哌拉西林-他唑巴坦在恶性血液病粒细胞缺乏伴发热经验性治疗中的应用

目的观察哌拉西林-他唑巴坦在恶性血液病化疗后粒细胞缺乏合并感染经验性治疗的效果和不良反应。方法回顾性分析本院收治血液系统恶性肿瘤患者化疗后粒缺合并感染146例，其中68例接受哌拉西林-他唑巴坦4．5g，每8小时1次；78例接受亚胺培南-西司他丁0．5g，每6小时1次，两组均联合依替米星。结果哌拉西林-他唑巴坦组有效率为75．0％，细菌清除率为73．3％；亚胺培南-西司他丁组的有效率为80．8％，细菌清除率为72．2％，P值均〉0．05。两组不良反应均较低且轻微，但与亚胺培南-西司他丁组相比，哌拉西林-他唑巴坦组胃肠道不良反应更少见（5．9％和17．9％，P（O．05），二重感染发生率低（13．2％和26．9％，P〈（）．05）。结论哌拉西林-他唑巴坦的疗效与亚胺培南-西司他丁相似，二重感染较少发生，可以作为恶性血液病化疗后感染的一线经验性治疗。

Efficacy of piperacillin-tazobactam in the treatment of febrile neutropenic patients with hematological malignancy

Objective To evaluate the safety and efficacy of intravenous piperacillin-tazobactam for the treatment of febrile neutropenic patients with hematological malignancy. Methods A total of 68 patients received piperacilljn-tazobactam 4.5 g every 8 hours; and 78 patients received imipenem-cilastatin 0.5 g every 8 hours. Both groups received etimicin. Results Clinical and bacteriological responses were equivalent between groups. The clinical response rate was 75.0% for piperacillin-tazobactam and 80.8 % for imipenem-cilastatin. Bacteriological clearance rate was 73.3 % for piperacillin-tazobactam and 72.2 % for imipenemcilastatin. The incidence of side effect was low in both groups. The effects were generally mild. Compared to imipenem-cilastatin group, piperacillin-tazobactam group showed lower gastrointestinal adverse reaction （5.9 % vs 17.9 %, P〈0.05） and lower incidence of superinfection （13.2 % vs 26.9 %, P〈0.05）. Conclusions Piperacillin-tazobactam is as effective as imipenem-cilastatin with fewer superinfection. It remains a good choice as initial empiric therapy for febrile neutropenic patients with hematological malignancy.