社團法人臺灣臨床藥學會

已出刊文章

【原著】Colistin之臨床應用於多重抗藥性菌再評估
Re-Evaluation of the Clinical Application of Colistin to Multidrug-Resistant Bacteria
Colistin, Multidrug-Resistant Acinetobacter baumannii (MDRAB), Carbapenem- Resistant Acinetobacter baumannii (CRAB)
林旭志Hsu-Chih Lin1 、張秀芳Hsiu-Fang Chang1 、鄭清連Cing-Lian Jheng1 、劉彥吟Yen-Yin Liu1 、陳子殷Tzu-Yin Chen1 、吳錦生Chin-Sheng Wu*1.2
1李綜合醫療社團法人大甲李綜合醫院藥劑科 、2中國醫藥大學藥用化妝品學系
本研究以回溯性分析某區域教學醫院自2011年1月至5月間接受colistin治療的住院病患。評估病患接受治療後30天的存活率、臨床適應症、用法/用量、療效及副作用。共收案33名患者(男性22名,女性11名),平均年齡78.5 ± 12.4歲。其中13名(39.4%)達成30天存活率,19名(57.6%)病危出院或死亡,1名(3%)因轉院而無法評估。患者疾病之嚴重度及年齡也會影響30天存活率的評估。患者感染症為肺炎(28名,84.8%)、敗血症(4名,12.1%)、泌尿道感染(1名,3.0%);細菌報告有28名(84.8%)為多重抗藥性鮑氏不動桿菌(multidrug-resistant Acinetobacter baumannii, MDRAB);平均用藥天數13.8 ± 5.2天。13名(39.4%)使用霧化吸入(劑量皆為66.8 mg q12h);靜脈注射有20名(60.6%),其中5名腎功能正常者用66.8 mg q8h、10名腎功能正常者用66.8 mg q12h、3名腎功能異常者減少給藥頻率,用66.8 mg qd、2位腎功能異常者減半劑量,用33.4 mg q12h。患者中有7名之Crea值呈上升(21.2%),其中靜脈注射5名(25%)、霧化吸入2名(15.4%),兩者的副作用並無顯著性差異。患者中有21名(63.6%)達到治療效果或改善。研究顯示colistin是治療碳青黴烯抗藥性鮑氏不動桿菌(carbapenem-resistant Acinetobacter baumannii, CRAB)和其他高度抗藥性細菌的重要抗生素,雖已被設定為後線的管制性抗生素,但唯有在有效的管理下使用,才能遏止各類抗生素抗藥性菌株的出現。
 
The aims of this retrospective study were to assess the clinical medication use of colistin in a regional teaching hospital. A total 33 hospitalized patients with infections was included, 28 patients with pneumonia (84.8%), 4 with sepsis (12.1%), and 1 with urinary tract infection (3.0%). The 30-day survival rate was 39.4% (13), 19 patients (57.6%) were discharged in critical condition or death, and 1 (3%) could not be assessed due to transfer. The disease severity and patient age also affected the 30-day survival rate. The bacterial cultures
showed 28 patients (84.8%) were infected from multidrug-resistant Acinetobacter baumannii (MDRAB).The average medication was 13.8 ± 5.2 days. Thirteen patients (39.4%) were given by aerosolized inhalation (dose: 66.8 mg q12h); 20 (60.6%) were given intravenously wherein 5 of normal renal function at the dose 66.8 mg q8h, 10 of normal renal function at 66.8 mg q12h, 3 of renal dysfunction at 66.8 mg qd, and 2 of renal dysfunction at 33.4 mg q12h. The Crea values of 7 patients (21.2%) were elevated, intravenous injection of 5
(25%) and aerosolized inhalation of 2 (15.4%). Side effects are not different significantly. Twenty one patients (63.6%) were cured or improved. Carbapenem-resistant Acinetobacter baumannii (CRAB) and other highly resistant bacteria have shown susceptibility to colistin in this study, Though it has been currently set to as a final-line controlled antibiotic, it should be used under the effective management in order to prevent the emergence of various types of antibiotic-resistant strains.
操作進行中,請稍候~~~~
×
加载中...