抗生素治療超廣效乙內醯胺酶腸內菌感染症之效能分析

Efficacy of Antibiotic Therapy for Extended-Spectrum β-lactamase-Producing Enterobacteriaceae Infections

陳西蕙(Hsi-Hui Chen) ； 楊清鎮(Ching-Cheng Yang) ； 賴建名(Jian-Ming Lai) ； 阮祺文(Chi-Wen Juan)

《弘光學報》 77期 (2016/03) Pp. 23-34

https://doi.org/10.6615/HAR.201603.77.04

摘要

研究目的：腸內菌因產生超廣效乙內醯胺酶(extended-spectrum β-lactamases; ESBL)引起的感染症有越來越增加的趨勢，對抗生素的臨床治療效果是一大挑戰。藉此研究收集較多的臨床數據，以了解產生ESBL感染症的危險因子及抗生素治療現況。研究方法：採用回溯性病歷回顧之案例系列(case series )研究，於2008年1月至2009年6月期間，判定為Escherichia coli 或Klebsiella pneumoniae 的ESBL感染症，並接受≧72小時抗生素治療者為研究對象，分析產生ESBL感染症的危險因子，及抗生素的治療成功率、療程與藥費。結果：研究區間共有266件ESBL感染症納入分析，感染源以泌尿道(n=187)為主，與產生ESBL感染症的相關危險因子主要是「先前曾經使用任何抗生素、使用導管裝置、使用呼吸器」。抗生素治療成功率平均89.5%，療程平均10.3天(範圍3-37天)，平均藥費16,154.8元(範圍88-107,590元)，單一療法治療成功率超過90%的包括piperacillin/tazobactam 95.0%(n=20)、meropenem 93.3%(n=45)、levofloxacin注射劑90.2%(n=32)。結論：治療Escherichia coli 或Klebsiella pneumoniae ESBL的泌尿道感染，抗生素的選擇除了carbapenem類之外，可以考慮使用piperacillin/tazobactam或levofloxacin注射劑。

關鍵字

超廣效乙內醯胺酶 ； 危險因子 ； 抗生素治療

並列摘要

Purpose Infections due to extended-spectrum beta-lactamase(ESBL)-producing Enterobacteriaceae are prevalent worldwide, the clinical treatment of antibiotics is a major challenge. We investigated the risk factors and antibiotics treatment outcomes for infections caused by ESBL-producing Escherichia coli or Klebsiella pneumoniae . Methods This was a case series study using retrospective chart review that examined the clinical outcomes and economic data of 200 patients who received ≧ 72 hours antibiotics for treatment of ESBLproducing Escherichia coli or Klebsiella pneumoniae infections. Results A total of 266 episodes of ESBL-producing infections included in the study, the most common infections treated were urinary tract infections (187 episodes). The most common risk factors for the development of infection with ESBL-producing organisms include previous antimicrobial use, catheter use, and ventilatory assistance use. 238 episodes(89.5%) having a positive clinical outcomes, therapy was continued for a average of 10.3 days (range 3-37 days), the average costs of antibiotic was NT$16,154.8 (range NT$88-107,590 ). In addition to carbapenems therapy, antibiotic monotherapy have a cure rate of greater than 90% include piperacillin/tazobactam 95.0%(n=20), levofloxacin injection 90.6%(n=32). Conclusion Treatment of Escherichia coli or Klebsiella pneumoniae ESBL urinary tract infection, antibiotic choice except carbapenems, consider using piperacillin/tazobactam or levofloxacin injection.

並列關鍵字

ESBL-producing infections ； risk factors ； antibiotic therapy

參考文獻

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