万古霉素治疗耐甲氧西林金黄色葡萄球菌肺炎老年患者的疗效分析

Efficacy of vancomycin in treatment of pneumonia caused by methicillin-resistant Staphylococcus aureus in the elderly patients

目的：探讨万古霉素治疗耐甲氧西林金黄色葡萄球菌（M RS A ）肺炎老年患者的疗效和安全性。方法回顾性分析M RS A肺炎老年患者40例，根据治疗方案，将患者分为2组：万古霉素组25例，给予万古霉素每次0．5 g ，每8小时1次，静脉滴注，治疗时间10～14 d；利奈唑胺组15例，给予利奈唑胺每次0．6 g ，每12小时1次，静脉滴注，治疗时间10～14 d。比较两组患者的疗效和不良反应。结果万古霉素组临床有效率为72．0％，利奈唑胺组为86．7％，两组比较差异无统计学意义（P＞0．05）；经治疗后，万古霉素组MRSA清除率为76．0％，利奈唑胺组为80．0％，两组比较差异无统计学意义（P＞0．05）；利奈唑胺组有3例发生血小板减少＞25％，占20．0％，万古霉素组未见血小板减少，万古霉素组有4例发生急性肾功能不全，占16．0％，利奈唑胺组未见肾功能损害。结论万古霉素治疗老年M RS A肺炎有较好的临床疗效，血小板减少的发生率低，应警惕急性肾功能不全的风险。

Objective To examine the efficacy and safety profile of vancomycin in treatment of pneumonia caused by methicillin‐resistant Staphylococcus aureus （MRSA）in the elderly patients .Methods The clinical data were retrospectively analyzed for 40 elderly patients with MRSA‐induced pneumonia .The patients were analyzed in terms of treatment regimen ,vancomycin （n=25）or linezolid （n= 15） .Vancomycin was administered intravenously at dose of 0 .5 g every 8 hours for 10‐14 days ,while linezolid was given intravenously at dose of 0 .6 g every 12 hours for 10‐14 days .The clinical efficacy and adverse events were compared between the two groups .Results The overall efficacy rate was 72 .0% in vancomycin group ,and 86 .7% in linezolid group （P＆gt;0 .05） .After treatment ,the clearance rate of MRSA was 76 .0% in vancomycin group ,and 80 .0% in linezolid group （P＆gt;0 .05） .Reduction of platelet counts by more than 25% was found in 3 （20 .0% ）patients treated with linezolid ,but none patient in vancomycin group .Acute renal dysfunction was reported in 4 （16 .0% ）patients in vancomycin group but not identified in linezolid group .Conclusions Vancomycin has positive effect in the treatment of MRSA pneumonia in the elderly . Vancomycin treatment is associated with lower risk of thrombocytopenia ,but relatively higher risk of acute renal dysfunction .