
Δ 基金项目 江苏省研究型医院学会精益化用药-石药专项科研基
observation group was significantly lower than the control
金项目（No.JY202015）；苏州大学附属第二医院科研预研基金项目
（No.SDFEYJLC2105） group （P＜0.05）. There was no statistically significant difference
＊第一作者 主管药师，硕士。研究方向：临床药学。电话：0512- between the two groups in terms of rehabilitation discharge
67783646。E-mail：maojiaojiao1989@126.com
rate， the proportion of patients transferred to general wards，
# 通信作者 副主任药师。研究方向：临床药学。电话：0512-
67783646。E-mail：xfsq@sina.com the proportion of dead patients， and the total incidence of

· 1984 · China Pharmacy 2023 Vol. 34 No. 16 中国药房 2023年第34卷第16期