目的 評估多黏菌素B對兒童耐碳青霉烯革蘭陰性菌(CR-GNB)所致醫(yī)院獲得性肺炎的情況分析。方法 回顧性分析鄭州大學(xué)附屬兒童醫(yī)院2018年5月-2021年12月收治的52例使用多黏菌素B治療CR-GNB所致醫(yī)院獲得性肺炎患兒的信息,記錄每位患兒的臨床資料、用藥信息、實(shí)驗(yàn)室檢查結(jié)果及用藥過程中出現(xiàn)的不良反應(yīng)。結(jié)果 52例患兒中男性28例,女性24例;年齡中位數(shù)為12個(gè)月。共檢出55株病原菌,鮑曼不動(dòng)桿菌34株,肺炎克雷伯菌20株,陰溝腸桿菌1株;其中3例為肺炎克雷伯菌合并鮑曼不動(dòng)桿菌?；純褐委熎骄鶗r(shí)間為(13.9±5.9) d,總體有效率為53.8%,細(xì)菌清除率為30.8%,總死亡率為32.7%。有效組和無效組之間細(xì)菌清除率無統(tǒng)計(jì)學(xué)意義;但有效組多黏菌素B治療時(shí)間明顯長于無效組(P<0.05)。不良反應(yīng)發(fā)生率13.5%,臨床表現(xiàn)為急性腎損傷、皮膚色素沉著和嗜酸性粒細(xì)胞增多。結(jié)論 多黏菌素B可作為兒童CR-GNB所致醫(yī)院獲得性肺炎的一種選擇,但仍需大樣本、多中心、設(shè)計(jì)良好的隨機(jī)對照研究來進(jìn)一步驗(yàn)證。

Objective To evaluate the effect of polymyxins B on hospital acquired pneumonia caused by carbapenem-resistant gramnegative bacteria (CR-GNB) in children.Methods A retrospective study was conducted on 52 children with hospital acquired pneumonia treated with polymyxin B for CR-GNB infection in a tertiary hospital from May 2018 to December 2021. Demographic characteristics, medical information, laboratory tests and adverse drug reactions were collected.Results Among the 52 children, 28 cases were male, 24 cases were female, with a median age of 12 months. A total of 55 pathogenic bacteria were detected, including Acinetobacter baumannii (34 cases), Klebsiella pneumoniae (20 cases) and Enterobacter cloacae (1 case), among which three patients were dual infection with Klebsiella pneumoniae and Acinetobacter baumannii. The mean treatment duration was (13.9 ±5.9) d. After treatment with polymyxin B, the clinical efficiency rate was 53.8%, the bacterial clearance rate was 30.8%, and the mortality rate was 32.7%. There was no statistical significance in the bacterial clearance rate between the favorable clinical response group and the unfavorable clinical response group. However, the treatment duration of favorable clinical response group was significantly longer than that of unfavorable clinical response group (P < 0.05). The rate of adverse reaction was 13.5%, mainly manifested as acute kidney injury, skin hyperpigmentation and eosinophilia.Conclusion Polymyxin B can be considered an alternative for the treatment of hospital acquired pneumonia due to CR-GNB in children. However, additional large scale, multicenter and well-designed randomized controlled studies are needed to confirm the conclusions.

R978.1

河南省醫(yī)學(xué)科技攻關(guān)計(jì)劃項(xiàng)目(2018020694);河南省科技攻關(guān)項(xiàng)目(222102310574)