康替唑胺与利奈唑胺对70岁以上重症院内获得性肺炎患者的疗效比较

Clnical outcomes and safety of contezolid versus linezolid in treatment of elderly patients with severe hospital-acquired pneumonia

背景康替唑胺作为抗革兰阳性菌的新型药物,其疗效不劣于利奈唑胺,且不良反应的发生情况较利奈唑胺更低,但其在医院获得性肺炎(hospital acquired pneumonia,HAP)领域应用尚少。目的比较康替唑胺治疗利奈唑胺对高龄重症院内获得性肺炎(severe hospital acquired pneumonia,SHAP)患者的疗效及不良反应。方法回顾性分析解放军总医院第二医学中心2021年1月1日—2023年2月15日发生SHAP、年龄≥70岁且在院内接受康替唑胺(800 mg,口服,1次/12 h)或利奈唑胺(600 mg,静滴或口服,1次/12 h)治疗患者的一般资料和临床资料,比较两组临床疗效及不良反应。结果共纳入358例患者。康替唑胺组111例,年龄(92.91±6.93)岁,男性占88.3%(98/111);利奈唑胺组247例,年龄(92.19±6.92)岁,男性占91.9%(227/247)。两组差异无统计学意义(P>0.05)。康替唑胺组与利奈唑胺的临床有效率分别为55.0%(61/111)和61.1%(151/247),差异无统计学意义(P>0.05)。对一般及临床基线指标进行倾向性评分匹配后,康替唑胺组与利奈唑胺组各36例患者,两组间临床有效率(61.1%vs 69.4%,P=0.458)、微生物清除率(22.2%vs 27.8%,P=0.296)差异均无统计学意义。康替唑胺组血小板下降的发生率显著低于利奈唑胺组(50.0%vs 80.6%,P=0.006);康替唑胺组和利奈唑胺组血红蛋白下降发生率分别为41.7%和61.1%,红细胞下降发生率分别为50.0%和61.1%,乳酸升高的发生率分别为44.1%和54.3%,乳酸酸中毒发生率分别为29.4%和34.3%,两组差异均无统计学意义(P>0.05)。结论康替唑胺治疗高龄SHAP的疗效与利奈唑胺相当,但其引起的血小板下降发生率显著低于利奈唑胺。

Background It has been shown that the efficacy of contezolid,a novel drug against Gram-positive bacteria,is not inferior to that of linezolid and the incidence of side effects is lower than that of linezolid,but its use in the field of hospital-acquired pneumonia(HAP)is still scarce.Objective To compare the efficacy and side effects of contezolid with those of linezolid in treatment of severe hospital-acquired pneumonia(SHAP)patients.Methods General and clinical data of patients with SHAP,aged more than 70 years,who developed SHAP from January 1,2021 to February 15,2023 and were treated in-hospital with either contezolid(800 mg once/12 h orally)or linezolid(600 mg once/12 h IV or orally)at the Second Medical Center of Chinese PLA General Hospital were retrospectively analyzed.General information,clinical efficacy and side effects of patients in the contezolid and linezolid groups were compared.Results A total of 358 patients were included,including 111 cases in the contezolid group and 247 cases in the linezolid group.The clinical effectiveness rates of the contezolid group and linezolid group were 55.0%(61/111)and 61.1%(151/247),respectively.The proportion of platelet decrease was 54.1%(60/111)in the contezolid group and 78.9%(195/247)in the linezolid group,the proportions of hemoglobin decrease were 56.8%(63/111)and 64.4%(159/247),respectively,and 61.3%(68/111)and 63.2%(156/247)for erythrocyte decline,respectively.After performing tilt-score matching,a total of 36 patients each were matched with contezolid and linezolid,and the differences in clinical efficiency(61.1%vs 69.4%,P=0.458)and microbial clearance(22.2%vs 27.8%,P=0.296)between the two groups were not statistically significant.The incidence of platelet decline in the contezolid group was significantly lower than that of linezolid(50%vs 80.6%,P=0.006).However,the incidence of haemoglobin decline in the contezolid and linezolid groups was 41.7%and 61.1%,the incidence of erythrocyte decline was 50%and 61.1%,the incidence of lactic acid elevation was 44.1%and 54.3%,and the incidence of lactic acidosis was 29.4%and 34.3%,respectively,and the differences between the two groups were not statistically significant(P>0.05).Conclusion The efficacy of contezolid in the treatment of elderly patients with SHAP is comparable to that of linezolid,but the incidence of platelet drop caused by it is significantly lower than that of linezolid.