利奈唑胺和万古霉素治疗重症医学科院内耐甲氧西林金黄色葡萄球菌肺炎疗效及安全性研究

Efficacy and safety of Linezolid versus Vancomycin in treatment of hospital-acquired pneumonia caused by methicillin-resistant Staphylococcus aureus in ICU

目的比较利奈唑胺与万古霉素对ICU患者耐甲氧西林金黄色葡萄球菌(MRSA)肺部感染的疗效及安全性。方法对2008年5月至2010年11月温州市中医院收治的72例肺部MRSA感染的患者,分别给予利奈唑胺(0.6 g/次,每日2次)和万古霉素(1.0 g/次,每日2次)治疗,观察并比较两种方法的临床疗效、细菌学疗效及不良反应。结果万古霉素与利奈唑胺治疗MRSA的治愈率分别为25.7%和18.9%,临床总有效率分别为65.7%和51.4%,细菌清除率分别为71.4%和48.6%,不良反应总发生率为8.5%和5.4%,两组间MRSA治愈率、总有效率和不良反应总发生率比较差异无统计学意义(P>0.05),细菌清除率比较差异有统计学意义(P<0.05)。结论对于ICU患者肺部MRSA感染,利奈唑胺与万古霉素敏感率均很高,总体疗效相似,且安全性及耐受性较好,利奈唑胺痰菌清除率略高于后者。

Objective To compare the efficacy and safety of linezolid versus vancomycin in treatment of pneumonia caused by methicillin-resistant Staphylococcus aureus （MRSA） in ICU. Methods Between May 2008 and November 2010,72 patients with MRSA pneumonia were admitted to Wenzhou Traditional Chinese Medicine Hospital. The patients received 600 mg linezolid or 1 g vancomycin every 12 h daily. The therapeutic effect,bacterial clearance and adverse events were compared between the two treatments. Results The rates of full recovery and overall response were 25.7% and 65.7% for vancomyein versus 18.9% and 51.4% for linezolid in the treatment of MRSA infection. The bacterium clearance rates were 71.4% and 48.6% ;and the incidence of side effects were 8.5% and 5.4% ,respectively. There were no significant differences between the two groups in terms of full recovery,bacterial clearance and overall incidence of adverse effects （ P 〉 0. 05 ）. Conclusion For treatment of MRSA infections,Linezolid is similar to vancomycin in microbial susceptibility, overall efficacy, good safety and patient tolerance. Linezolid may be more effective than vancomycin in microbiological eradication from sputum.