利奈唑胺替代万古霉素治疗颅内细菌性感染的初步探讨

Preliminary exploration of the therapeutic effect of linezolid replacing vancomycin on intracraniai bacterial infections

目的初步探讨利奈唑胺（LZD）对怀疑万古霉素耐药的细菌性颅内感染患者的疗效及安全性。方法前瞻性纳入2015年8月至2016年9月天津医科大学总医院神经外科重症监护病房因怀疑为革兰阳性球菌致颅内感染、且连续应用万古霉素≥7d疗效不佳而改用LZD治疗（600mg，静脉滴注，1次／12h）的患者11例。评价LZD治疗颅内细菌感染的疗效及安全性。结果11例患者中，10例治愈，1例死亡。LZD平均治疗时间为（22．3±5．3）d。LZD治疗后，5例出现血常规的多项指标下降，其中l例死亡，4例停药后恢复正常；血常规指标下降患者的中位年龄为60（Q。：21．5）岁，高于未下降者的33（Q。：20）岁，差异有统计学意义（P=0．017）。随访中未发现LZD诱导血常规持续异常及其他相关不良反应。结论在严密监测血常规的前提下，LZD可以作为万古霉素治疗无效的颅内革兰阳性球菌感染患者的替代选择药物。

Objective To analyze the efficacy and safety of linezolid （LZD） on patients suffering from intracranial bacterial infection with suspected resistance to vancomycin, and to provide some references for modifying the clinical strategy in the treatment of the intracranial bacterial infection. Methods A prospective study was conducted from August 2015 to September 2016, into which a total of 11 inpatients were enrolled who suffered from intracranial bacterial （gram positive cocci as suspected pathogen） infection, responded poorly to vancomycin （ ≥7 days） and were ahernatively treated with LZD （ 600 mg twice daily, i. v. ） at the Neurosurgical Intensive Care Unit （NICU） of Tianjin Medical University General Hospital. The treatment efficacy and safety using LZD were evaluated. Results Among the 11 cases, 10 were cured and l died. Patients were treated with LZD for an average of 22.3 ± 5.3 days. After LZD treatment, 5 cases showed abnormal decreases in multiple parameters of blood routine test, and among them 1 died and the other 4 cases recovered to normal levels after the end of LZD treatment. The median age of the 5 patients with abnormal blood test results was 60 （ QR ： 21.5） years, which was significantly higher than the median age [ 33 （ QR ： 20 ） ] of patients whose blood examination revealed normal （ P = 0. 017 ）. Persistent abnormalities in blood routine test or other related adverse reactions of LZD was not observed during follow-up. Conclusion With close monitoring of blood routine test results, LZD might be used as an alternative to treat intracranial bacterial （grain positive cocci） infection resistant to vancomvcin.