替考拉宁治疗抗甲氧西林金黄色葡萄球菌感染的临床疗效评价

Clinical effect of teicoplanin on treatment of methicillin-resistant Staphylococcus aureus infection

目的研究替考拉宁不同维持剂量及抗甲氧西林金黄色葡萄球菌(MRSA)和替考拉宁不同的最小抑菌浓度和患者临床预后的关系,评价不同剂量替考拉宁在治疗MRSA感染的临床疗效。方法回顾性分析2015年1月-2018年1月解放军第九六〇医院重症医学科替考拉宁治疗MRSA感染的患者140例。结果排除替考拉宁最小抑菌浓度(MIC)值因素,高剂量替考拉宁组比低剂量组有更佳预后(87.50%vs 45.00%;P<0.01)和更高的30天生存率,在多元分析中,匹兹堡菌血症评分≥4是不良预后的危险因素,同时,替考拉宁高剂量组与良好预后显著相关,其中替考拉宁MIC≥1.5 mg/L与预后OR为26.5[95%CI,5.4~140.0],MIC<1.5 mg/L的OR为5.5[95%CI,1.6~20.1]。根据倾向得分进行配对分析,高剂量替考拉宁组有更佳的预后(85.0%vs 42.5%;P<0.01)。结论排除替考拉宁MIC值因素,高剂量替考拉宁组比低剂量组治疗MRSA感染患者疗效更佳。

OBJECTIVE To explore the correlation between the teicoplanin maintenance doses,minimum inhibitory concentrations(MICs)of teicoplanin against methicillin-resistant Staphylococcus aureus(MRSA)and clinical outcomes so as to evaluate the clinical effect of different doses of teicoplanin on treatment MRSA infection.METHODS From Jan 2015 to Jan 2018,a total of 140 patients with MRSA infection who were treated with teicoplanin in critical care medicine department of the 960 th Hospital of the PLA were retrospectively analyzed.RESULTS Regardless of MIC of teicoplanin,the high-dose teicoplanin group had more favorable outcomes than did the low-dose teicoplanin group,and the 30-day survival rate of the high-dose group was higher than that of the low-dose group.Multivariate analysis showed that the Pittsburgh bacteremia score no less than 4 points was the risk factors for the unfavorable outcomes,meanwhile the high-dose teicoplanin was remarkably associated with the favorable outcomes,the MIC of teicoplanin no less than 1.5 mg/L and outcomes(OR 26.5%,95%CI,5.4~140.0),the MIC of teicoplanin less than 1.5 mg/L(OR 5.5,95%CI,1.6~20.1).The matched pair analysis based on the propensity score showed that the high-dose teicoplanin group had more favorable outcomes(85.0%vs 42.5%;P<0.01).CONCLUSION Regardless of MIC of teicoplanin,the high-dose teicoplanin can achieved more remarkable effect on treatment of the patients with MRSA infection than the low-dose teicoplanin.