De-escalation empirical antibiotic therapy improved survival for patients with severe aplastic anemia treated with antithymocyte globulin.
De-escalation empirical antibiotic therapy improved survival for patients with severe aplastic anemia treated with antithymocyte globulin.
复制标题
降级经验性抗生素治疗可改善接受抗胸腺细胞球蛋白治疗的严重再生障碍性贫血患者的生存率
DOI：
10.1097/md.0000000000005905
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发表时间：
2017-02
期刊：
影响因子：
1.6
通讯作者：
Shao Z
中科院分区：
文献类型：
--
作者：
Fu R;Chen T;Song J;Wang G;Li L;Ruan E;Liu H;Wang Y;Wang H;Xing L;Wu Y;Liu H;Qu W;Shao Z
摘要：本研究旨在探讨抗胸腺细胞球蛋白（ATG）治疗的严重再生障碍性贫血（SAA）患者控制感染的降压经验疗法的有效性和安全性。回顾性分析2006 - 2015年我院87例经atg治疗的微生物培养确诊的SAA患者。比较降压治疗和非降压治疗的疗效。在87例患者中，63例患者接受了降级治疗，24例患者接受了非降级治疗。首次抗菌药物治疗后第7天（60.32% vs. 25.00%, P = 0.003）和第30天（79.37% vs. 58.33%, P = 0.047），降级组患者对抗感染治疗的反应均高于非降级组。第30天，降级组的绝对中性粒细胞计数高于非降级组（76.19% vs. 45.83%, P = 0.007）；第90天，降级组的病死率较低（17.46% vs. 37.50%, P = 0.047），生存结局较好（P = 0.023）。降级组23例，非升级组5例接受了粒细胞输注。第7天输注粒细胞有助于缓解缓解组（P = 0.027）和非缓解缓解组（P = 0.042）的感染控制，但对第90天的生存没有改善。我们得出结论，降压抗生素改善了ATG治疗后SAA患者的生存。在接受ATG治疗的SAA患者中，应建议早期使用广谱抗生素，等待微生物培养，并承诺改用窄谱抗生素，以控制感染。粒细胞输注可能是控制感染的一种辅助治疗。
Abstract We aimed to investigate the efficacy and safety of de-escalation empirical therapy for controlling infection in patients with severe aplastic anaemia (SAA) treated with antithymocyte globulin (ATG). Eighty-seven ATG-treated SAA patients who had microbiological culture-confirmed infections from 2006 to 2015 in our center were retrospectively analyzed. The efficacy of de-escalation and non-de-escalation therapy was compared. Among all 87 patients, 63 patients were treated with de-escalation therapy and 24 patients with non-de-escalation therapy. More patients showed response to anti-infection treatment in de-escalation group than in non-de-escalation group both on day 7 (60.32% vs. 25.00%, P = 0.003) and on day 30 (79.37% vs. 58.33%, P = 0.047) since the initial antimicrobial therapy. On day 30, more patients had increased absolute neutrophil count in de-escalation group compared with non-de-escalation group (76.19% vs. 45.83%, P = 0.007), and de-escalation group had lower morality rate (17.46% vs. 37.50%, P = 0.047) and better survival outcome (P = 0.023) on day 90. Twenty-three patients in de-escalation group and 5 patients in non-escalation group received granulocyte transfusions. Granulocyte transfusions helped to control infections in both de-escalation group (P = 0.027) and non-de-escalation group (P = 0.042) on day 7, but did not improve survival on day 90. We concluded that de-escalation antibiotics improved survival in SAA patients after ATG treatment. Early administration of broad-spectrum antibiotics pending microbiological cultures combined with a commitment to change to narrow-spectrum antibiotics should be recommended for controlling infections in SAA patients treated with ATG. Granulocyte transfusions might be an adjunctive therapy in controlling infections.