了解以多粘菌素为基础的联合治疗方案对碳青霉烯耐药的鲍曼不动杆菌（CRAB）、肺炎克雷伯杆菌（CRKP）和铜绿假单胞菌（CRPA）细菌感染的临床疗效及不良反应发生情况，给临床上合理应用多粘菌素提供参考。

回顾性分析2019年1月至2023年8月使用多粘菌素治疗的42例患者临床资料。应用SPSS 24.0软件进行数据分析，计量资料以（）表示，采用独立样本t检验；计数资料以[例（%）]表示，采用χ²检验。P<0.05为差异有统计学意义。

42例使用多粘菌素联合抗感染治疗，28例有效，14例无效，治疗有效率66.7%。多粘菌素B的治疗有效率（72.4%）高于多粘菌素E（53.8%），两组比较有统计学差异（P<0.05）；应用多粘菌素前抗菌药物的使用时间影响疗效，抗菌药物使用时间在14 d内更改为多粘菌素，治疗有效率为73.3%（30/42），优于2周后再更改治疗方案的有效率50%（21/42）（P<0.05）；CRPA的清除率较高，CRKP、CRAB细菌清除率较低；能显著降低炎症指标CRP和PCT（P<0.05）；多粘菌素治疗后的不良反应主要是肾毒性，急性肾损伤（AKI）发生率16.7%，多粘菌素E肾毒性发生率38.5%高于多粘菌素B 6.9%。

以多粘菌素为基础的联合治疗CRAB、CRKP和CRPA细菌感染有效，且多粘菌素B的疗效优于多粘菌素E。多粘菌素主要不良反应是肾毒性，多粘菌素E肾毒性发生率高于多粘菌素B。使用期间应加强对肾功能的监测，避免同时使用其他肾功能损伤药物。

To understand the clinical efficacy and adverse reactions of polymyxin-based combination therapy for carbapenem-resistant Acinetobacter baumannii (CRAB), Klebsiella pneumoniae (CRKP) and Pseudomonas aeruginosa (CRPA), and to provide reference for rational clinical application of polymyxins.

The clinical data of 42 patients treated with polymyxins from January 2019 to August 2023 were retrospectively analyzed. SPSS 24.0 software was used for data analysis. Measurement data were represented by () and independent sample t test was adopted. The statistical data were expressed as [cases (%)] and χ² test was used. P<0.05 was considered statistically significant.

42 cases treated with polymyxin combined with anti-infection, 28 cases were effective and 14 cases were ineffective, the effective rate was 66.7%. The effective rate of polymyxin B (72.4%) was higher than that of polymyxin E (53.8%), and there was statistical difference between the two groups (P<0.05). The duration of antibiotic use before polymyxin application affected the curative effect of the patients. When the duration of antibiotic use was changed to polymyxin within 14 days, the effective rate was 73.3% (30/42), which was better than the effective rate of 50% (21/42) after 2 weeks (P<0.05). The clearance rate of CRPA was higher, while the clearance rate of CRKP and CRAB was lower. CRP and PCT were significantly decreased (P<0.05). Nephrotoxicity was the main adverse reaction after polymyxin treatment, the incidence of acute kidney injury (AKI) was 16.7%, and the incidence of polymyxin E nephrotoxicity was 38.5%, which was higher than that of polymyxin B 6.9%.

Polymyxin-based combination therapy is effective in the treatment of CRAB, CRKP and CRPA bacterial infections, and the efficacy of polymyxin-B is better than polymyxin-E. The main adverse reaction of polymyxin was nephrotoxicity, and the incidence of nephrotoxicity of polymyxin E was higher than that of polymyxin B. The monitoring of renal function should be strengthened during use, and the simultaneous use of other drugs with renal function injury should be avoided.