利奈唑胺和替考拉宁治疗住院高龄革兰阳性菌感染患者的临床应用分析

Linezolid and teicoplanin on very old patients with gram positive bacterium infection

目的调查和比较利奈唑胺和替考拉宁治疗住院高龄革兰阳性球菌感染患者的疗效和安全性。方法回顾性分析2008年1月至2011年8月我科住院的高龄革兰阳性球菌感染患者的临床资料，共58例[年龄84-98岁，平均（91．2±4．0）岁]，分为利奈唑胺组（30例）和替考拉宁组（28例），设定临床疗效评价（痊愈、显效、进步、无效）和细菌学疗效评价标准（清除、假设清除、未清除，替换、再感染），了解利奈唑胺和替考拉宁的疗效和不良反应。结果临床总有效率利奈唑胺组为93．3％，替考拉宁组为78．5％，二者无统计学差异（P=0．103）；细菌清除率利奈唑胺组为86．7％，明显高于替考拉宁组的53．6％（P〈0．05）。治疗过程中利奈唑胺组主要不良反应为血小板减少，替考拉宁组主要不良反应为血肌酐升高。结论利奈唑胺和替考拉宁在临床上治疗高龄革兰阳性球菌感染患者疗效肯定，利奈唑胺在临床疗效和细菌清除率方面优于替考拉宁。在选择用药时，要严格掌握适应证。需注意监测血小板和血肌酐的变化。

Objective To analyze the curative effect of linezolid and teicoplanin on aged patients with gram positive bacterium infection. Methods Clinical data of 58 cases [aged 84-98 years, mean（91.2 ± 4.0）years] from January 2008 to August 2011 were retrospective analyzed. The patients were divided into linezolid group（30 cases） and teicoplanin group（28 cases） and standards of clinical evaluation （clarified as recovery, effective, proceeding and ineffective） and bacteriological evaluation （eliminated, presumptively eliminated, un-eliminated, substitutive, reinfective） were set to assess the curative effect as well as the adverse reaction of linezolid and teicoplanin. Results There was no no statistical difference in total clinical effective rate between linezolid and teicoplanin groups （93.3% vs 78.5%, P=0.103）, while bacterial clear rate was significantly higher in linezolid group than in teicoplanin group （86.7% vs 53.6%, P 〈 0.05）. The major adverse reaction of linezolid during treatment was thrombocytopenia and increased serum creatinine was observed in teicoplanin group. Conclusions Both linezolid and teicoplanin have good curative effects on aged patients that infected by gram positive cocci. Linezlid has superior clinical curative effect and bacteria clearance. It must be careful in medicine selection according to the indications, meanwhile pay more attention to platelets and serum creatinine monitoring.