Clinical observation of polymyxin B in the treatment of CRKP-BSI in patients with hematological malignancies

LI Na; LIU Nan; ZHANG Ailing; LI Li; WAN Dingming; ZHANG Xiaojian

doi:10.6039/j.issn.1001-0408.2023.04.15

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Clinical observation of polymyxin B in the treatment of CRKP-BSI in patients with hematological malignancies

更新时间：2023-02-24

- Clinical observation of polymyxin B in the treatment of CRKP-BSI in patients with hematological malignancies
- ZHONGGUO YAOFANG Vol. 34, Issue 4, Pages: 461-465(2023)
- 作者机构：
  
  1.郑州大学第一附属医院药学部，郑州　450052
  2.河南省精准临床药学重点实验室，郑州　450052
  3.河南省精准临床药学应用与转化工程研究中心，郑州　450052
  4.郑州大学第一附属医院血液科，郑州　450052
- 作者简介：
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2023.04.15
  CLC： R978.1
- Published：28 February 2023，
  
  Received：06 June 2022，
  
  Revised：04 January 2023，
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李纳,刘楠,张爱玲等.多黏菌素B治疗血液系统恶性肿瘤伴CRKP-BSI的临床观察 ^Δ[J].中国药房,2023,34(04):461-465.

LI Na,LIU Nan,ZHANG Ailing,et al.Clinical observation of polymyxin B in the treatment of CRKP-BSI in patients with hematological malignancies[J].ZHONGGUO YAOFANG,2023,34(04):461-465.
李纳,刘楠,张爱玲等.多黏菌素B治疗血液系统恶性肿瘤伴CRKP-BSI的临床观察 ^Δ[J].中国药房,2023,34(04):461-465. DOI： 10.6039/j.issn.1001-0408.2023.04.15.

LI Na,LIU Nan,ZHANG Ailing,et al.Clinical observation of polymyxin B in the treatment of CRKP-BSI in patients with hematological malignancies[J].ZHONGGUO YAOFANG,2023,34(04):461-465. DOI： 10.6039/j.issn.1001-0408.2023.04.15.

摘要

目的

分析多黏菌素B治疗血液系统恶性肿瘤伴耐碳青霉烯类肺炎克雷伯菌（CRKP）-血流感染（BSI）的有效性和安全性。

方法

回顾性分析2019年9月－2021年6月于我院接受至少3 d多黏菌素B治疗的血液系统恶性肿瘤伴CRKP-BSI患者的资料。所有患者初始均采用以多黏菌素B+替加环素+碳青霉烯类药物为基础的三联治疗方案。

结果

共纳入10例患者，血培养检出11株CRKP，其中10株CRKP产肺炎克雷伯菌碳青霉烯酶（KPC），1株CRKP同时产KPC和金属

-内酰胺酶；9株对黏菌素敏感，7株对替加环素敏感，5株对阿米卡星敏感，2株对复方磺胺甲噁唑敏感。所有患者均伴有中性粒细胞减少，平均持续时间为（14.1±6.4）d；均表现为发热、寒颤、乏力。经治疗后，有6例患者治愈出院，4例患者因感染性休克治疗无效死亡；所有患者未发生多黏菌素B相关的严重不良事件。

结论

多黏菌素B可作为血液系统恶性肿瘤伴CRKP-BSI患者的治疗用药，治疗期间均未发生多黏菌素B相关的严重不良事件。

Abstract

OBJECTIVE

To analyze the efficacy and safety of polymyxin B in the treatment of carbapenem-resistant

Klebsiella pneumoniae

（CRKP）-bloodstream infection （BSI） in patients with hematologic malignancies.

METHODS

The medical records of patients with hematologic malignancies with CRKP-BSI who received polymyxin B for at least 3 days in our hospital from September 2019 to June 2021 were retrospectively analyzed. All patients were initially treated with a triple therapy namely polymyxin B+tigecycline+carbapenems for anti-infection therapy.

RESULTS

A total of 10 patients were enrolled as the study subjects. Eleven strains of CRKP were cultured in blood， including 10 strains of CRKP produced

Klebsiella pneumoniae

carbapenemase（KPC） and 1 strain of CRKP produced both KPC and metal-beta-lactamase； 9 strains were sensitive to colistin， 7 strains were sensitive to tigecycline， 5 strains were sensitive to amikacin and 2 strains were sensitive to compound sulfamethoxazole. All patients were accompanied by neutropenia， with an average duration of （14.1±6.4） days. They were all characterized by fever， chills and fatigue. After treatment， 6 patients were cured and discharged， 4 patients died of ineffective treatment of septic shock. No serious adverse events related to polymyxin B occurred in all patients.

CONCLUSIONS

Polymyxin B can be used as a therapeutic drug for CRKP-BSI in patients with hematological malignancies. No serious adverse event related to polymyxin B occurs during the treatment.

关键词

多黏菌素B耐碳青霉烯类肺炎克雷伯菌血液系统恶性肿瘤血流感染疗效安全性

Keywords

carbapenem-resistant Klebsiella pneumoniaehematologic malignancybloodstream infectiontherapeutic efficacysafety

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