目的 评估多黏菌素B对儿童耐碳青霉烯革兰阴性菌(CR-GNB)所致医院获得性肺炎的情况分析。方法 回顾性分析郑州大学附属儿童医院2018年5月-2021年12月收治的52例使用多黏菌素B治疗CR-GNB所致医院获得性肺炎患儿的信息,记录每位患儿的临床资料、用药信息、实验室检查结果及用药过程中出现的不良反应。结果 52例患儿中男性28例,女性24例;年龄中位数为12个月。共检出55株病原菌,鲍曼不动杆菌34株,肺炎克雷伯菌20株,阴沟肠杆菌1株;其中3例为肺炎克雷伯菌合并鲍曼不动杆菌。患儿治疗平均时间为(13.9±5.9) d,总体有效率为53.8%,细菌清除率为30.8%,总死亡率为32.7%。有效组和无效组之间细菌清除率无统计学意义;但有效组多黏菌素B治疗时间明显长于无效组(P<0.05)。不良反应发生率13.5%,临床表现为急性肾损伤、皮肤色素沉着和嗜酸性粒细胞增多。结论 多黏菌素B可作为儿童CR-GNB所致医院获得性肺炎的一种选择,但仍需大样本、多中心、设计良好的随机对照研究来进一步验证。

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

河南省医学科技攻关计划项目(2018020694);河南省科技攻关项目(222102310574)