替考拉宁与万古霉素治疗革兰阳性菌感染的临床研究

Clinical effects of teicoplanin and vancomycin on treatment of gram-positive bacteria infections

目的通过观察革兰阳性菌感染患者经替考拉宁和万古霉素治疗后的临床疗效、细菌清除率及安全性,为临床抗感染治疗提供参考。方法选取2013年6月-2017年9月在医院ICU住院期间应用替考拉宁或万古霉素治疗的革兰阳性菌感染患者129例为研究对象,根据治疗用药不同将患者分为替考拉宁组和万古霉素组,其中替考拉宁治疗67例,万古霉素治疗62例,治疗结束后观察两组患者临床疗效、细菌清除率及不良反应等情况。结果 129例入选患者中,肺部感染患者41例,泌尿系感染患者38例,血源性感染患者38例,其他感染患者12例;两组患者感染类型比较差异无统计学意义;治疗总有效率方面,替考拉宁组为83.58%,万古霉素组为74.19%,两组比较差异无统计学意义(P>0.05);细菌总清除率方面,替考拉宁组为83.58%,万古霉素组为77.42%,两组比较差异无统计学意义(P>0.05);不良反应发生率方面,替考拉宁组为4.47%低于万古霉素组(P<0.05);在检出病原菌中,金黄色葡萄球菌最多,其次为屎肠球菌。结论替考拉宁及万古霉素治疗革兰阳性菌感染均有较好的疗效,但替考拉宁的安全性要优于万古霉素。

OBJECTIVE To observe the clinical effects of teicoplanin and vancomycin on treatment of patients with gram-positive bacteria infections and analyze the bacterial clearance rates and safety so as to provide guidance for clinical treatment of the infections.METHODS From Jun 2013 to Sep 2017,a total of 129 patients with gram-positive bacteria infections who were treated with teicoplanin or vancomycin during the ICU stay were recruited as the study objects and divided into the teicoplanin group with 67 cases and the vancomycin group with 62 cases according to the use of antibiotics.The clinical curative effects,bacterial clearance rates and adverse reactions were observed and compared between the two groups of patients.RESULTS Of the 129 enrolled patients,41 had pulmonary infections,38 had urinary tract infections,38 had hematogenous infections and 12 had other sites of infections;there were no significant differences in the types of infections between the two groups of patients.The total effective rate of treatment was 83.58%in the teicoplanin group,74.19%in the vancomycin group,and there was no significant difference between the two groups（P 0.05）.The total bacterial clearance rate was 83.58% in the teicoplanin group,77.42% in the vancomycin group,and there was no significant difference between the two groups（P〈0.05）.The incidence of adverse reactions of the teicoplanin group was 4.47%,lower than that of the vancomycin group（P〈0.05）.The Staphylococcus aureus was the predominant species among the isolated pathogens,followed by the Enterococcus faecium.CONCLUSION Teicoplanin and vancomycin may achieve remarkable effect on treatment of the gram-positive bacteria infections,however,teicoplanin is safer than vancomycin.