基础药物换用或联合注射用头孢哌酮钠舒巴坦钠对泛耐药肺炎克雷伯菌肺部感染患者病情严重程度及预后的影响观察

doi:10.3969/j.issn.1006-6233.2025.03.029

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摘要 目的: 探究基础药物换用或联合注射用头孢哌酮钠舒巴坦钠对泛耐药肺炎克雷伯菌(XDR-KP)肺部感染患者病情严重程度及预后的影响。方法: 回顾性选取2021年1月至2024年6月收治的XDR-KP肺部感染患者临床资料,根据用药方案不同,使用基础抗菌药物治疗的54例为基础药物组,联合或换用头孢哌酮钠舒巴坦治疗的47例为头孢哌酮钠舒巴坦组。比较两组治疗1周左右时细菌清除情况,治疗初期、治疗1周左右血清炎症指标[血小板计数(PLT)、中性粒细胞比例(NEUT)和白细胞计数(WBC)]和感染性标记物[血清淀粉样蛋白A(SAA)、降钙素原(PCT)和C反应蛋白(CRP)]水平,记录药物不良反应事件和预后情况。结果: 头孢哌酮钠舒巴坦钠组临床症状改善时间低于基础药物组(P<0.05),治疗1周左右时,头孢哌酮钠舒巴坦钠组炎性指标正常率、细菌清除率高于基础药物组(P<0.05);治疗1周左右时,头孢哌酮钠舒巴坦组和基础药物组炎症指标(PLT、NEUT和WBC)水平、感染性标记物(SAA、PCT和CRP)水平均明显降低(P<0.05),且头孢哌酮钠舒巴坦组指标降低水平高于基础药物组(P<0.05);治疗期间,头孢哌酮钠舒巴坦组药物不良反应发生率(9.26%)与基础药物组(7.41%)无统计学差异(P>0.05);头孢哌酮钠舒巴坦组治疗第1周左右时临床治愈率70.21%高于基础药物组50.00%(P<0.05),30d病死率与住院时长与基础药物组比较差异无统计学意义(P>0.05)。结论: 基础药物联合或换用头孢哌酮钠舒巴坦治疗XDR-KP肺部感染患者效果显著,可控制感染,缓解炎症,改善患者预后,且不良反应少。

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	胡文杰
	王瑞凯
	刘家昌

关键词 ：泛耐药, 肺炎克雷伯菌, 头孢哌酮钠舒巴坦钠, 治疗效果, 严重程度, 预后

Abstract：Objective: To investigate the influence of basic drugs combined with (or switched to) the injection of cefoperazone/sulbactam on the disease severity and prognosis of patients with extensively-drug-resistant Klebsiella pneumoniae (XDR-KP) infections. Methods: The clinical data of patients with XDR-KP infection admitted from January 2021 to June 2024 were retrospectively selected. According to different medication regimens, they were assigned into basic antibacterial drugs (basic drug group, n=54) and basic drugs combined with (or switched to) the injection of cefoperazone/sulbactam (cefoperazone/sulbactam group, n=47). After about one week of treatment, the bacterial clearance, serum inflammatory indicators including platelet count (PLT), neutrophil ratio (NEUT) and white blood cell count (WBC), and infectious markers including serum amyloid A (SAA), procalcitonin (PCT) and C-reactive protein (CRP) were compared between groups. Treatment-emergent adverse events (TEAEs) and prognosis were recorded. Results: The improvement time of clinical symptoms in the cefoperazone/sulbactam group was significantly lower than that in the basic drug group (P<0.05). After about one week of treatment, the normal rate of inflammatory indicators and clearance rate of bacterial in the cefoperazone/sulbactam group were significantly higher than those in the basic drug group (P<0.05). After about one week of treatment, the levels of inflammatory indicators (PLT, NEUT and WBC) and infectious markers (SAA, PCT and CRP) in the both groups were significantly decreased (P<0.05), and the decrease in the cefoperazone/sulbactam group was more pronounced than that in the basic drug group (P<0.05). There was no statistical difference in the TEAEs between the cefoperazone/sulbactam group and the basic drug group (9.26% vs 7.41%, P>0.05). The clinical cure rate was significantly higher in the cefoperazone/sulbactam group than the basic drug group (70.21% vs 50.00%, P<0.05), and there were no statistical differences in 30d mortality and hospital stay between groups (P>0.05). Conclusion: The effects of basic drugs combined with (or switched to) the injection of cefoperazone/sulbactam are significant in the treatment of patients with XDR-KP infection, it can control infection, relieve inflammation, and improve the prognosis of patients, and it has few adverse reactions.

Key words： Extensively-drug-resistant Klebsiella pneumoniae Cefoperazone/sulbactam Therapeutic effect Severity Prognosis

基金资助:2019年安徽省重点研究与开发计划项目,(编号:201904a07020006)

引用本文:

胡文杰, 王瑞凯, 刘家昌. 基础药物换用或联合注射用头孢哌酮钠舒巴坦钠对泛耐药肺炎克雷伯菌肺部感染患者病情严重程度及预后的影响观察[J]. 河北医学, 2025, 31(3): 509-513.
HU Wenjie, WANG Ruikai, LIU Jiachang. Influence of Basic Drugs Combined with (or Switched to) the Injection of Cefoperazone/Sulbactam on Disease Severity and Prognosis of Patients with Extensively-drug-resistant Klebsiella Pneumoniae Infection. HeBei Med, 2025, 31(3): 509-513.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2025.03.029 或 http://www.hbyxzzs.cn/CN/Y2025/V31/I3/509

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