头孢他啶阿维巴坦在肺炎克雷伯菌肝脓肿侵袭综合征中的疗效观察

Efficacy of Ceftazidime-Avibactam in the Treatment of Klebsiella pneumoniae Liver Abscess Syndrome

摘要: 目的：探讨注射用头孢他啶阿维巴坦(Ceftazidime-Avibactam, CAZ)在肺炎克雷伯菌肝脓肿侵袭综合征(Klebsiella pneumoniae Liver Abscess Syndrome, KLAS)中的临床疗效与安全性。方法：回顾性分析2020年1月至2023年12月入住青岛大学附属医院的35例KLAS患者的临床资料，根据治疗方案不同分为CAZ治疗组(20例，在常规基础上给予CAZ治疗)和对照组(15例，在常规基础上给予碳青霉烯类联合替加环素治疗)，比较两组患者临床治疗总有效率、28天全因死亡率、发热消退时间、炎症指标变化(白细胞计数、C反应蛋白、降钙素原)、微生物清除率及药物相关不良反应发生率。结果：35例患者中，男性21例，女性14例，平均年龄(62.8 ± 10.3)岁。对照组的序贯器官功能衰竭评估(SOFA)评分略高于CAZ组，且该差异具有统计学意义(P < 0.05)；然而，CAZ组的临床治愈率和28天死亡率与对照组相比差异均无统计学意义(均P > 0.05)；同时，对照组的微生物清除率较CAZ组稍低，细菌清除所需时间以及平均退热时间也略长于CAZ组，但这些差异同样未达到统计学意义(均P > 0.05)；在治疗前后，两个组别在白细胞计数、降钙素原和C反应蛋白水平方面的差异均未显著(均P > 0.05)；值得注意的是，对照组中胃肠道症状的发生率高于CAZ组(21%对比5%)，但此差异并未达到统计学显著性(P > 0.05)。结论：对于KLAS患者，采用CAZ单药治疗与传统的多药联合方案在整体治疗效果上无明显差异，且CAZ安全性较高，可作为治疗KLAS患者的重要选择。

Abstract: Objective: To investigate the clinical efficacy and safety of Ceftazidime-Avibactam (CAZ) in the treatment of Klebsiella pneumoniae Liver Abscess Syndrome (KLAS). Methods: A retrospective analysis was conducted on the clinical data of 35 patients with KLAS admitted to the Affiliated Hospital of Qingdao University from January 2020 to December 2023. Based on the treatment regimen, the patients were divided into the CAZ treatment group (20 cases, receiving CAZ in addition to conventional therapy) and the control group (15 cases, receiving carbapenems combined with tigecycline in addition to conventional therapy). The total clinical effective rate, 28-day all-cause mortality, fever resolution time, changes in inflammatory markers (white blood cell count, C-reactive protein, procalcitonin), microbial clearance rate, and incidence of drug-related adverse reactions were compared between the two groups. Results: Among the 35 patients, 21 were male and 14 were female, with an average age of (62.8 ± 10.3) years. The Sequential Organ Failure Assessment (SOFA) score in the control group was slightly higher than that in the CAZ group, and the difference reached statistical significance (P < 0.05). There were no statistically significant differences in clinical cure rate and 28-day mortality between the CAZ group and the control group (both P > 0.05). The microbial clearance rate in the control group was slightly lower than that in the CAZ group, and the bacterial clearance time and average fever resolution time were slightly longer than those in the CAZ group, but the differences were not statistically significant (all P > 0.05). There were no statistically significant differences in white blood cell count, procalcitonin, and C-reactive protein levels before and after treatment in both groups (all P > 0.05). The incidence of gastrointestinal symptoms in the control group was higher than that in the CAZ group (21% vs 5%), but the difference was not statistically significant (P > 0.05). Conclusion: For patients with KLAS, monotherapy with CAZ shows no significant difference in overall treatment efficacy compared to traditional multi-drug combination regimens, and CAZ has a higher safety profile, making it an important option for the treatment of KLAS patients.