利奈唑胺治疗儿童化脓性脑膜炎的临床观察  

Linezolid in the Treatment of Bacterial Meningitis in Children

作　　者：黄胜 钱乔乔 冯源 朱红敏[1] 吴舒华[1] 吴革菲[1] 胡家胜[1] Huang Sheng;Qian Qiaoqiao;Feng Yuan;Zhu Hongmin;Wu Shuhua;Wu Gefei;Hu Jiasheng(Tongji Medical College,Huazhong University of Science and Technology,Wuhan Children's Hospital,Hubei Wuhan 430016,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院,湖北武汉430016

出　　处：《儿科药学杂志》2020年第9期25-28,共4页Journal of Pediatric Pharmacy

摘　　要：目的:观察利奈唑胺治疗儿童化脓性脑膜炎的疗效及安全性。方法:回顾性分析2012年12月至2017年12月武汉儿童医院确诊为化脓性脑膜炎一线抗生素治疗失败换用利奈唑胺治疗的患儿临床资料。结果:共纳入29例患儿,中位年龄4个月,主要前驱感染为肺炎14例(48.3%)。19例(65.5%)出现抽搐,合并神经系统并发症17例(58.6%),主要并发硬膜下积液。脑脊液培养阳性12例(41.4%),其中肺炎链球菌5例,无乳链球菌6例,金黄色葡萄球菌1例。29例患儿痊愈4例,好转22例,进步2例,未愈1例,总有效率89.7%。2例患儿血和脑脊液利奈唑胺平均谷浓度分别为1.8μg/mL、1.2μg/mL,脑脊液穿透率为66.7%。抗感染治疗后患儿超敏C反应蛋白、降钙素原、脑脊液白细胞计数、蛋白水平较治疗前下降(P<0.05),脑脊液葡萄糖明显恢复(P<0.05)。治疗过程中未见明显不良反应。结论:对于确诊或怀疑革兰阳性菌感染化脓性脑膜炎,若一线药物治疗失败,利奈唑胺可作为二线药物治疗儿童化脓性脑膜炎,其疗效可靠,安全性好。Objective:To observe the efficacy and safety of linezolid in the treatment of bacterial meningitis in children.Methods:Retrospective analysis was performed on the clinical data of children diagnosed with meningitis who had failed first-line antibiotic treatment and received linezolid in Wuhan Children's Hospital from Dec.2012 to Dec.2017.Results:A total of 29 cases were included,with a median age of 4 months,and 14 cases(48.3%)with precursor infection of pneumonia.Convulsions were found in 19 cases(65.5%),and 17 cases(58.6%)had neurological complications,mainly complicated by subdural effusion.Bacterial culture of cerebrospinal fluid was positive in 12 cases(41.4%),including 5 cases of Streptococcus pneumoniae,6 cases of Streptococcus agalactiae and 1 case of Staphylococcus aureus.Of the 29 cases,4 cases were cured,22 cases were significantly improved,2 cases were improved,and 1 case was not improved,and the total effective rate was 89.7%.The mean valley concentration of linezolid in the blood and cerebrospinal fluid of two children were respectively 1.8μg/mL and 1.2μg/mL,and the cerebrospinal fluid penetration rate was 66.7%.After anti-infection treatment,the hypersensitive C protein,procalcitonin,white blood cell count and protein levels were lower than those before treatment(P<0.05),and the cerebrospinal fluid glucose recovered significantly(P<0.05).No obvious adverse drug reactions were observed during the treatment.Conclusion:For confirmed or suspected bacterial meningitis infected by gram-positive bacteria infection,if the first-line drug treatment fails,linezolid can be used as the second-line drug treatment for children with bacterial meningitis,with reliable efficacy and higher safety.

关 键 词：儿童 脑膜炎 细菌性 利奈唑胺 

分 类 号：R742.9[医药卫生—神经病学与精神病学]