利奈唑胺、替考拉宁及万古霉素治疗院内MRSA肺炎的临床观察

摘要

目的：观察利奈唑胺、替考拉宁及万古霉素治疗院内耐甲氧西林金黄色葡萄球菌（MRSA）肺炎的临床疗效及安全性。方法：选取被诊断为院内MRSA肺炎的患者120例，按用药方案分为利奈唑胺组、替考拉宁组和万古霉素组，各40例。利奈唑胺组患者给予利奈唑胺注射液600 mg，ivgtt，bid；替考拉宁组患者给予替考拉宁注射液0.4 g，ivgtt，bid；万古霉素组患者给予盐酸万古霉素注射液1000 mg，ivgtt，bid。3组患者均治疗2周。观察3组患者临床疗效、细菌清除有效率及治疗前后血清炎症因子水平，并比较不良反应发生率。结果：利奈唑胺组、替考拉宁组和万古霉素组患者临床有效率分别为90.0％、72.5％、67.5％，细菌清除有效率分别为85.0％、60.0％、57.5％；利奈唑胺组患者临床有效率和细菌清除有效率明显高于替考拉宁组和万古霉素组，差异均有统计学意义（P＜0.05）；替考拉宁组和万古霉素组患者上述指标比较，差异无统计学意义（P＞0.05）。3组患者治疗前血清炎症因子比较，差异无统计学意义（P＞0.05）；3组患者治疗后血清C反应蛋白（CRP）、降钙原素（PCT）水平明显降低，且利奈唑胺组明显低于替考拉宁组和万古霉素组，差异均有统计学意义（P＜0.05）；替考拉宁组和万古霉素组患者治疗前后血清炎症因子比较，差异无统计学意义（P＞0.05）。3组患者不良反应发生率比较，差异无统计学意义（P＞0.05）。结论：利奈唑胺治疗院内MRSA肺炎优于替考拉宁及万古霉素，对患者肺部炎症控制更好，且安全性较高。%OBJECTIVE:To observe clinical efficacy and safety of linezolid,teicoplanin and vancomycin in the treatment of hospital-acquired pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA). METHODS:120 patients diagnosed as hospital-acquired MRSA pneumonia were divided into linezolid group,teicoplanin group and vancomycin group according to therapeutic regimen,with 40 cases in each group. Linezolid group received Linezolid injection 600 mg,ivgtt,bid;teicoplanin group received Teicoplanin injection 0.4 g,ivgtt,bid;vancomycin group received Vancomycin injection 1 000 mg,bid,ivgtt. 3 groups received 2 weeks of treatment. Clinical efficacy and bacterial clearance effective rate of 3 groups were observed as well as serum levels of inflammatory factors before and after treatment. ADR of 3 groups were compared. RESULTS:The clinical effective rates of linezolid group,teicoplanin group and vancomycin group were 90.0%,72.5% and 67.5%;the effective bacterial clearance rates were 85.0%,60.0% and 57.5%,respectively. The clinical effective rate and the effective bacterial clearance rate in linezolid group were significantly higher than those in teicoplanin group and vancomycin group,with statistical significance (P<0.05). There was no statistical significance in above indexes between teicoplanin group and vancomycin group (P>0.05). There was no statistical significance serum inflammatory factors among 3 groups before treatment (P>0.05). CRP and PCT of 3 groups de-creased significantly after treatment,and those of linezolid group were lower than teicoplanin group and vancomycin group,with statistical significance(P<0.05). There was no statistical significance in serum inflammatory factors between teicoplanin group and vancomycin group before and after treatment (P>0.05). There was no statistical significance in the incidence of ADR among 3 groups (P>0.05). CONCLUSIONS:For hospital-acquired MRSA pneumonia,linezolid is better than teicoplanin and vancomycin in pneumonia control with good safety.