替考拉宁治疗血液病感染及革兰阳性菌脓毒血症患者的疗效与安全性评价

Clinical efficacy and safety of teicoplanin for the treatment of neutropenic patients with hematological infections complicated gram-positive bacteria sepsis

目的评价替考拉宁治疗血液科病房中性粒细胞缺乏症合并感染以及革兰阳性菌脓毒血症患者的疗效及安全性,为临床诊疗提供依据。方法选取2013年10月-2016年9月医院血液科158例中性粒细胞缺乏合并感染住院患者,其中革兰阳性菌脓毒血症患者38例,给予替考拉宁注射液治疗,疗程5~14d,评价其临床疗效及安全性。结果 158例患者临床治愈101例,显效22例,总有效率为77.8%,不良反应率为3.2%,感染部位以呼吸道为主;急性白血病患者合并脓毒血症发生率较多发性骨髓瘤、淋巴瘤患者的发生率高,差异有统计学意义(P<0.05);38例革兰阳性菌脓毒血症患者中以金黄色葡萄球菌、屎肠球菌感染最为多见;死亡患者的PCT、hsCRP较非死亡患者显著升高,差异有统计学意义(P<0.05)。结论替考拉宁是一种高效、作用迅速的糖肽类抗菌药,其治疗血液科病房中性粒细胞缺乏合并感染患者疗效确凿,临床安全性高,是经验性治疗的理想药物;联合检测血清PCT、hsCRP对脓毒血症患者的临床诊断、治疗及预后判断具有重要意义。

OBJECTIVE To investigate the clinical efficacy and safety of teicoplanin for the treatment of neutrophil deficiency patients with hematological infections complicated gram-positive bacteria sepsis,so as to provide references for clinical treatment.METHODS A total of 158 neutropenic patients with infection from Oct.2013 to Sep.2016 were selected,including 38 cases of gram-positive bacteria sepsis who were treated with teicoplanin by infusion for 5~14 d.The clinical efficacy and safety were evaluated.RESULTS Among 158 patients,101 were cured,while 22 cases were markedly improved,with the overall effective rate of 77.8% ,and the adverse event rate was 3.2% .The respiratory tract was the main infection site.The incidence of sepsis in patients with acute leukemia was significantly higher than those with myeloma and lymphoma（P〈0.05）.Of the 38 patients with gram-positive sepsis,14 died,accounting for 36.8% of patients with sepsis,which were mainly infected by Staphylococcus aureus and Enterococcus faecium.The PCT and hsCRP of death group were significantly higher than those of nondeath group（P〈0.05）.CONCLUSION Teicoplanin is one of the glycopeptides antibiotic agents with high performance and fast effect,which is an ideal and safe agent for empirical therapy for neutrophil deficiency patients with infections in hematology units.Combined detection of serum PCT and hsCRP plays an important role in clinical diagnosis,treatment and prognosis of patients with sepsis.