目的 比較注射用美羅培南和注射用頭孢哌酮鈉舒巴坦鈉治療產(chǎn)超廣譜β-內(nèi)酰胺酶（ESBLs）腸桿菌科細(xì)菌血流感染患者的成本和療效，為合理用藥提供參考。方法 回顧性統(tǒng)計(jì)分析合肥市第一人民醫(yī)院濱湖院區(qū)2020年1月—2022年5月產(chǎn)ESBLs腸桿菌科細(xì)菌血流感染患者病歷，在綜合考慮治療效果和藥品不良反應(yīng)基礎(chǔ)上，運(yùn)用最小成本分析法進(jìn)行藥物經(jīng)濟(jì)學(xué)評(píng)價(jià)。結(jié)果 分別納入美羅培南組（A組）和頭孢哌酮鈉舒巴坦鈉組（B組）患者67例和68例，兩組一般情況無顯著性差異。經(jīng)抗菌藥物治療后，兩組總有效率（95.52% vs 98.53%，P＝0.303）、細(xì)菌清除率（95.52% vs 97.06%，P＝0.636）均無顯著性差異；兩組抗菌藥物停用后炎癥指標(biāo)C反應(yīng)蛋白（CRP）分別為5.97、6.82 mg·L^-1（P＝0.391）、降鈣素原（PCT）分別為0.29、0.21 ng·mL^-1（P＝0.228），差異無統(tǒng)計(jì)學(xué)意義；兩組體溫及白細(xì)胞恢復(fù)正常時(shí)間、抗菌藥物療程和住院時(shí)間也未見顯著性差異，兩治療組均未見嚴(yán)重不良反應(yīng)。采用最小成本分析法對(duì)兩組行成本效果分析，結(jié)果提示A組直接醫(yī)療成本稍高于B組（25 725.95元vs 25 277.62元，P＝0.914），其中藥品費(fèi)用、檢查治療費(fèi)、床位護(hù)理費(fèi)A組均高于B組，差異無統(tǒng)計(jì)學(xué)意義。結(jié)論 美羅培南和頭孢哌酮/舒巴坦治療產(chǎn)ESBLs腸桿菌科細(xì)菌血流感染的臨床療效和安全性相當(dāng)，頭孢哌酮/舒巴坦稍有經(jīng)濟(jì)優(yōu)勢(shì)。

Objective To compare the cost and efficacy of meropenem and cefoperazone/sulbactam in the treatment of ESBLs producing Enterobacteriaceae bacterial bloodstream infections, and provide reference for rational drug use. Methods A retrospective statistical analysis was conducted on the medical records of patients with ESBLs and Enterobacteriaceae bloodstream infections in BinHu District of Hefei First People's Hospital from January 2020 to May 2022. Based on comprehensive consideration of treatment efficacy and adverse drug reactions, cost-minimization analysis method was used for pharmacoeconomic evaluation. Results A total of 67 cases and 68 cases of ESBLs producing Enterobacteriaceae bacterial bloodstream infections were collected in the treatment with meropenem (group A) and cefoperazone/sulbactam (group B), respectively. There was no significant difference in the general situation between the two groups. After treatment with antibiotics, there was no significant difference in the effective rate (95.52% vs 98.53%, P = 0.303) and bacterial clearance rate (95.52% vs 97.06%, P = 0.636) between the two groups. After discontinuation of the two antibacterial drugs, the CRP indicators were 5.97 and 6.82 mg · L^-1, respectively (P = 0.391), and the PCT indicators were 0.29 and 0.21 ng·mL^-1, respectively (P = 0.228), with no statistically significant difference in the inflammatory indicators. There was no significant difference in the recovery time of body temperature and white blood cell, duration of antimicrobial treatment and length of hospital stay between the two groups. Neither treatment group had serious adverse reactions. Therefore, a cost-effectiveness analysis was conducted using the cost-minimization analysis method for both groups. The results showed that the direct medical cost of the meropenem group was slightly higher than that of the cefoperazone/sulbactam group (25 725.95 yuan vs 25 277.62 yuan, P = 0.914), while the drug costs, the examination and treatment costs and the nursing and bed expenses of the Meropenem group were all higher than those of the cefoperazone/sulbactam group, and the difference was not statistically significant. Conclusion The clinical efficacy and safety of meropenem and cefoperazone/sulbactam in the treatment of producing ESBLs bloodstream infection were comparable, while cefoperazone/sulbactam had slight economic advantages.

R978.1