塞夫塔胺-阿维巴克坦作为严重感染的免疫抑制儿童的救援治疗
Lvchang Zhu1, Qiongyao Hu2, Lijun Liu1
1Department of General Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou City, Zhejiang Province, People's Republic of China.
塞法胺-阿维巴克坦 (CAZ/AVI) 是对重症儿童多药耐药格拉姆阴性细菌感染的一种救援疗法. 在50%的病例中观察到临床改善,突出其潜力,特别是当细菌恢复时.
科学领域:
- 传染性疾病 传染性疾病
- 儿科重症监护 儿科重症监护
- 抗微生物耐药性 抗微生物耐药性
背景情况:
- 耐多药格拉姆阴性细菌 (MDR-GNB) 构成日益严重的全球威胁,其抗卡巴耐药性正在增加.
- 塞法胺-阿维巴克坦 (CAZ/AVI) 为MDR-GNB感染提供了一个潜在的治疗选择.
- 有限的临床数据存在于CAZ/AVI在重症患者,免疫抑制儿科群体的使用.
研究的目的:
- 评估CAZ/AVI作为重症感染,免疫抑制儿童的救援疗法的疗效和安全性.
- 在匹配的队列中,将CAZ/AVI治疗结果与其他抗生素治疗方案进行比较.
- 为了确定影响治疗反应和死亡率的因素,在这个脆弱的患者群体.
主要方法:
- 对2019年9月至2022年7月期间接受CAZ/AVI治疗的确诊GNB感染的重症免疫抑制儿童的回顾性分析.
- 将CAZ/AVI治疗患者与接受替代抗生素治疗的患者匹配.
- 评估临床改善,微生物学结果和死亡率.
主要成果:
- 25名儿童接受了CAZ/AVI治疗,主要是患有血液病和败血症的儿童.
- 在50%的CAZ/AVI疗程中出现了临床改善.
- 在48%的患者中发现了积极的微生物培养物,包括耐卡巴胺的GNB.
- 当GNB恢复时,临床反应显著更高 (66.7%对23.1%).
- 死亡率在14天后为24%,在30天后为28%,与缺乏GNB康复和医院获得的肺炎相关.
- 在CAZ/AVI和其他抗生素之间没有观察到主要结果的显著差异.
结论:
- 对于患有GNB感染的免疫抑制儿童来说,CAZ/AVI可以被认为是救援治疗选择.
- 在未经证实GNB恢复的患者中使用CAZ/AVI时,建议仔细考虑.
- 需要进一步的研究来优化CAZ/AVI在儿科重症监护机构的使用.
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