利奈唑胺治疗血液病合并革兰阳性球菌感染102例临床观察

Clinical analysis of 102 blood disease patients with gram positive cocci infection treated with Linezolid

目的 观察利奈唑胺治疗血液病患者合并革兰阳性（G＋）球菌感染的疗效和安全性.方法 对应用利奈唑胺治疗的102例确诊或疑似G＋球菌感染的血液病患者进行回顾性分析,总结其有效性和安全性.给药方法：利奈唑胺600 mg,静脉滴注,每12 h 1次,疗程（10.82±5.12）（1～51）d,≥7 d者占74.5%,≥10 d者占51.0%.结果 应用利奈唑胺治疗的102例血液病患者中,男57例,女45例,年龄（45.26±19.15）（11～81）岁;原发疾病均为血液病,其中造血系统恶性肿瘤49例（48.0%）,良性贫血53例（52.0%）;医院内感染94例（92.2%）,社区感染8例（7.8%）.感染部位为下呼吸道80例（78.4%）,败血症11例（10.8%）,其他11例（10.8%）;感染病程（29.02±19.19）（7～61）d.确诊G＋球菌感染45例,拟诊57例;确诊患者中共分离出G＋球菌51株,其中金黄色葡萄球菌22株、溶血性链球菌13株、表皮葡萄球菌9株、屎肠球菌6株、海氏肠球菌1株;耐甲氧西林的金黄色葡萄球菌（MRSA）19株,耐甲氧西林的表皮葡萄球菌（MRSE）7株;7例合并1种G-杆菌感染,4例合并2种G-杆菌感染,12例合并真菌感染.ITT（意向治疗）分析应用利奈唑胺治疗G＋球菌感染疗效,治愈40例（39.2%）,显效31例（30.4%）,临床有效率为69.6%;PP（符合方案）分析治愈39例（41.9%）,显效27例（29.0%）,临床有效率为70.9%;细菌清除率70.6%（51例中36例）;细菌学疗效为清除的患者临床有效率为88.9%;经验治疗的临床有效率64.9%（57例中37例）,目标治疗的临床有效率为75.6%（45例中34例）;不良反应发生率2.9%（102例中3例）,为一过性血清转氨酶增高及外周血血小板计数减少.结论 利奈唑胺是治疗血液病患者G＋球菌感染的一种安全、有效的抗生素.

Objective To observe the efficacy and safety of linezolid for the treatment of gram positive coccus infections in hematological disease patients. Methods One hundred and two hematological disease patients with suspected or proven gram positive coccus bacteria infection were enrolled in this study. Linezolid was given at a dosage of 600 mg, iv, ql2h. The mean treatment period was （ 10.82±5.12 ）days （ 1 to 51 days） with 74.5% over 7 d and 51.0% over 10 d. Results Among 102 patients, 57 were male, 45 female aged 11 to 81 years, with a mean of （45.26±19.15） years. Ninety four cases were nosocomial infection（92.2% ） and 8 community infection（7.8%） ; There were pneumonia in 80 （78.4%）, septicemia in 11 （ 10.8% ）, and infection of other organsin 11 （ 10.8% ） ; Forty five cases were proven gram positive coccus bacteria infection, and 57 were suspected infection; Fifty one bacteria strains were isolated from cultivated samples of proven patients, in which 22 were staphylococcus aureus with 19 methicillin resistant 13 hemolytic streptococcus, 9 staphylococcus epidermidis with 7 methicillin resistant 6 enterecoccus faecom, and 1 enterococcus hirae. Seven cases were mixed with one kind gram negative bacillus infection, 4 mixed with two kinds of gram negative baciUus infection, and 12 mixed with fungal infection; Total clinical response rates by ITT （intention to treatment） analysis was 69. 6%, in which 40 （39. 2% ） were curative and 31 （30. 4% ） obviously effective; PP （per-protocol） analysis was 70.9%, in which 39 （41.9%） were curative and 27 （29.0%） obviously effective. Bacteria clearance rate was 70.6%, and in this group the clinical effective rate was 88.9% ; Adverse effect rate was 2.9%, being transient thrombocytopenia and increased transaminase. Conclusion Linezolid is a safe and effective antibiotic used in hematological disease patients complicated with infections of gram positive coccus.