利奈唑胺和万古霉素治疗MRSA引起的复杂皮肤和软组织感染的效果比较  

Linezolid versus vancomycin in treatment of complex skin and soft tissue infections caused by methicillin-resistant Staphylococcus aureus

作　　者：袁慧姣[1] 韩波[1] Yuan Huijiao;Han Bo(Department of Laboratory,Hospital Affiliated to Liaoning University of Traditional Chinese Medicine,Shenyang 110032,China)

机构地区：[1]辽宁中医药大学附属医院检验科,沈阳110032

出　　处：《国际医药卫生导报》2021年第11期1613-1617,共5页International Medicine and Health Guidance News

基　　金：辽宁省教育厅科学技术研究项目(L201917)。

摘　　要：目的比较静脉注射利奈唑胺和万古霉素治疗由耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus,MRSA)引起的复杂皮肤和软组织感染(complex skin and soft tissue infections,cSSTIs)的临床效果。方法选取2017年3月至2018年3月于本院治疗并被确诊为MRSA引起的cSSTIs的患者98例,采用随机数字表法分为利奈唑胺组和万古霉素组,每组49例。利奈唑胺组中,男性25例,女性24例,年龄(43.25±4.90)岁,给予静脉注射利奈唑胺,600mg/次,2次/d,每次间隔12 h;万古霉素组中,男性27例,女性22例,年龄(43.15±5.25)岁,静脉注射万古霉素,根据患者体质量每次用量15 mg/kg,2次/d,每次间隔12 h。根据患者临床症状进行治疗7~14 d。评估并比较两组患者的临床疗效、抗菌治疗的持续时间、住院时间和安全性。结果在停药时(使用最后一剂药物后第24 h),利奈唑胺组的细菌清除率显著高于万古霉素组[85.7%(42/49)比67.3%(33/49),P=0.032],但在随访时(停药后第7天),两组患者的细菌清除率相当[75.5%(37/49)比67.3%(33/49),P=0.371]。在停药时和随访时,利奈唑胺组与万古霉素组患者临床有效率差异均无统计学意义(均P>0.05)。与治疗前相比,治疗后两组患者血清促炎症因子白细胞介素-6、白细胞介素-1β和肿瘤坏死因子-α水平均显著降低(均P<0.001),但组间比较差异均无统计学意义(均P>0.05);与治疗前相比,在停药时两组患者辅助性T细胞17占CD4+T细胞的比例均显著降低(均P<0.001),但组间比较差异无统计学意义(P>0.05)。利奈唑胺组患者不良反应总发生率显著低于万古霉素组患者[51.02%(25/49)比71.43%(35/49),P<0.05];利奈唑胺组的住院时间为(7.6±0.5)d,静脉治疗时间为(5.6±0.3)d,万古霉素组分别为(8.9±0.6)d、(10.4±0.7)d,两组比较,差异均有统计学意义(均P<0.001)。结论利奈唑胺是治疗由MRSA引起的cSSTIs的万古霉素的有效替代药物。Objective To explore the clinical efficacies of intravenous injection of linezolid versus vancomycin in the treatment of complex skin and soft tissue infections(cSSTIs)caused by methicillin-resistant Staphylococcus aureus(MRSA).Methods A total of 98 patients diagnosed with cSSTIs caused by MRSA in our hospital from March,2017 to March,2018 were included and divided into a linezolid group and a vancomycin group by the randomly number table method,with 49 cases in each group.There were 25 males and 24 females in the linezolid group;they were(43.25±4.90)years old.There were 27 males and 22 females in the vancomycin group;they were(43.15±5.25)years old.The linezolid group was intravenously injected 600 mg linezolid once every 12 hours,and the vancomycin group was intravenously injected vancomycin 15 mg/kg once every 12 hours,for 7 to 14 days.The clinical efficacies,durations of antimicrobial therapy,lengths of hospital stay,and safety in these two groups were assessed and compared.Results At the time of withdrawal(24 h after the last doses of the drugs),the bacterial clearance rate of the linezolid group was significantly higher than that of the vancomycin group[85.7%(42/49)vs.67.3%(33/49);P=0.032];the bacterial clearance rate during follow-up(7 days after discontinuation)was 75.5%(37/49)in the linezolid group,and was 67.3%(33/49)in the vancomycin group(P=0.371).There were no statistical differences in the clinical efficacies at the time of withdrawal and during the follow up between the linezolid group and the vancomycin group(both P>0.05).The serum levels of pro-inflammatory cytokines,IL-6,IL-1β,and TNFα,as well as the proportion of Th17 in CD4+T cells,at the time of withdrawal were significantly lower than those before the treatment in the two groups(all P<0.001),with no statistical differences between the two groups(all P>0.05).The overall incidence of adverse reactions was significantly lower and the length of hospital stay and duration of intravenous therapy were shorter in the linezolid group than in the v

关 键 词：利奈唑胺 万古霉素 MRSA cSSTIs 疗效 

分 类 号：R751[医药卫生—皮肤病学与性病学]