头孢哌酮/舒巴坦治疗产ESBLs大肠埃希菌感染的疗效观察
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摘要
目的探讨头孢哌酮/舒巴坦治疗产超广谱β-内酰胺酶(ESBLs)大肠埃希菌感染的临床疗效。方法选择2018年1月至2019年3月期间东莞市中医院细菌培养显示产ESBLs大肠埃希菌的非重症住院患者80例为研究对象,根据随机数表法分为观察组与对照组,每组40例。对照组患者采用哌拉西林/他唑巴坦抗感染治疗,观察组则采用头孢哌酮/舒巴坦治疗,疗程至末次细菌培养阳性,以及感染相关的症状体征好转后的7～14 d。比较两组患者治疗前后的血白细胞计数(WBC)、C反应蛋白(CRP)及降钙素原(PCT)水平,以及临床疗效和微生物学疗效。结果治疗14 d后,观察组患者的血WBC计数、CRP及PCT水平分别为(11.38±3.53)×10~9/L、(7.09±2.51) mg/L、(0.92±0.32) ng/mL,对照组分别为(10.42±3.29)×10~9/L、(6.58±2.32) mg/L、(0.81±0.38) ng/mL,与治疗前比较均明显降低,差异均有统计学意义(P<0.05),但治疗后,两组患者的WBC计数、CRP及PCT水平比较差异均无统计学意义(P>0.05);观察组患者临床有效率及细菌清除率分别为80.00%、82.50%,与对照组的85.00%、97.50%比较差异均无统计学意义(P>0.05)。结论头孢哌酮/舒巴坦治疗产ESBLs大肠埃希菌感染的疗效与哌拉西林/他唑巴坦的疗效相近,临床上可根据情况选择应用。
Objective To investigate the clinical efficacy of cefoperazone/sulbactam in the treatment of extended-spectrum β-lactamase(ESBLs)-producing Escherichia coli infection. Methods Eighty inpatients with non-severe ESBLs-producing Escherichia coli infection from January 2018 to March 2019 in Dongguan Hospital of Traditional Chinese Medicine were selected as the study subjects. According to the random number table, they were divided into observation group and control group, with 40 cases in each group. The control group was treated with piperacillin/tazobactam anti-infection therapy, while the observation group was treated with cefoperazone/sulbactam. The treatment lasted until 7 to 14 days after positive bacterial culture and improvement of symptoms and signs associated with infection. The changes of white blood cell count(WBC), C-reactive protein(CRP), procalcitonin(PCT) levels before and after treatment,clinical efficacy, and microbiological efficacy were compared between the two groups. Results After 14 days of treatment, the WBC count, CRP, and PCT levels were(11.38±3.53)×10~9/L,(7.09±2.51) mg/L,(0.92±0.32) ng/m L in the observation group, and(10.42±3.29)×10~9/L,(6.58±2.32) mg/L,(0.81±0.38) ng/m L in the control group, which were significantly lower than those before treatment(P<0.05); After treatment, there was no significant difference in WBC count, CRP,and PCT levels between the two groups(P>0.05). The clinical effective rate and bacterial clearance rate of the observation group were 80.00% and 82.50%, respectively, which showed no significant difference with 85.00% and 97.50% in the control group(P>0.05). Conclusion Cefoperazone/sulbactam and piperacillin/tazobactam have similar effects in the treatment of ESBLs-producing Escherichia coli infection, which should be chosen according to the situation.
Objective To investigate the clinical efficacy of cefoperazone/sulbactam in the treatment of extended-spectrum β-lactamase(ESBLs)-producing Escherichia coli infection. Methods Eighty inpatients with non-severe ESBLs-producing Escherichia coli infection from January 2018 to March 2019 in Dongguan Hospital of Traditional Chinese Medicine were selected as the study subjects. According to the random number table, they were divided into observation group and control group, with 40 cases in each group. The control group was treated with piperacillin/tazobactam anti-infection therapy, while the observation group was treated with cefoperazone/sulbactam. The treatment lasted until 7 to 14 days after positive bacterial culture and improvement of symptoms and signs associated with infection. The changes of white blood cell count(WBC), C-reactive protein(CRP), procalcitonin(PCT) levels before and after treatment,clinical efficacy, and microbiological efficacy were compared between the two groups. Results After 14 days of treatment, the WBC count, CRP, and PCT levels were(11.38±3.53)×10~9/L,(7.09±2.51) mg/L,(0.92±0.32) ng/m L in the observation group, and(10.42±3.29)×10~9/L,(6.58±2.32) mg/L,(0.81±0.38) ng/m L in the control group, which were significantly lower than those before treatment(P<0.05); After treatment, there was no significant difference in WBC count, CRP,and PCT levels between the two groups(P>0.05). The clinical effective rate and bacterial clearance rate of the observation group were 80.00% and 82.50%, respectively, which showed no significant difference with 85.00% and 97.50% in the control group(P>0.05). Conclusion Cefoperazone/sulbactam and piperacillin/tazobactam have similar effects in the treatment of ESBLs-producing Escherichia coli infection, which should be chosen according to the situation.
引文
[1]殷翠香,史瑀,陆德生. 2014—2016年产超广谱-β内酰胺酶细菌耐药趋势分析[J].国际检验医学杂志, 2017, 38(24):3445-3447.
[2]季孝.超广谱β-内酰胺酶大肠埃希菌的临床分布及抗生素耐药分析[J].现代实用医学, 2014, 26(8):1035-1036.
[3]唐景云,秦晓林.加强抗菌药物管理对产超广谱β-内酰胺酶肺炎克雷伯菌耐药性的影响[J].海南医学, 2016, 27(5):753-755.
[4]赵宗珉,褚云卓,万建华,等.哌拉西林一他唑巴坦替换第三代头孢菌素对肠道产超广谱β-内酰胺酶大肠埃希菌定植的影响[J].中华内科杂志, 2007, 46(9):714-717.
[5]抗菌药物临床试验技术指导原则》写作组.抗菌药物临床试验技术指导原则[J].中国临床药理学杂志, 2014, 30(9):844-856.
[6]韦鸿雁,谭波宇,邓楠.美罗培南与头孢哌酮-舒巴坦治疗儿科产ESBLs菌致支气管肺炎的临床疗效及安全性评价[J].湖南师范大学学报(医学版), 2016, 13(1):28-30.
[7]孙瑞,何丹,郝雯,等.泸州地区医院环境中产超广谱β-内酰胺酶大肠杆菌耐药基因研究[J].西南医科大学学报, 2018, 41(5):393-397.
[8]庞众多,任君慧,陈永红.产超广谱β--内酰胺酶大肠埃希菌的检测[J].中国卫生检验杂志, 2009, 19(3):619-620.
[9] RODRIGUEZ-BANO J, NAVARRO MD, RETAMAR P, et al.β-Lactam/β-Lactam inhibitor combinations for the treatment of bacteremia due to extended-spectrumβ-lactamase-producing escherichia coli:a post hoc analysis of prospective cohorts[J]. Clin Infect Dis, 2012, 54(2):167-174.
[10] GUTIERREZ-GUTIERREZ B, PEREZ-GALERA S, SALAMANCA E, et al. A multinational preregistered cohort study ofβ-lactam/β-lactamase inhibitor combinations for treatment of bloodstream infections due to extended-spectrum-β-lactamase-producing Enterobacteriaceae[J]. Antimicrob Agents Chemother, 2016, 60(7):4159-4169.
[11] MUHAMMED M, FLOKAS ME, DETSIS M, et al. Comparison between carbapenems andβ-lactam/β-lactamase inhibitors in the treatment for bloodstream infections caused by extended-spectrumβ-lactamase-producing enterobacteriaceae:a systematic review and meta-analysis[J]. Open Forum Infect Dis, 2017, 4(2):99.
[12] SCHUETZ AN, REYES S, TAMMA PD. Point-counterpoint:piperacillin-tazobactam should be used to treat infections with extended-spectrum-beta-lactamase-positive organisms[J]. J Clin Microbiol,2018, 56(3):1917.
[13]周冠宇,康梅,叶慧,等.头孢哌酮/舒巴坦(2:1)治疗产ESBLs大肠埃希菌感染的临床疗效分析[J].四川大学学报(医学版), 2015, 46(1):153-154.
[2]季孝.超广谱β-内酰胺酶大肠埃希菌的临床分布及抗生素耐药分析[J].现代实用医学, 2014, 26(8):1035-1036.
[3]唐景云,秦晓林.加强抗菌药物管理对产超广谱β-内酰胺酶肺炎克雷伯菌耐药性的影响[J].海南医学, 2016, 27(5):753-755.
[4]赵宗珉,褚云卓,万建华,等.哌拉西林一他唑巴坦替换第三代头孢菌素对肠道产超广谱β-内酰胺酶大肠埃希菌定植的影响[J].中华内科杂志, 2007, 46(9):714-717.
[5]抗菌药物临床试验技术指导原则》写作组.抗菌药物临床试验技术指导原则[J].中国临床药理学杂志, 2014, 30(9):844-856.
[6]韦鸿雁,谭波宇,邓楠.美罗培南与头孢哌酮-舒巴坦治疗儿科产ESBLs菌致支气管肺炎的临床疗效及安全性评价[J].湖南师范大学学报(医学版), 2016, 13(1):28-30.
[7]孙瑞,何丹,郝雯,等.泸州地区医院环境中产超广谱β-内酰胺酶大肠杆菌耐药基因研究[J].西南医科大学学报, 2018, 41(5):393-397.
[8]庞众多,任君慧,陈永红.产超广谱β--内酰胺酶大肠埃希菌的检测[J].中国卫生检验杂志, 2009, 19(3):619-620.
[9] RODRIGUEZ-BANO J, NAVARRO MD, RETAMAR P, et al.β-Lactam/β-Lactam inhibitor combinations for the treatment of bacteremia due to extended-spectrumβ-lactamase-producing escherichia coli:a post hoc analysis of prospective cohorts[J]. Clin Infect Dis, 2012, 54(2):167-174.
[10] GUTIERREZ-GUTIERREZ B, PEREZ-GALERA S, SALAMANCA E, et al. A multinational preregistered cohort study ofβ-lactam/β-lactamase inhibitor combinations for treatment of bloodstream infections due to extended-spectrum-β-lactamase-producing Enterobacteriaceae[J]. Antimicrob Agents Chemother, 2016, 60(7):4159-4169.
[11] MUHAMMED M, FLOKAS ME, DETSIS M, et al. Comparison between carbapenems andβ-lactam/β-lactamase inhibitors in the treatment for bloodstream infections caused by extended-spectrumβ-lactamase-producing enterobacteriaceae:a systematic review and meta-analysis[J]. Open Forum Infect Dis, 2017, 4(2):99.
[12] SCHUETZ AN, REYES S, TAMMA PD. Point-counterpoint:piperacillin-tazobactam should be used to treat infections with extended-spectrum-beta-lactamase-positive organisms[J]. J Clin Microbiol,2018, 56(3):1917.
[13]周冠宇,康梅,叶慧,等.头孢哌酮/舒巴坦(2:1)治疗产ESBLs大肠埃希菌感染的临床疗效分析[J].四川大学学报(医学版), 2015, 46(1):153-154.