利奈唑胺对老年人医院获得性MRSA肺炎的疗效观察

目的探讨利奈唑胺对老年人医院获得性MRSA肺炎的疗效和安全性。方法用HIS系统调取应用利奈唑胺治疗的老年人医院获得性MRSA肺炎39例资料，回顾性分析其疗效和不良反应（特别是对血小板的影响）。31例使用利奈唑胺注射剂，另8例采用序贯疗法（早期使用注射剂随后使用片剂），疗程均10～14d；1个疗程后MRSA未转阴9例再次静脉给药7～10d。结果27例临床有效，5例无效，死亡7例，总有效率69．23％。总疗程结束后，除去死亡7例，32例中MRSA清除27例（清除率84．4％）。18例患者用药后血小扳下降（46．15％），其中4例（10．26％）从正常值下降至正常值以下；39例用药前后血ALT、Cr、Hb变化均不明显。结论利奈唑胺治疗老年人医院获得性MRSA肺炎的疗效较好，血小板降低是利奈唑胺的主要不良反应。

Objective To investigate the efficacy and safety of linezolid for hospital MRSA Pneumonia in the elderly patients. Methods A retrospective analysis was employed to investigate linezolid in the treatment of confirmed hospital- acquired MRSA pneumonia patients in the cadres ward of our hospital in 2011. All the efficacy and safety of linezolid were explored, especially the impact on the platelet. Total 39 patients were enrolled with HIS system, 48 cases of application of linezolid. Among them 31 patients using linezolid injection, the other eight patients were treated with sequential therapy, early using injections subsequent using tablets. The actual course of treatment was 10 to 14 days with an average of 13.76 ± 6.56 days. Results By the end of treatment, 27 cases were clinically effective, 5 cases were ineffective, 7 patients died, the total effective rate was 69.23%.The bacteriological examination of 23 patients was negative, 9 patients re-used linezolid due to the uncleared bacteria. Except for the death cases, the MRSA of 27 cases was cleared, the MRSA clearance rate was 84.4%. 18 patients with thrombocytopenia after treatment （ 46.15% ） , including four cases of patients with platelet count dropped below to normal （ 10.26% ） , the platelet count decreased significantly （ P〈0.05 ） .The ALT, Cr and Hgb of all patients didn＇t change significantly （ P〉0.05 ） before and after treatment. Conclusion Linezolid is effective in the treatment on hospital- acquired MRSA pneumonia in elderly patients, its main adverse reactions is platelet descend.