依拉环素治疗神经重症免疫抑制合并耐碳青霉烯类鲍曼不动杆菌肺炎患者的临床分析

doi:10.3877/cma.j.issn.2096-1537.2024.03.18-0001

中华重症医学电子杂志 doi: 10.3877/cma.j.issn.2096-1537.2024.03.18-0001

常佳¹, 赖蓉², 廖康³, 冯黎², 孙逊沙², 冯慧宇², 周鸿雁²^,^†(

)

^1. 130000　长春，吉林省人民医院神经内科；510000　广州，中山大学附属第一医院神经内科
^2. 510000　广州，中山大学附属第一医院神经内科
^3. 510000　广州，中山大学附属第一医院检验科

收稿日期:2024-01-02
通信作者: 周鸿雁

Clinical analysis of Eravacycline in the treatment of patients with severe immunosuppression combined with Carbapenem-resistant Acinetobacter baumannii pneumonia

Jia Chang¹, Rong Lai², Kang Liao³, Li Feng², Xunsha Sun², Huiyu Feng², Hongyan Zhou²^,^†()

^1. Department of Neurology, Jilin Provincial People's Hospital, Changchun 130000, China; Department of Neurology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510000, China
^2. Department of Neurology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510000, China
^3. Department of Clinical Laboratory, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510000, China

Received:2024-01-02
Corresponding author: Hongyan Zhou

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目的

探讨依拉环素治疗神经重症免疫抑制合并耐碳青霉烯类鲍曼不动杆菌（CRAB）肺炎的效果和安全性。

方法

回顾性分析2023年7月至12月中山大学附属第一医院神经内科ICU收治的3例因原发疾病使用免疫抑制剂，后合并CRAB肺炎的神经重症患者的临床资料，包括临床特征、生化指标、细菌培养及药敏试验结果、抗菌药物种类、治疗前后的影像学资料及急性生理学和慢性健康状况评价（APACHE Ⅱ）评分，评估患者临床疗效、用药不良反应等。

结果

3例患者中女性1例，男性2例，年龄52~60岁。分别在肺泡灌洗液、痰液、咽拭子标本中检出鲍曼不动杆菌，药敏试验均提示碳青霉烯类抗生素耐药。经依拉环素治疗后患者APACHE Ⅱ评分、临床表现、炎症指标、影像学检查等均明显好转。未发现依拉环素治疗相关不良反应。

结论

依拉环素对CRAB引起的肺炎具有良好的疗效和安全性。

关键词: 耐碳青霉烯类鲍曼不动杆菌, 多重耐药菌感染肺炎, 依拉环素

Objective

To investigate the efficacy and safety of Eravacycline in the treatment of severe immunosuppression complicated with Carbapenem-resistant Acinetobacter baumannii (CRAB) pneumonia.

Methods

The clinical data of 3 patients with severe neurological conditions admitted to Department of Neurology ICU of the First Affiliated Hospital of Sun Yat-sen University from July 2023 to December 2023 were retrospectively analyzed. They were treated with immunosuppressants due to the primary disease and subsequently combined with CRAB pneumonia. Clinical characteristics, biochemical indexes, bacterial culture and drug sensitivity test results, antibacterial drug types, imaging data before and after treatment and APACHE Ⅱ score of patients were collected to evaluate clinical efficacy and adverse drug reactions of patients.

Results

Among the 3 patients, 1 was female and 2 were male, aged 52-60 years. Acinetobacter baumannii was detected in alveolar lavage fluid, sputum and pharyngeal swab samples, and drug sensitivity test indicated Carbapenem antibiotic resistance. After treatment with Eravacycline, APACHE II scores, clinical manifestations, inflammatory indicators, and imaging examinations were significantly improved. No adverse reactions associated with Eravacycline were found.

Conclusion

Eravacycline has good efficacy and safety in the treatment of pneumonia caused by CRAB.

Key words: Carbapenem-resistant Acinetobacter baumannii, Multidrug-resistant bacteria infect pneumonia, Elacycline

表1 3株鲍曼不动杆菌体外药敏结果（MIC，μg/ml）

抗生素	1号菌	2号菌	3号菌
黏菌素	≤0.5（S）	≤0.5（S）	≤0.5（S）
替加环素	4（I）	1（S）	2（S）
米诺环素	8（I）	4（I）	8（I）
依拉环素	0.125（S）	-	0.25（S）
亚胺培南	≥16（R）	≥16（R）	≥16（R）
美罗培南	≥16（R）	≥16（R）	≥16（R）

表1 3株鲍曼不动杆菌体外药敏结果（MIC，μg/ml）

抗生素	1号菌	2号菌	3号菌
黏菌素	≤0.5（S）	≤0.5（S）	≤0.5（S）
替加环素	4（I）	1（S）	2（S）
米诺环素	8（I）	4（I）	8（I）
依拉环素	0.125（S）	-	0.25（S）
亚胺培南	≥16（R）	≥16（R）	≥16（R）
美罗培南	≥16（R）	≥16（R）	≥16（R）

图1 3例患者治疗前后胸部影像学对比。图a、d为病例1，图b、e为病例2，图c、f为病例3注：治疗前为应用依拉环素前1 d，治疗后为停用依拉环素后1 d

表2 3例患者治疗前后感染指标及相关评分变化情况

患者		CRP（mg/L）	PCT（ng/dl）	WBC（×10⁹/L）	NEUT%	NEUT#（×10⁹/L）	APACHEⅡ评分	氧合指数（mmHg）
病例1	治疗前	103.78	80	12.19	94	17.70	18	190
	治疗后	48.20	54	10.52	77	8.06	16	245
病例2	治疗前	62.60	105	8.02	90	10.36	17	220
	治疗后	4.23	19	6.33	91	6.08	14	260
病例3	治疗前	17.89	21	9.29	94	6.34	10	182
	治疗后	6.10	6	5.87	88	5.32	3	310

表2 3例患者治疗前后感染指标及相关评分变化情况

患者		CRP（mg/L）	PCT（ng/dl）	WBC（×10⁹/L）	NEUT%	NEUT#（×10⁹/L）	APACHEⅡ评分	氧合指数（mmHg）
病例1	治疗前	103.78	80	12.19	94	17.70	18	190
	治疗后	48.20	54	10.52	77	8.06	16	245
病例2	治疗前	62.60	105	8.02	90	10.36	17	220
	治疗后	4.23	19	6.33	91	6.08	14	260
病例3	治疗前	17.89	21	9.29	94	6.34	10	182
	治疗后	6.10	6	5.87	88	5.32	3	310

表3 3例患者治疗前后肝肾功能对比

患者		肝功能				肾功能
患者		ALT（U/L）	AST（U/L）	r-GGT（U/L）	总胆红素（μmol/L）	BUN（mmol/L）	Cr（μmol/L）
病例1	治疗前	24	39	123	9.2	13.2	12
	治疗后	47	58	118	8.1	14.1	16
病例2	治疗前	209	274	117	15.1	13.7	50
	治疗后	187	64	164	10.5	10.6	32
病例3	治疗前	40	57	96	17.2	10.6	29
	治疗后	93	106	174	10.9	9.2	19

表3 3例患者治疗前后肝肾功能对比

患者		肝功能				肾功能
患者		ALT（U/L）	AST（U/L）	r-GGT（U/L）	总胆红素（μmol/L）	BUN（mmol/L）	Cr（μmol/L）
病例1	治疗前	24	39	123	9.2	13.2	12
	治疗后	47	58	118	8.1	14.1	16
病例2	治疗前	209	274	117	15.1	13.7	50
	治疗后	187	64	164	10.5	10.6	32
病例3	治疗前	40	57	96	17.2	10.6	29
	治疗后	93	106	174	10.9	9.2	19

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Clinical analysis of Eravacycline in the treatment of patients with severe immunosuppression combined with Carbapenem-resistant Acinetobacter baumannii pneumonia

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Clinical analysis of Eravacycline in the treatment of patients with severe immunosuppression combined with Carbapenem-resistant Acinetobacter baumannii pneumonia