万古霉素治疗葡萄球菌肺炎的疗效与肾毒性评价

Evaluation of vancomycin on nephrotoxicity and efficacy in treating patients with staphylococcal pneumonia

目的:评价万古霉素治疗葡萄球菌肺炎的疗效及肾毒性.方法:回顾性分析浙江省中医院加强监护病房(ICU)应用万古霉素治疗67例葡萄球菌感染病人的临床资料.根据病人肌酐清除率,决定每日万古霉素剂量,每日剂量(30±s 10)mg·kg-1,疗程7～14d,疗程剂量(22±13)g.结果:临床有效率为88%,细菌清除率88%(59/67),毒性发生率为16%(11/67),在发生肾毒性的病人中,23%肾功能可以恢复正常.Logistic回归分析表明APACHEⅡ评分及万古霉素治疗前感染持续时间是临床疗效相关因素,肾毒性的发生与APACHEⅡ评分、万古霉素剂量及其他药物密切相关.结论:万古霉素治疗葡萄球菌肺炎疗效明显,肾毒性低,是安全可靠的抗生素.

AIM: To evaluate the efficacy and nephrotoxicity of vancomycin in treating the patients with staphylococcal pneumonia. METHODS: The data from 67 patients treated with vancomycin because of staphylococcal pneumonia were retrospectively analyzed in our department. The daily dosage of vancomycin determined mainly by the creatine cleararce rate was (30±s 10) mg·kg -1 on average and the total dosage during different treatment time from 7 to 14 d was (22±13) g. RESULTS: Clinical effective rate was 88 % and bacterial eradication rate was 88 %(59/67) and the incidence of kidney toxicity was 16 % . Of all the patients with nephrotoxicity, 23 % could have normal renal function recovery. By means of logistic regression analysis, APACHEⅡ score and the infection duration before vancomycin treatment were the related factors for clinical efficacy. Moreover, the nephrotoxicity was closely related with APACHEⅡscore, vancomycin dosage and other drugs. CONCLUSION: Vancomycin is safe effective and reliable together with low renal toxicity to treat the patients with staphylococcal pneumonia.