替考拉宁治疗ICU患者革兰阳性菌所致呼吸机相关性肺炎的临床疗效与安全性评价

Efficacy and safety of teicoplanin in the treatment of ventilator-associated pneumonia cause by gram-positive bacteria in intensive care unit

目的评价替考拉宁治疗重症监护病房(ICU)患者中革兰阳性菌所致呼吸机相关性肺炎(VAP)的疗效与安全性。方法回顾性分析2015年5月-2016年5月期间,替考拉宁治疗ICU革兰阳性菌感染的VAP患者51例,观察治疗前后的临床症状、最高体温、炎症反应指标、微生物学检查及不良反应。结果 51例患者分离出58株革兰阳性菌,治疗后,46株被清除,细菌学清除率为79.31%;痊愈23例,显效18例,总有效率80.39%;不良反应发生率5.88%,表现轻微且短暂,无需特殊干预;51例患者的急性生理与慢性健康(APACHEⅡ)、体温、白细胞(WBC)、C反应蛋白(CRP)、降钙素原(PCT)治疗后与治疗前比较,均显著降低,差异有统计学意义(P<0.05)。结论替考拉宁治疗由革兰阳性菌感染的VAP疗效确切,不良反应小,可考虑初始经验性使用。

OBJECTIVE To evaluate the efficacy and safety of teicoplanin in the treatment of patients with ventilator-associated pneumonia（VAP）cause by gram-positive bacteria in intensive care unit（ICU）.METHODS A total of 51 patients with ventilator-associated pneumonia（VAP）of gram-positive bacteria infection who were treated with teicoplanin in intensive care unit（ICU）from May 2015 to May 2016 were retrospectively analyzed.The clinical symptom,maximum temperature,inflammatory response index,microbiologic examination and adverse reactions were observed before and after treatment.RESULTS Fifty-eight strains of gram-positive bacteria were isolated from 51 patients,and after treatment,46 strains of gram-positive coccus were eliminated,with the bacteriological eliminated rate of 79.31% .After treatment,23 patients were cured while 18 case were markedly improved,and the overall effective rate of the clinical treatment was 80.39% .The incidence of adverse reactions was5.88% ,which was mild and short,and didn′t require special treatment interventions.In addition,the average of APACHE Ⅱ score,body temperature,WBC number,and CRP were significantly decreased after treatment,and the differences were significant（P〈0.05）.CONCLUSIONIt is efficacy to use teicoplanin in the patients with VAP of gram-positive bacteria infection,and the adverse reactions are small,which may be a choice for initial empirical treatment.