Objective: To investigate the efficacy and safety of colistin sulfate in the treatment of hematonosis patients infected by multidrug-resistant (MDR) gram-negative bacteria (GNB), and discuss the possible factors that affect the efficacy of colistin sulfate.
Methods: The clinical data of 85 hematologic patients infected with MDR GNB in the Soochow Hopes Hematonosis Hospital from April 2022 to November 2022 were collected and divided into clinically effective group with 71 cases and ineffective group with 14 cases according to the therapeutic efficacy of colistin sulfate. The age, gender, type of hematologic disease, status of hematopoietic stem cell transplantation, infection sites, type of pathogen, timing of administration, daily dose and duration of colistin sulfate, and combination with other antibacterial agents of patients in two groups were compared. Logistic regression was used to analyze on the meaningful variables to study the influencing factors of colistin sulfate. The adverse reactions of colistin sulfate were also evaluated.
Results: There were no significant differences in age, gender, type of hematologic disease, hematopoietic stem cell transplantation status, infection sites and pathogen type between the effective group and the ineffective group (P>0.05). Compared with the medication time more than 7 days, meropenem used within 7 days in the clinical effective group, and timely replacement with colistin sulfate could obtain better efficacy, the difference was statistically significant (P=0.018). The duration of tigacycline before colistin sulfate did not affect the efficacy, and there was no significant difference in efficacy between the effective and ineffective groups. The therapeutic effect of colistin sulfate at daily dose of 500 000 U q8h was better than that of 500 000 U q12h, the difference was statistically significant (P=0.035). The time of colistin sulfate use in the clinically effective group was longer than that in the ineffective group, which had a statistical difference (P=0.003). Compared with the clinical ineffective group, the efficacy of combination regimens with colistin sulfate was better than that of colistin sulfate monotherapy, and the difference was statistically significant (P=0.013). Multivariate logistic regression analysis was performed on the indicators with statistical differences in the two groups of patients, which suggested that the use time of colistin sulfate (B: 2.358; OR: 10.573; CI: 1.567-71.361; P=0.015) and the combination of colistin sulfate (B: 1.720; OR: 5.586; CI: 1.210-25.787; P=0.028) were influential factors in the efficacy of colistin sulfate. During the treatment, the incidence of nephrotoxicity, hepatotoxicity and peripheral neurotoxicity were 5.9%, 1.2% and 1.2%, respectively.
Conclusion: The use of colistin sulfate improves the clinical efficacy of MDR GNB infections in hematological patients, and the timing of colistin sulfate administration and the combination of drugs are independent factors affecting its clinical efficacy, and the safety during treatment is high.
题目: 硫酸黏菌素治疗血液病患者多重耐药革兰阴性菌 感染的临床疗效观察.
目的: 探讨硫酸黏菌素治疗血液病患者多重耐药(Multidrug-resistant，MDR)革兰阴性菌(Gram-negative bacteria，GNB)感染的临床疗效与安全性.
方法: 收集2022年04月-2022年11月苏州弘慈血液病医院85例确诊MDR GNB的血液病患者的临床资料，经硫酸黏菌素抗感染治疗，根据患者治疗效果分为临床有效组（71例）和临床无效组（14例）。比较两组患者的年龄、性别、血液病类型、造血干细胞移植状态、感染部位、病原体类型、硫酸黏菌素用药时机、日剂量及使用时间以及与其他抗菌药物联合使用情况。运用Logistic回归分析其中有统计学意义的指标，以探讨硫酸黏菌素疗效的影响因素。同时评估硫酸黏菌素的不良反应.
结果: 临床有效组与无效组患者的年龄、性别、血液病类型、造血干细胞移植状态、感染部位、病原体类型的差异均无统计学意义(P>0.05)。相对于用药时间>7 d，美罗培南使用7 d内及时更换为硫酸黏菌素能获得更好的疗效，差异有统计学意义(P=0.018)。使用硫酸黏菌素前替加环素的使用时间不影响疗效，临床有效组和无效组之间差异无统计学意义(P>0.05)。使用硫酸黏菌素日剂量50万U q8h疗效优于50万U q12h，差异有统计学意义(P=0.035)。临床有效组的硫酸黏菌素用药时间较无效组长，差异有统计学意义(P=0.003)。与临床无效组相比，临床有效组硫酸黏菌素联合用药疗效优于单药硫酸黏菌素，差异有统计学意义(P=0.013)。运用多元Logistic回归分析其中有统计学意义的变量，发现硫酸黏菌素使用时间(B: 2.358; OR: 10.573; CI: 1.567-71.361; P=0.015)以及硫酸黏菌素联合用药(B: 1.720; OR: 5.586; CI: 1.210-25.787; P=0.028)是影响硫酸黏菌素疗效的因素。在治疗过程中，肾毒性的发生率为5.9%，肝毒性的发生率为1.2%，周围神经毒性的发生率为1.2%。.
结论: 使用硫酸黏菌素能提高血液病患者多重耐药革兰阴性菌感染的临床疗效，硫酸黏菌素的使用时间及联合用药是影响其临床疗效的独立相关因素，且治疗过程中安全性高.
Keywords: colistin sulfate; gram-negative bacteria; hematonosis; multidrug-resistant bacteria.