利奈唑胺对AECOPD合并革兰阳性球菌感染的疗效分析

Analysis of curative effect of Linezolid in treatment of AECOPD complicated with gram positive cocci infection

目的观察利奈唑胺对慢性阻塞性肺疾病急性加重（AECOPD）期合并革兰阳性球菌感染患者的临床疗效及安全性。方法回顾分析我科收治的58例AECOPD合并革兰阳性球菌感染患者的临床资料,均给予利奈唑胺治疗,疗程5-12 d10观察患者临床疗效及不良反应发生情况。结果 58例患者合并感染的革兰阳性球菌包括耐甲氧西林金黄色葡萄球菌、耐甲氧西林凝固酶阴性葡萄球菌、耐甲氧西林表皮葡萄球菌、肺炎链球菌、屎肠球菌、粪肠球菌、表皮葡萄球菌及耐万古霉素金黄色葡萄球菌。利奈唑胺治疗总有效率为86.2%（50/58）,细菌学清除率为81.0%（45/58）,不良反应发生率为27.6%（16/58）。不良反应主要为血小板减少、胃肠道反应、皮疹,对症处理后均好转,未见其他严重不良反应。结论利奈唑胺治疗AECOPD合并革兰阳性球菌感染疗效确切,不良反应患者可耐受,可作为临床常规抗菌药物治疗无效的AECOPD合并革兰阳性球菌感染患者或多重耐药菌感染患者治疗的首选。

Objective To observe the clinical effect and safety of Linezolid in treatment of acute exacerbation of chronic obstructive pulmonary disease（ AECOPD） complicated with gram positive cocci infection. Methods Retrospective analysis was made for the clinical data of 58 patients with AECOPD complicated with gram positive cocci infection to receive treatment in our department,and Linezolid was administered for a treatment course of 5-12 days. The clinical effect and adverse reactions were observed. Results The infected gram positive cocci included methicillin-resistant staphylococcus aureus（ MRSA）,methicillin-resistant coagulase negative staphylococcus（ MRCNS）,methicillin-resistant staphylococcus epidermidis（ MRSE）,streptococcus pneumonia（ SP）,enterococcus faecalis（ EFs）,enterococcus faecium（ EFm）,staphylococcus epidermidis（ SEp） and vancomycin-resistant staphylococcus aureus（ VRSA）. The total effective rate of Linezolid therapy was 86. 2%（ 50 /58）,the rate of bacteriological clearance was 81. 0%（ 45 /58）,and the incidence of adverse reaction was 27. 6%（ 16 /58）. The major adverse reactions were thrombocytopenia,gastrointestinal reaction,and rash,which turned better after corresponding treatment,and there were no other serious adverse reactions. Conclusion Linezolid has definite curative effect on AECOPD complicated with gram positive cocci infection,and its adverse reaction is tolerable. It can be used as a preferable conventional antibacterial method in treatment of AECOPD complicated with gram positive cocci infection or multiple drug-resistant bacteria infection.