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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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| 篇名： | 多黏菌素B治疗血液系统恶性肿瘤伴CRKP-BSI的临床观察 |
| TITLE： | Clinical observation of polymyxin B in the treatment of CRKP-BSI in patients with hematological malignancies |
| 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3d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。 |
| 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. |
| 期刊： | 2023年第34卷第04期 |
| 作者： | 李纳；刘楠；张爱玲；李丽；万鼎铭；张晓坚 |
| AUTHORS： | LI Na，LIU Nan，ZHANG Ailing，LI Li，WAN Dingming，ZHANG Xiaojian |
| 关键字： | 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 |
| KEYWORDS： | polymyxin B； carbapenem-resistant Klebsiella pneumoniae； hematologic malignancy； bloodstream infection； |
| 阅读数： | 639 次 |
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