利奈唑胺治疗糖肽类药物治疗无效MRSA的感染分析

Analysis of linezolid in treatment of MRSA infection after ineffective glycopeptide antibiotics treatment

目的了解利奈唑胺对于治疗糖肽类药物治疗无明显效果的耐甲氧西林金黄色葡萄球菌(MRSA)感染的效果及优点,为临床用药提供参考。方法对2008年2月—2009年7月入住我院ICU并细菌培养为MRSA,且确定为致病菌,给予足够剂量的万古霉素或替考拉宁治疗大于5d无明显效果,后给予利奈唑胺治疗收到满意效果的患者进行回顾性分析。结果所有培养为MRSA的药敏结果均回报对万古霉素、替考拉宁及利奈唑胺敏感。12例患者均根据药敏结果首先选用万古霉素或替考拉宁治疗,疗程均在5d以上,患者血象、体温无明显好转,再次细菌培养仍为MRSA。所有患者给予利奈唑胺治疗后,血象、体温明显好转,再次细菌培养未见细菌生长。4例患者治疗时间超过28d,3例出现三系细胞减低,考虑利奈唑胺致骨髓抑制,停药1周后回复正常。结论利奈唑胺可以做为治疗糖肽类药物初始治疗失败的革兰阳性菌感染的选择用药;疗程超过28d的患者,有出现骨髓抑制等药物相关性副作用的风险,应密切监测血常规。

Objective To investigate the effect and safety of Linezolid in the treatment of Methicillin-resistant Staphylococcus aureus （MRSA） infection which is after ineffective glycopeptide antibiotics treatment. Methods We retrospectively analyzed 12 cases with positive bacterial culture for MRSA in ICU of our hospital from February, 2008 to July, 2009. These patients were all administered with Linezolid after more than five days ineffective vancomycin or teicoplanin treatment. Results All drug susceptibility test show cultured MRSA was senstive to vancomycin, teicoplanin and linezolid.All 12 patients were first treated with vancomycin or teicoplanin according to the drug susceptibility results. After more than five days treatment,showed no significant amelioration in the patients body temperature or hemogram and bacterial culture were still MRSA positive. But, after administered with Linezolid all patients showed significant amelioration in body temperature or hemogram and bacterial culture became negative. Four cases of patients were administered with Linezolid more than 28 days, three of them showed peripheral blood cell reduction, which might due to linezolid-induced bone marrow suppression, their hemogram returned to normal after drug withdrawal for 1 week. Conclusions Linezolid can be used in the treatment of MRSA infection which is after ineffective glycopeptide antibiotics treatment.Patients with linezolid treatment over 28 days might show features of bone marrow suppression and other drug associated adverse effects,that need closely monitor of the blood.