| 315 | 9 | 65 |
| 下载次数 | 被引频次 | 阅读次数 |
目的探讨多重耐药菌引起颅内感染的治疗方案及替加环素鞘内/脑室内给药方案的临床应用情况。方法以"替加环素""鞘内给药""脑室内给药"为主题词检索CNKI和万方数据库,以"tigecycline""intrathecalinjection""intraventricularinjection"为英文检索词检索Pub Med、Science Direct、Embase、Wily Online Library等英文数据库,时间范围为建库至2020年2月,选择应用替加环素鞘内/脑室内给药治疗颅内感染的病例。提取并分析患者的性别、年龄、脑脊液培养结果、药敏结果、外科和药物治疗方案、用药疗程和预后等数据。结果共检出文献30篇,其中有效文献21篇,纳入病例27例。替加环素鞘内/脑室内给药对革兰阴性菌和革兰阳性菌(包括多重耐药鲍曼不动杆菌、肺炎克雷伯菌和耐万古霉素肠球菌等)引起的颅内感染显示出了良好的治疗效果,给药方案从2 mg,qd到10 mg,q12h不等,疗程中位数为16 d,没有出现严重不良反应的病例报道,27例患者经治疗后脑脊液培养均呈阴性。结论替加环素鞘内/脑室内给药在其他药物治疗无效时可以有效治疗多重耐药菌颅内感染,但多为个案报道,其安全性和有效性有待更大规模的研究。
Abstract：AIM To investigate the treatment of intracranial infection caused by multidrug-resistant bacteria and the clinical application of tigecycline intrathecal/intraventricular administration. METHODS Databases of CNKI, WanFang, PubMed, ScienceDirect, Embase, Wily Online Library were retrieved by using the key words including "tigecycline", "intrathecal administration" or "intraventricular administration". The cases of intracranial infection treated by intrathecal/intraventricular administration of tigecycline were selected. The gender, age of patients, cerebrospinal fluid culture results, drug sensitivity results, surgical and drug treatment plan, course of treatment and the prognosis of the patients were analyzed. RESULTS A total of 30 literatures were detected, including 21 valid literatures and 27 cases. Tigecycline intrathecal/intraventricular administration showed a good therapeutic effect on intracranial infection caused by gram-negative bacteria and gram-positive bacteria(including multidrug resistant Acinetobacter baumanii, multidrug resistant Klebsiella pneumoniae, vancomycin resistant Enterococcus, etc.), the dosage of tigecycline ranged from 2 mg. qd to 10 mg, q12 h and the median duration was 16 d. No serious adverse drug reactions were reported and the cerebral spinal fluid culture of 27 patients was negative after treatment. CONCLUSION Intrathecal/intraventricular administration of tigecycline can effectively treat the intracranial infection of multidrug-resistant bacteria, but its safety and effectiveness need further attention and more large-scale research.
[1]TUNKEL A R,HASBUN R,BHIMRAJ A,et al.2017 infectious diseases society of America’s clinical practice guidelines for healthcare-associated ventriculitis and meningitis[J].Clin Infect Dis,2017,64(6):e34.
[2]黄勋,邓子德,倪语星,等.多重耐药菌医院感染预防与控制中国专家共识[J].中国感染控制杂志,2015,14(1):1.
[3]赵旻,朱明欣,李晓鹏,等.替加环素鞘内注射成功治疗颅内感染1例[J].中国临床神经外科杂志,2018,23(6):446.
[4]陈宾,张恒,赵宗珉,等.替加环素鞘内注射治疗泛耐药鲍曼不动杆菌颅内感染1例报告及文献复习[J].中国感染控制杂志,2019,18(4):335.
[5]夏博铭,朱磊,张恒柱,等.多途径联合用药治疗广泛耐药鲍曼不动杆菌颅内感染1例报告并文献复习[J].临床神经外科杂志,2019,16(3):266.
[6]黄榕彬,谷铁波.用替加环素颅内给药治疗一例泛耐药鲍曼不动杆菌的颅内感染[J].药学服务与研究,2019,19(3):226.
[7]王仙,李涛.开颅术后泛耐药鲍曼不动杆菌致颅内感染的治疗分析[J].实用药物与临床,2017,20(4):455.
[8]吴健标,张春红.多重耐药菌致颅内感染患者的药学监护[J].医药导报,2019,38(5):659.
[9]王小刚,朱伟杰,刘强,等.替加环素联合头孢哌酮钠舒巴坦钠治疗嗜麦芽窄食单胞菌致颅内感染1例[J].实用医药杂志,2020,37(1):41.
[10]WANG L J,ZHANG J R,YU X Q,et al.Intrathecal injection of tigecycline in treatment of multidrug-resistant Acinetobacter baumannii meningitis:a case report[J].Eur J Hosp Pharm,2017,24(3):182.
[11]TAK V,MATHUR P,VARGHESE P,et al.Elizabethkingia meningoseptica:an emerging pathogen causing meningitis in a hospitalized adult trauma patient[J].Indian J Med Microbiol,2013,31(3):293.
[12]FANG Y Q,ZHAN R C,JIA W,et al.A case report of intraventricular tigecycline therapy for intracranial infection with extremely drug resistant Acinetobacter baumannii[J].Medicine (Baltimore),2017,96(31):e7703.
[13]WU Y X,CHEN K,ZHAO J W,et al.Intraventricular administration of tigecycline for the treatment of multidrug-resistant bacterial meningitis after craniotomy:a case report[J].J Chemother,2018,30(1):49.
[14]LAURETTI L,D'ALESSANDRIS Q G,FANTONI M,et al.First reported case of intraventricular tigecycline for meningitis from extremely drug-resistant Acinetobacter baumannii[J].JNeurosurg,2017,127(2):370.
[15]?AHIN A,DALGIC N.Intraventricular plus intravenous tigecycline for the treatment of daptomycin nonsusceptible vancomycin-resistant enterococci in an infant with ventriculoperitoneal shunt infection[J].World Neurosurg,2019,130:470.
[16]SOTO-HERNáNDEZ J L,SOTO-RAMíREZ A,PéREZ-NERII,et al.Multidrug-resistant Klebsiella oxytoca ventriculitis,successfully treated with intraventricular tigecycline:a case report[J].Clin Neurol Neurosurg,2020,188:105592.
[17]LONG W Y,YUAN J,LIU J P,et al.Multidrug resistant brain abscess due to Acinetobacter baumannii ventriculitis cleared by intraventricular and intravenous tigecycline therapy:a case report and review of literature[J].Front Neurol,2018,9:518.
[18]DENG Z W,WANG J,QIU C F,et al.A case report of intraventricular and intrathecal tigecycline infusions for an extensively drugresistant intracranial Acinetobacter baumannii infection[J].Medicine (Baltimore),2019,98(15):e15139.
[19]PRATHEEP R,RAY S,MUKHOPADHYAY K,et al.First case report of intraventricular tigecycline in a neonate with extensively drug-resistant Acinetobacter baumannii ventriculitis[J].Pediatr Infect Dis J,2019,38(8):e172.
[20]TSOLAKI V,KARVOUNIARIS M,MANOULAKAS E,et al.Intraventricular CNS treatment with Colistin-Tigecycline combination:a case series[J].J Crit Care,2018,47:338.
[21]LIU Y,PU Z H,ZHAO M M.Case report of successful treatment of extensively drug-resistant Acinetobacter baumannii ventriculitis with intravenous plus intraventricular tigecycline[J].Antimicrob Agents Chemother,2018,62(11):01625.
[22]CUREBAL B,DALGIC N,BAYRAKTAR B.Intraventricular tigecycline for the treatment of shunt infection:a case in pediatrics[J].J Neurosurg Pediatr,2018,23(2):247.
[23]焦永成,孔海波,刘爱军,等.替加环素鞘内注射治疗多重耐药鲍曼不动杆菌颅内感染[J].临床神经外科杂志,2020,17(1):90.
[24]徐廷伟,敖祥生,秦永芳,等.神经外科患者术后颅内感染危险因素分析[J].中华医院感染学杂志,2016,26(8):1758.
[25]高建国,叶英.鲍曼不动杆菌颅内感染临床特征与预后危险因素分析[J].中华医学杂志,2018,98(37):2973.
[26]肖婷婷,肖永红.替加环素临床应用剖析[J].医药导报,2019,38(5):544.
[27]LENGERKE C,HAAP M,MAYER F,et al.Low tigecycline concentrations in the cerebrospinal fluid of a neutropenic patient with inflamed meninges[J].Antimicrob Agents Chemother,2011,55(1):449.
[28]CHEN J L,ORSINI J,KILLU C.Poor central nervous system penetration of tigecycline in a patient with Sepsis and ventriculitis caused by multidrug-resistant Klebsiella pneumoniae[J].JPharm Technol,2007,23(6):344.
[29]中华医学会神经外科学分会,中国神经外科重症管理协作组.中国神经外科重症患者感染诊治专家共识(2017)[J].中华医学杂志,2017,97(21):1607.
[30]LOHO T,DHARMAYANTI A.Colistin:an antibiotic and its role in multiresistant Gram-negative infections[J].Acta Med Indones,2015,47(2):157.
[31]CUNHA B A.Pharmacokinetic considerations regarding tigecycline for multidrug-resistant (MDR) Klebsiella pneumoniae or MDRAcinetobacter baumannii urosepsis[J].J Clin Microbiol,2009,47(5):1613.
基本信息:
DOI：10.19577/j.1007-4406.2021.01.012
中图分类号:R969.4;R742.9
引用信息:
[1]陈玥,李佳安,朱曼,等.替加环素鞘内/脑室内给药治疗多重耐药菌颅内感染的文献分析[J].中国临床药学杂志,2021,30(01):46-50.DOI:10.19577/j.1007-4406.2021.01.012.
2021-01-25
2021-01-25