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美罗培南联合头孢哌酮／舒巴坦与米诺环素联合治疗泛耐药鲍曼不动杆菌性呼吸机相关肺炎的临床观察杨新良;刘玮;王雪松;刘永安;陈涵【摘要】Objective To observe the clinical effects of meropene and cefoperazone sulbactam associated with minocycline on the patients with ventilator-associated pneumonia caused by universal drug-resistant acinetobacter baumannii .Methods Forty-eight pa-tients with ventilator-associated pneumonia caused by PDRAB were respectively treated for a succession of 10 to 14 days with the follow-ing regimens:60-min intravenous infusion of 100 ml physiological saline +2 g meropene once every 8 hours;60-min intravenous infu-sion of 100 ml physiological saline +3 g cefoperazone sulbactam associated with minocycline also once every 8 hours;and 0.1g mino-cycline nasal gavage three times a day .Then, clinical therapeutic effects, bacterial clearance, hepatorenal function, C-reactive protein, calcitonin, blood routine and adverse drug reactions were observed closely .Results The clinical cure rate of combined drugs in the treatment of ventilator-associated pneumonia caused by universal drug-resistant acinetobacter baumannii was 62.50%, the effective rate was 75.00%, and the bacterial clearance rate was 62.50%, without obvious adverse drug reactions and effects on heptorenal function . Conclusion Combined treatment of meropene , cefoperazone sulbactam and minocycline could produce good effects on the patients with ventilator-associated pneumonia caused by universal drug-resistant acinetobacterbaumannii .%目的：观察美罗培南、头孢哌酮／舒巴坦、米诺环素联合治疗泛耐药鲍曼不动杆菌性呼吸机相关肺炎的临床疗效。
收稿日期：2015-01-08基金项目：国家科技部十二五重大新药创制-心脑血管疾病新药临床评价技术平台研究课题(No. 2012ZX09303-008-002)。
作者简介：钟雪，女，生于1988年，在读博士研究生，主要研究抗菌药物耐药机制。
E-mail: bhdxzhongxue@*通迅作者，胡欣，E-mail: huxinbjyy@ ；程刚，E-mail: chenggang63@文章编号：1001-8689(2015)11-0870-06替加环素研究新进展钟雪1,2 陈东科2 许宏涛2 程刚1,* 胡欣2,*(1 沈阳药科大学药学院， 沈阳 110016；2 北京医院药学部，北京 100730)摘要: 近年来随着广谱抗生素、免疫抑制剂、侵入性治疗的广泛应用，多重耐药菌、甚至泛耐药菌比例不断上升，给临床抗感染治疗带来了巨大困难。
替加环素这一具有对抗多种耐药机制的新型抗生素于2011年进入我国市场，为临床有效抗感染治疗带来了新的希望，也被誉为抗感染的最后一道防线。
随着国内外科研人员及临床医生不断探索，近些年对替加环素的认识又有了新的突破。
我们综述了近年来替加环素的研究进展，包括体外抗菌活性测定，耐药机制及应对措施，超适应症用药及使用剂量。
关键词： 替加环素；体外抗菌活性；耐药机制；适应症；剂量中图分类号：R978.1 文献标志码：A New advance in the study of tigecyclineZhong Xue 1,2, Chen Dong-ke 2, Xu Hong-tao 2, Cheng Gang 1 and Hu Xin 2(1 Department of Pharmaceutics, School of Pharmcy, Shenyang Pharmaceutical University, Shenyang 110016;2 Department of Pharmacy, Beijing Hospital, Beijing 100730)Abstract There is a huge challenge for clinical anti-infection treatment due to the increasing proportion of multidrug-resistant pathogens and pan drug-resistant pathogens caused by wide application of broad spectrum antibiotics, immunosuppressants and invasive treatment in recent years. Tigecycline, a new antimicrobial agent which can overcome multiple resistance mechanisms, was launched in China in 2011. It has brought new hope for clinical effective anti-infection treatment, and it has been known as the last line for anti-infection treatment. We have a new breakthrough understanding of tigecycline with continuously exploring by the domestic and foreign researchers and clinicians in recent years. In this article we reviewed advance of tigecycline in recent years, including antibacterial activity test in vitro , resistance mechanism and solutions, super indication and dosage.Key words Tigecycline; Susceptibility testing; Drug-resistance mechanism; Indication; Dosage 近年来耐药菌的检出率逐年增高，尤其是产超广谱β-内酰胺酶(ESBL)和AmpC 酶肠杆菌属及泛耐药的肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌的抗生素选择已成为世界抗感染治疗面临的严峻挑战。
替加环素治疗高龄老年院内获得性肺炎的疗效及安全性分析吴晓玲;王桦;汪琦;林宴晨;李晨芳;刘国栋【摘要】目的：观察替加环素治疗高龄老年院内获得性肺炎( HAP)耐药鲍曼不动杆菌感染的临床疗效与安全性。
方法筛选2014年6月-2015年8月我院老年病科应用替加环素治疗多重或泛耐药鲍曼不动杆菌感染的高龄HAP病例，收集患者临床相关资料，总结分析其临床、细菌学疗效及药物安全性。
结果共30例合格病例被纳入研究，分为两组：替加环素单药治疗组6例，临床有效3例，细菌清除1例。
替加环素为基础联合其他抗生素治疗组24例，临床有效15例，死亡1例；细菌清除10例。
临床总有效率为60%，细菌清除率36．7%。
治疗前后患者肝肾功能无明显变化，治疗过程中出现恶心、欲吐不良反应1例。
结论替加环素能有效改善高龄HAP耐药鲍曼不动杆菌感染患者的临床疗效，临床可尝试选用替加环素进行治疗，但同时需密切观察其不良反应。
%Objective To evaluate the efficacy and safety of tigecycline in the treatment of elderly patients with hospital-acquired pneumonia ( HAP) caused by drug resistant Acinetobacter baumannii. Methods All patients with HAP caused by multiple or extensive drug resistant Acinetobacter baumannii were screened out in our department of geriatrics from June 2014 to August 2015, and their clinical information were collected to analyze the clinicaleffi-cacy and drug safety. Results 30 eligible cases were enrolled in the study, and they were divided into two groups. The control group was only given tigecycline (n=6), and the study group was given tigecycline combined with other antibiotics (n=24). In the control group, there were 3 clnical effective cases and 1 microbiology cleared case. In the study group,there were 15 clinical effective cases, 10 microbiology cleared cases and 1 case died. The total clin-ical efficacy rate was 60%, and the bacteria clearance rate was 36. 7% respectively. The function of hepatic and re-nal didn't change obviously after treatment. 1 case showed adverse drug reaction of feeling nausea and vomiting. Con-clusion Tigecycline is effective in the treatment of elderly patients with HAP caused by drug resistant Acinetobacter baumannii. When the choice of antibiotics is limited, tigecycline can be applied, but its adverse reactions should be paid close attention.【期刊名称】《临床肺科杂志》【年(卷),期】2016(000)003【总页数】4页(P464-467)【关键词】替加环素;医院获得性肺炎;鲍曼不动杆菌【作者】吴晓玲;王桦;汪琦;林宴晨;李晨芳;刘国栋【作者单位】430071 湖北武汉，武汉大学中南医院老年科;430071 湖北武汉，武汉大学中南医院老年科;430071 湖北武汉，武汉大学中南医院老年科;430071 湖北武汉，武汉大学中南医院老年科;430071 湖北武汉，武汉大学中南医院老年科;430071 湖北武汉，武汉大学中南医院老年科【正文语种】中文【Abstract】ObjectiveTo evaluate the efficacy and safety of tigecycline in the treatment of elderly patients with hospital-acquired pneumonia (HAP) caused by drug resistant Acinetobacter bauma nnii. MethodsAll patients with HAP caused by multiple or extensive drug resistant Acinet obacter baumannii were screened out in our department of geriatrics from June 2014 to August 2015, and their clinical information were collected to analyze the clinical efficacy and drug safety. Results30 eligible cases were enrolled in the study, and they were divided into tw o groups. The control group was only given tigecycline (n=6), and the stud y group was given tigecycline combined with other antibiotics (n=24). In th e control group, there were 3 clnical effective cases and 1 microbiology cle ared case. In the study group, there were 15 clinical effective cases, 10 micr obiology cleared cases and 1 case died. The total clinical efficacy rate was 60%, and the bacteria clearance rate was 36.7% respectively. The function of hepatic and renal didn't change obviously after treatment. 1 case showe d adverse drug reaction of feeling nausea and vomiting. Conclusion Tigecycline is effective in the treatment of elderly patients with HAP cause d by drug resistant Acinetobacter baumannii. When the choice of antibioti cs is limited, tigecycline can be applied, but its adverse reactions should be paid close attention.【Key words】tigecycline; HAP; Acinetobacter baumannii院内获得性肺炎(HAP)是最常见的医院内感染，发病率和病死率逐年增高，其病死率高达30%～70%，是患者死亡的重要原因。
替加环素治疗呼吸机相关性肺炎患者泛耐药鲍氏不动杆菌感染的临床研究发表时间：2018-10-16T09:52:37.230Z 来源：《中国医学人文》2018年第10期 作者： 林春玉[导读] 观察分析替加环素治疗重症呼吸机相关性肺炎患者泛耐药鲍氏不动杆菌感染的临床疗效。
哈尔滨市传染病院 黑龙江哈尔滨 150030
【摘 要】目的 观察分析替加环素治疗重症呼吸机相关性肺炎患者泛耐药鲍氏不动杆菌感染的临床疗效。方法 选择我院2017年2月-2018年2月收治的确诊为泛耐药鲍氏不动杆菌重症呼吸机相关性肺炎的患者14例为研究对象，应用替加环素静脉滴注进行治疗，首次剂量为100mg，然后每次50mg，每日2次；同时联合应用舒巴坦或碳青霉烯类或单独用药，所有患者治疗时间为10-14d。观察治疗效果以及药物不良反应。结果 本组14例患者中，痊愈8例，占57.14%，好转4例，占28.57%，无效2例，占14.29%，总有效率为85.71%（12/14）。本次患者在临床症状改善方面，结果如下：明显改善9例，占64.29%，改善4例，占28.57%，死亡1例，占7.14%。本组14例患者中，出现消化道反应2例，主要的临床表现为呕吐以及排便次数增多；轻度肝功能损害4例，经护肝等对症治疗后完全缓解。所有患者的药物不良反应均比较轻微，均未对后续的治疗造成影响。结论 替加环素单独或联合用药治疗泛耐药鲍氏不动杆菌感染重症呼吸机相关性肺炎患者可以取得显著的临床疗效，安全性较高，值得临床推广应用。
【关键词】替加环素；泛耐药；鲍氏不动杆菌；重症；呼吸机相关性肺炎；临床效果 Clinical study of transcycline in the treatment of drug-resistant Pap infection in patients with ventilator-related pneumonia Abstract：objective：to observe and analyze the clinical efficacy of tetracycline in the treatment of patients with severe ventilator-related pneumonia with pap infection. Methods 14 patients with severe pneumonia-related pneumonia-resistant Botox were selected fortreatment from February 2017 to February 2018. The first dose was 100 MG，and then 50 mg each time，2 times daily. At the sametime，schubatine or carbene were combined or used alone，and all patients were treated for 10-14d. To observe the therapeutic effectand adverse drug reactions.Results Of the 14 patients in this group，8 were cured，accounting for 57.14 %，4 were improved，accounting for 28.57 %，2 were invalid，accounting for 14.29 %，and the total effective rate was 85.71 %（12/14）. The results of thispatient's improvement in clinical symptoms are as follows：9 cases，accounting for 64.29 %，4 cases，accounting for 28.57 %，and 1death，accounting for 7.14 %. Of the 14 patients in this group，2 had gastrointestinal reactions，the main clinical manifestations werevomiting and increased bowel movements. Mild liver damage in 4 cases was completely relieved after treatment with liver care. Theadverse drug reactions in all patients were relatively mild and did not affect subsequent treatment. Conclusion the single or combinedtreatment of tetracycline in patients with severe respiratory associated pneumonia with pap infection can achieve significant clinicalefficacy and safety，and is worthy of clinical application. [Keywords]：Tiacycline；Pan-resistance；Botox；Severe illness；Respiratory related pneumonia；Clinical effects
鲍氏不动杆菌（ABA）是导致重症监护室（ICU）医院感染性疾病的主要致病菌之一，发病率和病死率高，由于临床广谱抗菌药物应用，导致多药耐药、广泛耐药、全耐药ABA不断上升，加重了患者的痛苦，增加了患者的经济负担，对患者的康复造成严重的影响[1]。本文观察分析了替加环素治疗重症呼吸机相关性肺炎患者泛耐药鲍氏不动杆菌感染的临床疗效，现将研究结果报告如下。 1 资料与方法 1.1一般资料
选择我院2017年2月-2018年2月收治的确诊为泛耐药鲍氏不动杆菌重症呼吸机相关性肺炎的患者14例为研究对象，其中，男性患者9例，女性患者5例，年龄61-84岁，平均年龄（69.18±4.55）岁，病程1-6d，平均病程（3.3±0.8）d。
1.2治疗方法
所有患者在应用替加环素治疗前均分别应用头孢哌酮／舒巴坦、亚胺培南、美罗培南、哌拉西林／他唑巴坦、头孢吡肟、万古霉素以及利奈唑胺等抗菌药物进行治疗；一旦确诊为泛耐药ABA感染，即开始静脉滴注替加环素治疗，首次剂量为100mg/次，然后每次50mg；同时联合舒巴坦或碳青霉烯类或单独用药。所有患者均连续治疗10-14天。 1.3观察指标
观察本组患者的临床治疗效果：痊愈为患者感染的临床症状、体征、影像学检查及细菌学检查4项指标均恢复正常；好转为患者的临床症状、体征、影像学检查以及细菌性检查中仍有1项未恢复正常；无效为患者用药治疗72h后，病情未改善甚至加重。细菌学疗效评定：细菌清除：治疗中及停药后第１天细菌培养无病原菌生长；未清除：疗程结束后原病原菌依然存在。 1.4统计学处理
采用SPSS17.0软件对数据进行统计分析，计数资料率的组间比较分析采用x2检验，计量资料的组间比较采用t检验，当P<0.05时，为差异有统计学意义。 2 结果 2.1本组泛耐药ABA感染患者细菌清除率和疗效率
本组14例患者中，痊愈8例，占57.14%，好转4例，占28.57%，无效2例，占14.29%，总有效率为85.71%（12/14）。本次患者在临床症状改善方面，结果如下：明显改善9例，占64.29%，改善4例，占28.57%，死亡1例，占7.14%。
2.2本组患者药物不良反应情况
本组14例患者中，出现消化道反应2例，主要的临床表现为呕吐以及排便次数增多；轻度肝功能损害4例，经护肝等对症治疗后完全缓解。所有患者的药物不良反应均比较轻微，均未对后续的治疗造成影响。 3 讨论 ABA是不动杆菌属中最常见的非发酵、革兰阴性菌，系条件致病菌，广泛分布于医院环境，具有很强的在干燥环境生存的能力，可引起严重的医院获得性肺炎、血流感染、腹腔感染、中枢神经系统感染、泌尿系感染等；尤其是在ICU中，ABA临床分离率逐年上升。其中痰液标本最为多见，且出现了大量的多药耐药菌株甚至泛耐药菌株，原因在于ICU收住患者多为老年危重、机体免疫抵抗力差、人工气道建立和有创侵入性操作、糖皮质激素及长期超广谱抗菌药物应用，从而导致ABA诱导和筛选产生多药耐药性产生；同时由于医院感染认知及执行力度薄弱和病区住院环境条件的限制，导致患者交叉感染，是造成ICU暴发多耐药及泛耐药ABA的主要原因[2]。ABA虽然属条件致病菌、致病力弱，但其耐药速度快，尤其在ICU，泛耐药ABA成为医院感染的标志菌。替加环素为新一代四环素类抗菌药物，系甘氨酰环素类抗菌药物，结构独特，通过与核糖体30S亚单位结合，阻止氨酰化tRNA分子进入核糖体A位而抑制细菌蛋白质的合成，克服大多数细菌对四环素耐药机制的产生，因其不受 β-内酰胺酶、靶位修饰、大环内酯类抗菌药物外排泵或酶靶位改变等耐药机制的影响，具有抗菌谱广、抗菌活性更强的特点[3]。本次研究结果显示，本组14例患者中，痊愈8例，占57.14%，好转4例，占28.57%，无效2例，占14.29%，总有效率为85.71%（12/14）。本次患者临床症状明显改善9例，占64.29%，改善4例，占28.57%，死亡1例，占7.14%。所有患者的药物不良反应均比较轻微，均未对后续的治疗造成影响。综上所述，替加环素单独或联合用药治疗泛耐药鲍氏不动杆菌感染重症呼吸机相关性肺炎患者可以取得显著的临床疗效，安全性较高，值得临床推广应用。参考文献：[1]蒙光义，彭评志，冯桂湘.替加环素治疗鲍曼不动杆菌感染的研究进展[J].临床合理用药，2017，10（6c）：163-165. [2]何群，朱宇，蒋芬芬，等.替加环素治疗呼吸机相关性肺炎患者泛耐药鲍氏不动杆菌感染的临床研究[J].中华医院感染学杂志，2016，26（6）：1229-1231.
[3]薄晓霞，刘丽菲，刘颖，等.替加环素联合舒巴坦及法罗培南治疗耐药性老年呼吸机相关性肺炎疗效观察[J].中华实用诊断与治疗杂志，2017，31（2）：172-173.
