替加环素治疗血液透析并发万古霉素不敏感播散性金黄色葡萄球菌败血症一例并文献复习  

Tigecycline in treating hemodialysis patient with vancomycin insensitivity disseminated methicillinresistant Staphylococcus aureus sepsis: a case report and literature review

作　　者：崔蓉 卢方平 卢照翾 姜磊 CUI Rong;LU Fangping;LU Zhaoxuan;JIANG Lei(Department of Respiratory and Critical Care Medicine Division,the First Hospital of Tsinghua University,Beijing 100016,China;Department of Nephrology,the First Hospital of Tsinghua University,Beijing 100016,China)

机构地区：[1]清华大学第一附属医院呼吸与危重症医学科,北京100016 [2]清华大学第一附属医院肾内科,北京100016

出　　处：《中国研究型医院》2021年第5期72-76,共5页Chinese Research Hospitals

摘　　要：目的探讨替加环素治疗血液透析并发万古霉素不敏感的播散性耐甲氧西林金黄色葡萄球菌(MRSA)败血症的临床效果。方法分析2020年确诊为血液透析并发播散性金黄色葡萄球菌败血症的1例患者的临床资料,其对万古霉素治疗不敏感,结合相关文献复习,观察替加环素对该病的临床效果。结果本例患者长期维持血液透析,因发热3 d入院,确诊后经万古霉素、替考拉宁治疗无效,利奈唑胺治疗后双手出现多发出血性皮疹,经替加环素治疗有效。结合相关文献显示,在治疗MRSA致血流感染(BSI)方面,替加环素和万古霉素疗效相当,替加环素在肾功能不全或血液透析患者中无须进行剂量调整。结论替加环素治疗播散性MRSA败血症安全有效。Objective To explore the clinical effect of tigecycline in treating hemodialysis patients with vancomycin insensitivity disseminated methicillin resistant Staphylococcus aureus(MRSA)sepsis. Methods The clinical data of 1 patient was analyzed. The patient was diagnosed with hemodialysis complicated by MRSA sepsis in 2020. The patient was not sensitive to vancomycin treatment. The clinical effect of tigecycline on this disease was observed in conjunction with a review of the relevant literature. Results The patient was on long-term maintenance hemodialysis and was admitted with fever for 3 days. After diagnosis, treatment with vancomycin and teicoplanin was ineffective. Multiple hemorrhagic rashes appeared on both hands after linezolid treatment. Treatment with tigecycline was effective. Combined with the relevant literature, vancomycin and tigecycline are comparable in efficacy in treating MRSAcausing bloodstream infections(BSI), and tigecycline does not require dose adjustment in patients with renal insufficiency or hemodialysis. Conclusion Tigecycline is safe and effective in the treatment of disseminated MRSA sepsis.

关 键 词：葡萄球菌 金黄色 万古霉素 感染 血液透析 

分 类 号：R515.3[医药卫生—内科学] R692.5[医药卫生—临床医学]