利奈唑胺与万古霉素治疗耐甲氧西林金黄色葡萄球菌致呼吸机相关性肺炎的效果

Effects of linezolid and vancomycin on treatment of ventilator-associated pneumonia caused by meticillin-resistant Staphylococcus aureus

目的探讨利奈唑胺与万古霉素治疗耐甲氧西林金黄色葡萄球菌(MRSA)所致呼吸机相关性肺炎(VAP)的疗效及安全性,为临床诊断治疗提供决策依据。方法对68例MRSA所致VAP患者随机分为利奈唑胺组和万古霉素组,每组各34例,两组的疗程均为7～14d;比较两组患者的疗效、细菌清除率、炎性反应及不良反应发生情况。结果利奈唑胺组MRSA清除率为73.5%、总有效率为64.7%,均显著高于万古霉素组55.9%、44.1%,差异有统计学意义(P<0.05);与治疗前比较,两组治疗后白细胞、前降钙素及C反应蛋白水平均显著下降(P<0.05),利奈唑胺组白细胞、前降钙素及C反应蛋白水平下降程度显著优于万古霉素组,差异有统计学意义(P<0.05);两组不良反应发生率分别为8.8%、14.7%,差异无统计学意义。结论利奈唑胺治疗MRSA所致VAP疗效优于万古霉素,可明显提高细菌清除率,减轻肺部炎性反应,不良反应少。

OBJECTIVE To explore the efficacy and safety of linezolid and vancomycin in the treatment of ventilator- associated pneumonia（VAP） caused by meticillin-resistant Staphylococcus aureus （MRSA） so as to guide the clinical diagnosis and treatment. METHODS A total of 68 cases of patients with VAP caused by MRSA were randomly divided into the linezolid group（n= 34） and the vaneomycin group（n= 34）. All the treatment courses were 7-14 days. The clinical effect, bacterial clearance rate, inflammatory reaction and side effect were observed and compared. RESULTS The bacterial clearance rate and the total effective rate of the linezolid group were respectively 73. 5M and 64. 7%, significantly higher than 55. 9% and 44. 1% of the vancomycin group, the difference was statistically significant （P 〈 0. 05）. The levels of white blood cell, C-reactive protein and procalcitonin in both groups were significantly decreased compared with those before the treatment （P〈 0.05）, while those indicators were decreased more remarkably in the linezolid group than in the vancomycin group, the difference was statistically significant （P〈0.05）. The incidence rate of the adverse reaction was 8. 8% in the linezolid group and 14.7% in the vancomycin group, the difference was not statistically significant. CONCLUSION Linezolid is more effective than vancomycin in the treatment of VAP caused by MRSA, it can remarkably raise the bacterial clearance rate and reduce the pulmonary inflammatory reactions, with less adverse reactions caused.