替考拉宁治疗儿童急性耐甲氧西林金黄色葡萄球菌性骨髓炎的疗效

Efficacy of teicoplanin in treatment of children with acute methicillin-resistant Staphylococcus aureus osteomyelitis

目的 探讨比较替考拉宁与万古霉素在治疗儿童急性耐甲氧西林金黄色葡萄球菌(Methicillin-resistant Staphylococcus aureus,MRSA)性骨髓炎的疗效和安全性.方法 选择2013年1月-2017年6月重庆医科大学附属儿童医院收治的急性耐甲氧西林金黄色葡萄球菌性骨髓炎患儿49例,其中经替考拉宁抗感染治疗21例,经万古霉素抗感染治疗28例,比较两组患儿的临床疗效、感染指标[C-反应蛋白(C-reactive protein,CRP)、红细胞沉降率(Erythrocyte sedimentation rate,ESR)、白细胞计数(WBC)]水平恢复情况和不良反应发生率.结果 经抗感染治疗后,替考拉宁、万古霉素两组患儿WBC和ESR恢复正常的天数分别为11.8 d VS.10.7 d和21.7 d VS.23.7 d,差异无统计学意义;而CRP恢复正常的天数,替考拉宁组患儿为9.8 d,明显短于万古霉素组的11.9 d(P<0.05).替考拉宁、万古霉素两种药物治疗急性MRSA性骨髓炎总体有效率分别为85.7%、82.1%,差异无统计学意义.替考拉宁不良反应发生率为4.8%,万古霉素不良反应发生率为28.6%,差异有统计学意义(P<0.05).结论 替考拉宁治疗儿童急性耐甲氧西林金黄色葡萄球菌性骨髓炎临床疗效可靠,且给药次数、不良反应发生率较万古霉素少,安全性高.

OBJECTIVE To explore the efficacy and safety of teicoplanin and vancomycin in treatment of the children with acute methicillin resistant Staphylococcus aureus(MRSA)osteomyelitis.METHODS A total of 49 children with acute MRSA osteomyelitis who were treated in Children′s Hospital of Chongqing Medical University from Jan 2013 to Jun 2017 were enrolled in the study,21 of whom were treated with teicoplanin,and 28 were treated with vancomycin.The clinical effect,indexes of infection C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),white blood cell(WBC)and incidence of adverse reactions were observed and compared between the two groups of patients.RESULTS After the treatment for infections,the durations of recovery of WBC and ESR of the two groups were respectively 11.8 days VS.10.7 days and 21.7 days VS.23.7 days,and there were no significant differences;the duration of recovery of CRP of the teicoplanin group was 9.8 days,significantly shorter than 11.9 days of the vancomycin group(P<0.05).The overall effective rates of treatment of acute MRSA osteomyelitis of teicoplanin and vancomcin were 85.7%and 82.1%,respectively,and there were no significant differences.The incidence of adverse reactions of teicoplanin was 4.8%,the incidence of adverse reactions of vancomycin was 28.6%,and there was significant difference(P<0.05).CONCLUSION Teicoplanin can achieve reliable clinical effect on treatment of the children with acute MRSA osteomyelitis,the administration frequency and incidence of adverse reactions of teicoplanin are less than those of vancomycin,and the safety is higher.