中国药房2025，Vol.36Issue(21)：2705-2710,6.DOI:10.6039/j.issn.1001-0408.2025.21.15
头孢他啶/阿维巴坦联合阿米卡星治疗CRE感染重症肺炎的疗效与安全性分析
Efficacy and safety analysis of ceftazidime/avibactam combined with amikacin in the treatment of severe pneumonia caused by CRE infection
摘要
Abstract
OBJECTIVE To evaluate the efficacy and safety of ceftazidime/avibactam(CAZ/AVI)combined with amikacin(AMK)in the treatment of carbapenem-resistant Enterobacteriaceae(CRE)severe pneumonia.METHODS A retrospective cohort study was conducted on 240 patients diagnosed with severe pneumonia caused by CRE infection in the intensive care unit(ICU)of the Affiliated Hospital of Xuzhou Medical University from January 2022 to December 2024.The patients were divided into a combination group(CAZ/AVI combined with AMK,n=136)and a control group(CAZ/AVI alone,n=104).The 28-day mortality rate,clinical efficacy,mechanical ventilation time,ICU stay,infectious markers[C-reactive protein(CRP),procalcitonin(PCT),interleukin-6(IL-6),white blood cell count(WBC),and neutrophil percentage(N%)],Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)scores,and total incidence of adverse reactions were compared between two groups of patients.At the same time,subgroup analysis was conducted based on the severity of the condition,mechanical ventilation status,and baseline renal function.RESULTS The 28-day mortality rate of patients in the combination group was significantly lower than that in the control group(20.6%vs.34.6%,P=0.022),and the clinical effective rate was significantly higher than that in the control group(80.1%vs.65.4%,P=0.004).The mechanical ventilation time and ICU hospitalization time in the combination group were significantly shorter than those in the control group[(7.2±2.4)days vs.(10.4±3.6)days,(10.5±3.1)days vs.(13.7±3.8)days;P＜0.01].After 7 days of treatment,the CRP,PCT,IL-6,WBC,N%and APACHE Ⅱ scores of patients in the combination group significantly decreased compared to before treatment,and the decrease was significantly greater than that of the control group(P＜0.01).There was no statistically significant difference in the total incidence of adverse reactions between the two groups of patients(11.8%vs.13.5%,P=0.690).Subgroup analysis showed that among high-risk(APACHE Ⅱ score≥15)and mechanically ventilated patients,the 28-day mortality rate and weaning time of the combination group were significantly lower/shorter than those of the control group(P＜0.05),while there was no significant difference in the total incidence of adverse reactions between the combination group and the control group after dose adjustment in patients with chronic renal insufficiency(P＞0.05).CONCLUSIONS The CAZ/AVI combined with AMK regimen has better anti-infective efficacy and good safety in patients with severe pneumonia caused by CRE infection compared to the CAZ/AVI regimen alone;the survival benefits of this joint regimen are more significant in high-risk and mechanically ventilated patients,with critically ill patients being the main beneficiaries.关键词
头孢他啶/阿维巴坦/阿米卡星/碳青霉烯类耐药肠杆菌/重症肺炎/联合治疗Key words
ceftazidime/avibactam/amikacin/carbapenem-resistant Enterobacteriaceae/severe pneumonia/combination therapy分类
医药卫生引用本文复制引用
张天棋,陈碧,张灿堂..头孢他啶/阿维巴坦联合阿米卡星治疗CRE感染重症肺炎的疗效与安全性分析[J].中国药房,2025,36(21):2705-2710,6.基金项目
江苏省自然科学基金项目(No.JSZRQN202300028) （No.JSZRQN202300028）
