2025 年第 4 期 第 20 卷

注射用头孢他啶阿维巴坦钠单独使用对耐碳青霉烯类肺炎克雷伯菌感染所致肺炎的治疗效果及安全性分析

Analysis of the efficacy and safety of ceftazidime avibactam sodium for injection alone in the treatment of pneumonia caused by carbapenem-resistant Klebsiella pneumoniae infection

作者：李银花1牛建星2李喜元1

英文作者：Li Yinhua1 Niu Jianxing2 Li Xiyuan1

单位：1航空总医院重症医学科，北京100012；2航空总医院神经外七科，北京100012

英文单位：1Department of Intensive Care Medicine Aviation General Hospital Beijing 100012 China; 2Seventh Department of Neurosurgery Aviation General Hospital Beijing 100012 China

关键词：肺炎；注射用头孢他啶阿维巴坦钠；耐碳青霉烯类肺炎克雷伯菌感染

英文关键词：Pneumonia;Ceftazidimeandavibactamsodiumforinjection;Pneumoniacausedbycarbapenem-resistantKlebsiellapneumoniaeinfection

• 摘要：

• 目的 探讨注射用头孢他啶阿维巴坦钠对耐碳青霉烯类肺炎克雷伯菌 (CRKP)感染所致肺炎的治疗效果及安全性。方法 回顾性分析2022年1月1日至2024年10月31日入住航空总医院重症监护病房确诊为CRKP感染所致肺炎38例患者的临床资料，根据治疗方案不同分为单药治疗组（16例，在常规治疗基础上给予注射用头孢他啶阿维巴坦钠静脉滴注治疗）和联合治疗组（22例，在常规治疗基础上给予注射用头孢他啶阿维巴坦钠联合注射用美罗培南或替加环素或依拉环素或多黏菌素B静脉滴注治疗）。收集相关资料，比较2组患者的临床治疗效果（临床有效率、微生物治愈率、细菌清除时间、体温复常时间、炎症指标变化、28 d死亡率、住院总死亡率）及不良反应发生情况。结果 联合治疗组的急性生理学与慢性健康状况评分系统Ⅱ评分稍高于单药治疗组，差异有统计学意义（P<0.05）。2组患者临床有效率、28 d死亡率及住院总死亡率差异均无统计学意义（均P>0.05），联合治疗组的微生物治愈率稍高于单药治疗组，细菌清除时间及体温复常时间稍短于单药治疗组，但差异均无统计学意义（均P>0.05）。2组治疗前后白细胞计数、降钙素原、C反应蛋白水平差异均无统计学意义（均P>0.05）。联合治疗组肾损伤、肝损伤及胃肠道症状发生率稍高于单药治疗组［13.6%（3/22）比12.5%（2/16）、18.2%（4/22）比12.5%（2/16）、18.2%（4/22）比12.5%（2/16）］，但差异均无统计学意义（均P>0.05）。结论 对于CRKP感染所致肺炎的患者，采用注射用头孢他啶阿维巴坦钠单药治疗与联合其他药物治疗在整体效果上无明显差异，且不良反应方面无明显差异。

• Objective To investigate the efficacy and safety of ceftazidime avibactam sodium for injection in the treatment of pneumonia caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) infection. Methods Clinical data of 38 patients with pneumonia caused by CRKP admitted to the intensive care unit of Aviation General Hospital from January 1, 2022 to October 31, 2024 were retrospectively analyzed. According to different treatment regimens, they were divided into monotherapy group (16 cases, treated with intravenous infusion of ceftazidime avibactam sodium for injection on the basis of conventional treatment) and combined treatment group (22 cases, treated with intravenous infusion of ceftazidime avibactam sodium for injection combined with meropenem or tigecycline or epiracycline or polymyxin B on the basis of conventional treatment). Relevant data were collected, and the clinical treatment effects (clinical effective rate, microbial cure rate, bacterial clearance time, body temperature normalization time, inflammatory index changes, 28-day mortality, total hospital mortality) and adverse reactions were compared between the two groups. Results The acute physiology and chronic health evaluation Ⅱ score of the combined treatment group was slightly higher than that of the monotherapy group (P<0.05). There were no significant differences in clinical efficacy, 28-day mortality and total in-hospital mortality between the two groups (all P>0.05). The microbial cure rate of the combined treatment group was slightly higher than that of the monotherapy group, and the bacterial clearance time and body temperature normalization time were slightly shorter than those of the monotherapy group, but the differences were not statistically significant (all P>0.05). There was no significant difference in white blood cell count, procalcitonin and C-reactive protein levels between the two groups before and after treatment (all P>0.05). The incidence of kidney injury, liver injury and gastrointestinal symptoms in the combined treatment group was slightly higher than that in the monotherapy group ［13.6%(3/22) vs 12.5%(2/16), 18.2%(4/22) vs 12.5%(2/16), 18.2%(4/22) vs 12.5%(2/16)］, but the differences were not statistically significant (all P>0.05). Conclusion For patients with pneumonia caused by CRKP infection, there is no significant difference in the overall efficacy between ceftazidime avibactam sodium injection monotherapy and combination therapy with other drugs, and there is no significant difference in adverse reactions.