Evaluation Of The Efficacy And Safety Of Tigecycline In The Treatment Of Neurosurgery CRO Infection

Objective:(1)to analyze the distribution of carbapenem resistant G-bacteria(CRO)in neurosurgery.(2)Objective to investigate the efficacy and safety of tigecycline in the treatment of CRO infection.(3)It is expected to provide theoretical support for the development of expert consensus and clinical guidelines for the treatment of CRO infection.Methods: the data of 272 patients who used tigecycline in neurosurgery department from January 2018 to December 2019 were searched.According to the inclusion criteria,171 patients with CRO infection were selected as the research objects and analyzed retrospectively.The clinical efficacy and safety of tigecycline in the treatment of CRO in Department of neurosurgery were evaluated.Results:(1)Distribution of pathogens: among 171 patients with CRO infection,pulmonary infection was the most common(n = 153),followed by intracranial infection(n= 30);Among 234 strains of CRO,Acinetobacter baumannii(46.58%)and Klebsiella pneumoniae(44.87%)were the top two.(2)Effectiveness analysis: tigecycline had a good effect on pulmonary CRO(65.18%)and a poor effect on intracranial infection(29.41%);135 cases of pulmonary CRO infection were divided into two groups and analyzed.The curative effect of double dose group was better than that of standard dose group(72.58%vs 57.45%);The combination regimen was better than the single regimen;Among the four combinations,tigecycline + amikacin + cefoperazone and sulbactam had the highest effective rate(77%).(3)Liver function: 119 cases had complete liver function index,1case had drug-induced liver damage after treatment,TBIL increased,ALT and AST decreased after treatment with tigecycline(all P < 0.05);According to the analysis of dose grouping,TBIL and AST had no significant change in the standard dose group(P > 0.05),ALT decreased(P < 0.05),TBIL increased,ALT decreased(P < 0.05),AST had no significant change in the double dose group(P > 0.05).(4)Coagulation function: the coagulation function indexes of 42 cases were complete,17 cases had coagulation disorder during the treatment,FIB < 2G / L in 26 cases,FIB < 1g / L in 9 cases,INR,Pt,APTT and TT increased,PLT,FIB and D-D decreased after treatment(all P < 0.05).According to the dose group analysis,TT increased and FIB decreased in 12 cases of standard dose group(all P < 0.05),but PLT,INR,Pt,APTT and D-D had no significant difference(P > 0.05);INR,Pt,APTT,TT increased,PLT,FIB,D-D decreased in 19 cases of double dose group(all P < 0.05).According to whether combined with cefoperazone sulbactam or not,TT increased,FIB and D-D decreased in 17 cases of tigecycline group(all P < 0.05),but PLT,INR,Pt and APTT had no significant difference(P > 0.05);INR,Pt,APTT,TT increased,PLT,FIB,D-D decreased in combination group(all P < 0.05).Conclusion:(1)In neurosurgery,CRO infection mainly occurs in the lung and intracranial,and the most common type of CRO is crab and crkp.(2)Tigecycline is effective in the treatment of pulmonary CRO,but not in the presence of intracranial infection;Tigecycline has a good therapeutic effect on pulmonary crab and crkp infection.Its curative effect is related to the dosage and combination regimen.The effective rate of double dose is higher than the standard dose,and the combination regimen is better than the single drug regimen.Among the four commonly used combination regimens,tigecycline + amikacin +cefoperazone sulbactam has the best curative effect.(3)Tigecycline is less likely to cause severe liver damage in patients with liver function below moderate level.The main clinical symptom of liver dysfunction caused by tigecycline is the increase of total bilirubin,which is dose-dependent.The effect of tigecycline on the increase of glutamic oxaloacetic transaminase and alanine aminotransferase is not obvious.(4)Tigecycline has different degrees of influence on various coagulation indexes,especially on fib.When the dosage is doubled or combined with cefoperazone sulbactam,the risk of bleeding will increase significantly,so we should be vigilant in the process of clinical use.