利奈唑胺治疗耐甲氧西林金黄色葡萄球菌血流感染的效果及安全性

Efficacy and safety of linezolid among patients with methiciillin-resistant Staphylococcus aureusbacteremia

目的探讨利奈唑胺治疗耐甲氧西林金黄色葡萄球菌（MRSA）血流感染的效果及安全性。 方法回顾性分析2010年1月至2014年4月浙江大学医学院附属第一医院确诊的52例MRSA血流感染患者的临床资料。按照利奈唑胺治疗方案分为初始治疗组（19例）和替换治疗组（33例）。比较分析两组患者临床特征、发热持续时间、临床有效率、细菌清除率、28 d病死率、药物不良反应等。 结果52例MRSA血流感染患者中复杂性血流感染比例高达82.7%（43/52）；发热为最常见临床表现，占86.5%（45/52）。初始治疗组治疗前肾功能不全占68.4%（13/19）；替换治疗组替换原因：持续发热或反复发热占69.7%（23/33）、糖肽类使用后肾功能损害占12.1%（4/33）、治疗期间出现新发MRSA感染病灶占18.2%（6/33）。初始治疗组与替换治疗组的治疗有效率[78.9%（15/19）比81.8%（27/33）]、发热持续时间[4（3，15）比12（5，24）d]、28 d病死率[15.8%（3/19）比9.1%（3/33）]、不良反应发生率[15.8%（3/19）比12.1%（4/33）]差异均无统计学意义（均P〉0.05）。 结论利奈唑胺治疗MRSA血流感染临床效果好且较安全。

Objective To study the efficacy and safety of linezolid for the treatment of patients with bacteremia caused by methicillin-resistant Staphylococcus aureus （MRSA）. Methods Totally 52 cases of MRSA bacteremia patients, from January 2010 to April 2014 in the First Affiliated Hospital, School of Medicine, Zhejiang University, were retrospectively analyzed. They were classified into two groups based on linezolid therapeutic regimen： primary treatment with linezolid （19 cases） and ahemated to linezolid （33 cases）. The following data were collected and compared： clinical characteristics, lasting time of fever, bacterial clearance rate, clinical efficacy, fatality rate, and adverse events. Results Forty three of the 52 patients （82. 7% ） suffered complicated MRSA bactcremia. The most common clinical feature was fever [86. 5% （45/52）]. Linezolid was initiatively used mostly because of renal insufficiency [ 68.4% （ 13/19 ） ]. In the other 33 patient, glyeopeptides were initiatively used, then alternated to linezolid because of persistent fever[69.7% （23/33）1; damage of kidney function during treatment period of glycopeptides 12. 1% （4/33）]; occurrence of new infectious site related to MRSA [ 18.2% （6/33）1. The clinical efficacy were 78.9% （15/19） in the group of primary treatment with linczolid and 81.8% （27/33） in the group of alternated to linezolid, persistent time of fever were 4（3, 15） d and 12（5,24） d, mortality during 28 d period were 15.8% （3/19） and 9. 1% （3/33）, adverse rate were 15.8% （3/19） and 12. 1% （4/33） in these two groups, respectively （all P 〉 0. 05 ）. Conclusion Linezolid is an option with high clinical efficacy and good safety for MRSA bacteremia patients.