利奈唑胺与万古霉素对耐甲氧西林金黄色葡萄球菌血流感染的有效性和安全性比较

Efficacy and degree of safety of vancomycin and linezolid in the treatment of MRSA bloodstream infection

目的比较万古霉素和利奈唑胺治疗耐甲氧西林金黄色葡萄球菌(MRSA)血流感染的效果及安全性。方法纳入MRSA血流感染患者14例,随机分为万古霉素组(n=8)和利奈唑胺组(n=6)。观察两种药物治疗后的临床效果及药物不良反应。结果两组28d病死率(16.7%和12.5%,P>0.05)、细菌清除率(83.3%和87.5%,P>0.05)、血管活性药物使用时间(3±1和4±1d,P>0.05)比较无统计学差异;万古霉素组退热时间短于利奈唑胺组(4.5±0.6和5.4±0.9d,P<0.05),细菌清除时间短于利奈唑胺组(4.0±0.8和4.4±0.9d,P<0.05),但ICU住院时间长于利奈唑胺组(19.8±2.5和16.4±2.7d,P<0.05)。两组治疗后白细胞、中性粒细胞比值与治疗前相比,自第3天开始下降,第5天出现明显下降(P<0.05),但组间比较无统计学差异(P>0.05);降钙素原(PCT)、C反应蛋白(CRP)结果与上述变化相似,在治疗第5天开始与治疗前出现明显差异(P<0.05);万古霉素组内生肌酐清除率(CrCl)在第3天下降,于第5天达到峰值,与治疗前相比有统计学差异(P<0.05),第14天又回复至治疗前水平(P>0.05)。两组接受血液透析或血液滤过的患者数没有增加。利奈唑胺组CrCl治疗前后比较无统计学意义(P>0.05)。结论利奈唑胺和万古霉素治疗MASA血流感染疗效基本相当,且两种药物安全性、耐受性均较好。

Objective To compare the efficacy and degree of safety between vancomycin and linezolid in the treatment of methicillin-resistant Staphylococcus aureus （MRSA） bloodstream infection. Methods Fourteen patients with MRSA bloodstream infection were randomly assigned into vancomycin group （n=8） and linezolid group （n=6）. The clinical efficacy and adverse effects of the two drugs were observed. Results No significant differences existed between vancomycin group and linezolid group in 28-day death rate （1/6 vs 1/8, P0.05）, bacterial clearance rate （5/6 vs 7/8, P0.05） and time of vasopressor therapy （3±1 vs 4±1d, P0.05）. Compared with vancomycin group, the ICU length of stay was shortened （16.4±2.7d vs 19.8±2.5d, P0.05） while the time of bacteria clearance （4.4±0.9d vs 4.0±0.8d, P=0.01） and pyretolysis lengthened （5.4±0.9d vs 4.5±0.6d, P=0.04） in linezolid group. WBC and neutrophile ratio in the both groups began to decline on the 3rd day after treatment, and declined significantly on the 5th day （P0.05） compared with those before treatment, and there was no difference between two groups. Determinations of procalcitonin （PCT） and C reactive protein （CRP） showed similar results as above. Change in their antents was significant on the 5th day after the treatment （P0.05）. Creatinine clearance rate decreased from day 3 to 5 （P0.05） and returned to pre-treatment level on day 14 （P0.05） in vancomycin group. The number of patients in whom hematodialysis or hemofiltration was necessary was not increased. There was no statistical difference in creatinine clearance rate （P0.05） before and after treatment in linezolid group. Conclusions Vancomycin and linezolid treatment against MRSA bloodstream infection appears to have equal efficacy, and both drugs were safe and well-tolerable.