Objective: To compare the efficacy and safety of eravacycline and polymyxin drugs in the treatment of multidrug-resistant complicated intra-abdominal infections(cIAI). Methods: The cIAI patients diagnosed or highly suspected of multidrug resistant bacterial infection who received eravacycline treatment at Sir Run Run Shaw Hospital and Shulan (Hangzhou) Hospital from June to August 2023 were prospectively included as the elacycline group. The cIAI patients with cIAI caused by multidrug resistant bacteria who received treatment with polymyxin (B or E) from January 2021 to August 2023 were retrospectively collected. The acute physiology and chronic health scores and age were matched with those of the elacrinid group, and they were included in the polymyxin group. The study mainly analyzed the clinical efficacy, microbial clearance rate, comprehensive efficacy, and safety of the two groups at the end of treatment and discharge. Results: A total of 72 patients with cIAI were included in the study, including 53 males and 19 females, aged (56.0±15.4) years. Among them, there were 28 cases in the eravacycline group and 44 cases in the polymyxin group. There was no statistically significant differences in the baseline, the proportion of patients who used combined drugs, the strains, the infection sites and infection conditions of patients between the two groups(all P>0.05).The clinical efficacy rate at the end of treatment [89.3% (25/28) vs 56.8%(25/44), P=0.004] and discharge [(88.5%(23/26) vs 63.6%,(28/44), P=0.024], microbial clearance rate at the end of treatment [(88.9% (24/27) vs 47.6%(20/42), P=0.001] and discharge [(91.3%(21/23) vs 59.5%(25/42), P=0.007], and overall recovery rate at the end of treatment [(89.3%(25/28) vs 52.3%(23/44), P=0.001] and discharge [(88.5%(23/26) vs 63.6%(28/44), P=0.024] in the erythromycin group were higher than those in the polymyxin drug group. In terms of safety, only 2 cases of mild vasculitis were observed in the eravacycline group. Conclusions: Combined regimens based on eravacycline showed better clinical effect in the treatment of cIAI caused by multidrug-resistant bacteria. The clinical effective rate, microbial clearance rate and comprehensive efficacy were significantly higher than those of polymyxin drugs at the end of treatment and discharge with good safety.
目的： 比较依拉环素和多黏菌素类药物对多重耐药复杂腹腔感染（cIAI）的疗效与安全性。 方法： 前瞻性纳入2023年6至8月在浙江大学医学院附属邵逸夫医院和树兰国际医学院附属树兰（杭州）医院就诊的已知或高度怀疑多重耐药菌感染的cIAI患者，作为依拉环素组。回顾性收集2021年1月至2023年8月接受多黏菌素（B或E）治疗的多重耐药菌感染的cIAI患者，通过急性生理与慢性健康评分和年龄与依拉环素组进行匹配，纳入多黏菌素组。分析两组治疗结束和出院时的临床有效率、微生物清除率、综合疗效和安全性。 结果： 研究共纳入72例cIAI患者，男53例，女19例，年龄（56.0±15.4）岁。其中依拉环素组28例，多黏菌素组44例。两组患者基线指标、联合用药患者比例、菌株、感染部位和感染情况方面差异均无统计学意义（均P>0.05）。依拉环素组患者在治疗结束时［89.3%（25/28）比56.8%（25/44），P=0.004］和出院时［88.5%（23/26）比63.6%（28/44），P=0.024］的临床有效率、治疗结束时［88.9%（24/27）比47.6%（20/42），P=0.001］和出院时［91.3%（21/23）比59.5%（25/42）， P=0.007］的微生物清除率以及治疗结束时［89.3%（25/28）比52.3%（23/44），P=0.001］和出院时［88.5%（23/26）比63.6%（28/44）， P=0.024］的综合疗效均高于多黏菌素组。安全性方面，依拉环素组患者仅观察到2例轻度血管炎。 结论： 基于依拉环素的联合方案对多重耐药菌引起的cIAI有较好的临床疗效，在治疗结束和出院时的临床有效率、微生物清除率和综合疗效均优于多黏菌素类药物，且安全性良好。.