舒巴坦-度洛巴坦治疗肝移植受者术后广泛耐药鲍曼不动杆菌肺部感染的临床疗效分析

Clinical efficacy analysis of sulbactam-durlobactam in the treatment of postoperative pulmonary infection caused by extensively drug-resistant Acinetobacter baumannii in liver transplant recipients

摘要

目的 评估舒巴坦-度洛巴坦治疗肝移植受者术后广泛耐药鲍曼不动杆菌（XDR-AB）肺部感染的临床疗效与安全性。方法 回顾性分析西安交通大学第一附属医院2025年5月至12月间收治的3例肝移植术后XDR-AB肺部感染，并接受以舒巴坦-度洛巴坦为基础的抗感染方案的受者资料，分析临床资料、临床疗效、微生物学反应、安全性及结局。结果 所有分离菌株均为OXA-23型碳青霉烯酶的XDR-AB，且体外药敏试验显示对舒巴坦-度洛巴坦敏感。舒巴坦-度洛巴坦治疗后，3例受者均达到临床治愈与微生物清除，用药疗程6~8 d，病原菌清除时间为3~6 d。所有受者感染性休克得到有效控制，成功脱离机械通气，氧合指数与器官功能评分亦显著改善。治疗期间未发现与舒巴坦-度洛巴坦相关的明确肾毒性或其他严重不良反应，30 d全因病死率为0。2例重症受者在联合噬菌体雾化吸入治疗后实现快速病原学清除。结论 舒巴坦-度洛巴坦为基础的治疗方案对肝移植术后XDR-AB肺部感染受者展现出良好的疗效与安全性，具有积极的临床应用前景。

Abstract

Objective To evaluate the clinical efficacy and safety of sulbactam-durlobactam in the treatment of pulmonary infection caused by extensively drug-resistant Acinetobacter baumannii (XDR-AB) after liver transplantation. Methods A retrospective analysis was performed on the data of 3 liver transplant recipients admitted to the First Affiliated Hospital of Xi'an Jiaotong University from May to December 2025, who developed postoperative XDR-AB pulmonary infection and received sulbactam-durlobactam-based anti-infective therapy. Clinical data, clinical efficacy, microbiological response, safety and outcomes were analyzed. Results All isolated strains were XDR-AB producing OXA-23 carbapenemase, and in vitro antimicrobial susceptibility testing showed sensitivity to sulbactam-durlobactam. After treatment with sulbactam-durlobactam, all 3 recipients achieved clinical cure and microbiological eradication, with a treatment course of 6-8 days and pathogen clearance time of 3-6 days. Septic shock was effectively controlled in all recipients, who were successfully weaned from mechanical ventilation, and oxygenation index and organ function scores were significantly improved. No definite nephrotoxicity or other severe adverse reactions related to sulbactam-durlobactam were observed during treatment, and the 30-day all-cause fatality was 0. Two critically ill recipients achieved rapid microbiological clearance after combined nebulized phage therapy. Conclusions Sulbactam-durlobactam-based regimen shows favorable efficacy and safety in liver transplant recipients with postoperative XDR-AB pulmonary infection, and has a promising clinical application prospect.

关键词

舒巴坦-度洛巴坦 / 肝移植 / 广泛耐药鲍曼不动杆菌 / 肺部感染 / 耐碳青霉烯肺炎克雷伯菌 / 噬菌体 / 多黏菌素 / 急性呼吸窘迫综合征

Key words

Sulbactam-durlobactam / Liver transplantation / Extensively drug-resistant Acinetobacter baumannii / Pulmonary infection / Carbapenem-resistant Klebsiella pneumoniae / Bacteriophage / Polymyxin / Acute respiratory distress syndrome

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基金资助

国家自然科学基金青年项目(82500803)