探讨替加环素对NICU碳青霉烯耐药菌感染的院内获得性肺炎患者的抗感染疗效，为神经重症的抗感染治疗提供理论依据。

回顾性分析2015年5月至2018年11月在我科重症加护病房(NICU)确诊碳青霉烯类耐药细菌感染的院内获得性肺炎患者131例临床资料。依据痰细菌培养结果分为鲍曼不动杆菌阳性组和肺炎克雷伯杆菌阳性组。依据抗感染治疗方案分为3组：替加环素与美罗培南联合治疗组；替加环素与亚胺培南西司他丁钠联合治疗组；替加环素与头孢哌酮舒巴坦联合治疗组。采用χ²检验或t检验分析各组患者的一般情况，临床有效率、微生物清除率以及炎症指标变化。采用Logistic回归分析观察与临床疗效相关的危险因素。

①在鲍曼不动杆菌阳性组中替加环素与美罗培南联合治疗组的临床有效率为63.64%，与其他两组比较有显著差异(P<0.05)。在肺炎克雷伯杆菌阳性组中3种联合治疗方案的临床有效率无明显差异(P>0.05)；②在鲍曼不动杆菌阳性组和肺炎克雷伯杆菌阳性组中各组微生物清除率均无明显差异(P>0.05)；③给予3种不同替加环素联合抗感染治疗后各组患者白细胞数量、降钙素原、C反应蛋白等炎症标记物较抗感染治疗前均显著下降(P<0.05)；④Logistic回归分析发现性别、气管插管/气管切开、治疗前降钙素原、治疗前C反应蛋白对临床有效率产生显著影响(P<0.05)。

NICU碳青霉烯耐药菌感染的院内获得性肺炎患者给予替加环素联合治疗具有较好的抗感染疗效。在我科NICU泛耐药菌菌种以鲍曼不动杆菌为主，以替加环素与美罗培南联合具有显著抗感染疗效。

To provide theoretical evidences, we analyzed the effect of tigecycline on the anti-infection treatment of the patients with hospital-acquired pneumonia caused by carbapenem-resistant bacteria in the Neurosurgical Intensive Care Unit (NICU) in our hospital.

The clinical data of 131 NICU patients with hospital-acquired pneumonia caused by carbapenem-resistant bacteria from May 2015 to November 2018 were analyzed retrospectively. According to the results of sputum bacterial culture, they were divided into an extensively drug-resistant Acinetobacter baumannii positive group and an extensively drug-resistant Klebsiella pneumoniae positive group. Then the patients received the following three anti-infective treatments, respectively: tigecycline combined with meropenem, tigecycline combined with imipenem-cilastatin sodium, and tigecycline combined with cefoperazone/sulbactam. Then Student′s t test or chi-square test were used to analyze the data among the three treated groups including the clinical characteristics, clinical efficiency, microbiological eradication rate and inflammatory markers. Logistic regression analysis was used to determine the risk factors related to the clinical cure rate.

①Compared with the other two groups, the clinical efficiency of the group of tigecycline combined with meropenem was the most highest in the extensively drug resistant Acinetobacter baumannii positive group (63.64%, P<0.05). There were no significant differences in the clinical efficiencies of the three treatment groups in the extensively drug resistant Klebsiella pneumoniae positive group (P>0.05). ②There were no significant differences in the microbiological eradication rates of the three treatment groups in both extensively drug resistant Klebsiella pneumoniae positive group and Acinetobacter baumannii positive group (P>0.05). ③Compared with the inflammatory markers before anti-infective treatments, the inflammatory markers of all the groups, such as white blood cell count, C reaction protein and procalcitonin, were significantly decreased after anti-infectice treatments (P<0.05). ④The results of Logistic regression analysis showed that the markers, such as gender, tracheal intubation/tracheotomy, the values of C reaction protein and procalcitonin, before anti-infective treatments, had a significant impact on the clinical efficiency (P<0.05).

Tigecycline combined treatments can achieve better clinical therapeutic effects on the NICU patients with hospital-acquired pneumonia caused by carbapenem-resistant bacterias. Acinetobacter baumannii is the main extensively drug-resistant strain in our NICU. Treatment of tigecycline combined with meropenem has a significant anti-infective effect on the patients with hospital-acquired pneumonia caused by the extensively drug resistant Acinetobacter baumannii.