利奈唑胺治疗新生儿耐药革兰氏阳性球菌败血症临床分析

Linezolid treatment in drug-resistant gram-positive coccobacterial sepsis of newborn:a clinical analysis

【目的】观察分析利奈唑胺治疗新生儿耐药革兰氏阳性球菌败血症的临床疗效和安全性。【方法】回顾分析本院新生儿科收治的30例耐药革兰氏阳性球菌败血症的临床特征、细菌学结果以及应用利奈唑胺治疗的临床疗效和安全性。【结果】30例血培养共检出耐甲氧西林凝固酶阴性葡萄球菌(methicillin resistant coagulase negativestaphylococci,MRCNS)22株,屎肠球菌5株,耐甲氧西林金黄色葡萄球菌(methicillin-resistant staphylococcus aureus,MR-SA)3株,药敏结果对青霉素、红霉素、氨苄西林、头孢唑啉等均耐药,对利奈唑胺敏感。MRCNS中表皮葡萄球菌12株、溶血葡萄球菌6株、人葡萄球菌2株,科氏葡萄球菌2株。治愈22例(73.3%),显效5例(16.7%),进步自动出院2例(6.7%),无效1例(3.3%),总有效率90%,血培养转阴率96.7%。治疗过程中5例(16.7%)发生不良反应,2例贫血,2例腹泻(1例合并粒细胞减少),1例呕吐,不良反应均较轻微,不影响用药,未见血小板减少,肝肾功能损害,皮疹及听神经病变等不良反应。【结论】利奈唑胺治疗新生儿耐药革兰氏阳性球菌败血症疗效显著、安全性好。

[Objective] To evaluate the clinical efficacy and safety of linezolid in the treatment of drug-resistant grampositive coccobacterial sepsis of newborn. [Methods] Totally 30 neonates with drug-resistant gram-positive coccobacterial sepsis were enrolled. Clinical characteristics,pathogens,efficacy and safety of linezolid were evaluated. [Results] 30 resistant gram-positive strains were detected. Of these,there were 22 strains methicillin resistant coagulase negative staphylococci （MRCNS）, 5 strains enterococcus faecom and 3 strains staphylococcus aureus. Drug sensitivity results showed that all strains were resistant to penicillin,erythromycin,ampicillin and cefazoline,but were sensitive to linezolid. Among the MRC- NS,staphylococcus epidermidis accounted for 12 strains, staphylococcus haemolyticus 6 strains, staphylococcus hominis 2 strains and staptococcus cohnii 2 strains. The clinical cure rate, significant rate, improvement rate and none effective rate were 73.3 %, 16. 7%, 6. 7% and 3. 3 %, respectively. The overall effective rate was 90%. Overall pathogen eradication rate was 96.7%. The main adverse reactions included anemia in 2 cases,diarrhea in 2 cases （diarrhea plus granulocytopenia in 1 case） ,and nausea in 1 case. Liver and renal function showed no influence. [Cenclusion] Linezolid is well-tolerated and effective in the treatment of drug-resistant gram-positive coccobacterial sepsis in neonates.