利奈唑胺在治疗难治性中枢神经系统革兰阳性球菌感染中的价值  

Value of Linezolid in Treatment of Gram-positive Refractory Central Nervous System Infection Caused by Coccus

作　　者：王小文[1] 赵松[1] 宋阳[1] 陈秀凯[1] 张贵辰[1] 李文雄[1] 郑悦[1] 隋锋[1] 

机构地区：[1]首都医科大学附属北京朝阳医院外科ICU,北京100020

出　　处：《中华医院感染学杂志》2010年第20期3207-3209,共3页Chinese Journal of Nosocomiology

摘　　要：目的探讨利奈唑胺在治疗球菌引起的难治性中枢神经系统感染中的合理性及其价值。方法对2008年3月-2009年7月3例使用利奈唑胺治疗难治性中枢神经系统革兰阳性球菌感染的患者进行疗效观察。结果 3例患者均进行了脑脊液培养:第1例为耐甲氧西林表皮葡萄球菌(MRSE),但使用万古霉素不能控制感染;第2例为肠膜明串珠葡萄聚糖亚种,药敏对万古霉素和替考拉宁耐药,对利奈唑胺敏感;第3例最初为头状葡萄球菌,对万古霉素敏感,使用万古霉素3周后感染控制不理想,脑脊液培养出现了万古霉素耐药的屎肠球菌(VREF)。3例患者最终均使用了利奈唑胺4～6周并且得以康复出院,随诊未复发。结论利奈唑胺有良好的脑脊液的穿透率,可用于治疗中枢神经系统革兰阳性球菌感染,尤其在难治性中枢神经系统革兰阳性球菌感染中的价值更为突出,希望能够得到更多成功病例的进一步验证。OBJECTIVE To discuss the rationality and value of Linezolid in the treatment of to treat central nervous system infection caused by Gram-positive coccus.METHODS The treatment results of three cases of central nervous system infection patients treated by using linezolid from Mar 2008 to July 2009 were obserued.RESULTS Cerebrospinal fluid（CSF）from 3 patients were cultared,the first case：methicillin-resistant Staphylococcus epidermidis（MRSE）,vancomycin could not control the spread of infection.Cerebrospinal fluid（CSF）cultivation of the second case：leuconostoc mesenteroides subsp,dextranciu resistant to vancomycin and teicoplanin,sensitive to Linezolid.Cerebrospinal fluid（CSF）cultivation of the third case：S.capitis.Sensitive to vancomycin.The infection was not controlled very well by using vancomycin for three weeks and vancomycin-resistant Enterococcus faecium（VREF）was found in the CSF cultivation.The three patients finally used Linezolid for about four to six weeks and got recovery and no recurrence lately.CONCLUSION Linezolid has very good penetration ability in CSF,it can be used in the treatment of central nervous system infection caused by Gram-positive coccus.It has an out standing value in the treatment of the refractory central nervous system infection caused by coccus,hoping that it can be approved by more successful cases.

关 键 词：利奈唑胺 万古霉素 中枢神经系统感染 革兰阳性球菌 

分 类 号：R978.1[医药卫生—药品]