高剂量达托霉素挽救性治疗血液病感染19例临床观察  

High dose daptomycin as salvage therapy in hematological patients with infections:a retrospective observational study of 19 cases

作　　者：刘毅[1] 郑培浩[1] 岑坚[1] 李莉[1] 赵德峰[1] 尹文杰[1] 钱李仁[1] 马媛媛[1] 王立新[1] 沈建良[1] 

机构地区：[1]海军总医院血液科,北京100048

出　　处：《转化医学杂志》2017年第6期370-373,共4页Translational Medicine Journal

摘　　要：目的观察高剂量达托霉素挽救性治疗血液病感染患者的临床疗效及安全性。方法回顾性分析19例血液病感染患者使用达托霉素挽救性治疗(剂量>6 mg/kg)的临床资料。感染类型包括多发皮肤软组织感染11例、导管相关血流感染1例、肝脓肿1例、长期发热可疑血流感染6例。结果达托霉素中位剂量7.8(6.3~10.4)mg/kg,中位疗程9(2~82)d。治愈8例,改善4例,失败3例,无法评价4例,临床有效率63.2%。感染类型、粒细胞缺乏及达托霉素剂量与疗效无关,而达托霉素疗程与疗效有关。除1例因肌酸磷酸激酶升高停止用药外,其余患者均耐受性良好。结论高剂量达托霉素挽救性治疗血液病感染患者,具有较好的临床疗效和安全性。Objective To investigate the efficacy and safety of high dose daptomycin as salvage therapy in hematological patients with infections. Methods A retrospective observational study of hematological patients treated with daptomycin（ 〉6 mg/kg） for at least 48 hours was performed in Navy General Hospital between January 2014 and January 2016. All patients were treated with daptomycin after glycopepetide and/or linezolid use. Sites of infections included complicated skin and soft tissue infections（ n = 11）,catheter-related bloodstream infection（ n = 1）,hepatic abscess（ n =1）,and long-term fever suspected bloodstream infections（ n = 6）. Results A total of 19 patients（ 15 males） with a median age of 40 years received a median dose of 7. 8 mg/kg（ range,6. 3 —10. 4 mg/kg） of daptomycin for a median duration of 9 days（ range,2 — 82 days）. Overall,12（ 63. 2%） patients achieved clinical success. Clinical success was related to duration of daptomycin treatment,but unrelated to infected sites,neutropenia and drug dosage. In addition to a patient appea-red creatine phosphokinase increase and stopped treatment,adverse effects of daptomycin were genera-lly well-tolerated. Conclusion Treatment with high dose daptomycin as salvage therapy in hematological patients with infections was generally effective and safe.

关 键 词：达托霉素 感染 血液病 挽救性治疗 疗效 

分 类 号：R552[医药卫生—血液循环系统疾病]