The clinical effect of cefoperazone sulbactam associated with tigecycline on pulmonary infection caused by pan drug-resistant Acinetobacter baumannii / 中国中西医结合急救杂志

ABSTRACT

Objective To approach the clinical effect of cefoperazone sulbactam associated with tigecycline for treatment of patients with severe pulmonary infection caused by pan drug-resistant Acinetobacter baumannii in intensive care unit(ICU). Methods Retrospectively,the treatments of 88 patients with sepsis and pulmonary infection caused by pan drug-resistant Acinetobacter baumannii admitted in ICU from January,2011 to June,2013 were analyzed,among them antibiotics were used for 82 patients,and the rest 6 patients did not use antibiotics because of family refusal or abandonment of therapy. The patients having used antibiotics were divided into three groups:A group(27 patients)received cefoperazone sulbactam,B group(30 patients)received cefoperazone sulbactam associated with amikacin,and C group(25 patients)received cefoperazone sulbactam associated with tigecycline, antimicrobial treatment being for 7-15 days. The venous blood was collected to determine the changes in white blood cell count(WBC),C-reactive protein(CRP)and procalcitonin(PCT)before and after therapy. The rate of bacteriological efficiency,successful weaning of mechanical instrument,28-day mortality rate and clinical efficacy were observed after therapy in three groups. Results Before therapy,the comparisons of levels of WBC,CRP and PCT among three groups were of no statistically significant difference(all P>0.05),and they were decreased obviously after therapy in three groups among which they were decreased most significantly in C group〔WBC(×109/L):17.01±5.35 vs. 20.40±6.54,18.28±6.41;CRP(mg/L):64.6±8.4 vs. 68.3±12.7,70.0±13.4;PCT(μg/L):20.84±7.26 vs. 36.14±10.12,52.66±13.47,P<0.05〕. The rates of bacteriological efficiency and successful weaning in C group were increased more significantly than those in either A or B groups after therapy(bacteriological efficiency:76.00%vs. 44.44%,46.67%,χ2=9.750,P=0.006;rate of successful weaning:72.00%vs. 40.74%, 43.33%,χ2=12.083,P=0.009),and 28-day mortality rate in C group was much lower than those in A and B groups (24.00% vs. 48.15%,36.67%,χ2=11.510,P=0.030). The total clinical efficiency in C group was much higher than those in A and B groups(76.00%vs. 44.44%,46.67%,both P<0.05). Conclusion Cefoperazone sulbactam associated with tigecycline has significant clinical therapeutic effect in patients with pulmonary infection caused by pan drug-resistant Acinetobacter baumannii in ICU,as it can decrease inflammatory reaction,increase the rates of successful weaning and survival.