替考拉宁与利奈唑胺治疗肾功能不全革兰阳性菌感染患者的临床疗效及安全性评价  

Evaluation of clinical efficacy of teicoplanin and linezolid for infection caused by gram-positive bacteria in patients with renal insufficiency

作　　者：王丽[1] 陈瑞 许彬 唐莲[2] 陆件[1] WANG Li;CHEN Rui;XU Bin;TANG Lian;LU Jian(Suzhou Municipal Hospital,Gusu School of Nanjing Medical University,Suzhou Hospital Af filiated to Nanjing Medical University,Suzhou,Jiangsu 215002,China)

机构地区：[1]南京医科大学附属苏州医院,南京医科大学姑苏学院,苏州市立医院重症医学科,江苏苏州215002 [2]南京医科大学附属苏州医院,南京医科大学姑苏学院,苏州市立医院药剂科,江苏苏州215002

出　　处：《中华医院感染学杂志》2024年第16期2422-2427,共6页Chinese Journal of Nosocomiology

基　　金：苏州市卫建委“临床重点病种诊疗技术专项”项目(LCZX202112);苏州市卫建委“姑苏卫生人才计划”培养项目(GSWS2022064)。

摘　　要：目的比较替考拉宁与利奈唑胺治疗肾功能不全革兰阳性菌感染患者的临床疗效、血药谷浓度监测及安全性。方法收集苏州市立医院本部重症医学科2018年6月-2023年3月收治的革兰阳性菌感染肾功能不全患者83例,分为替考拉宁治疗组43例和利奈唑胺治疗组40例,比较两组患者的临床治疗有效率、革兰阳性菌清除率、血药谷浓度监测及不良反应发生率等情况。结果替考拉宁治疗组和利奈唑胺治疗组临床有效率和28d死亡率差异无统计学意义,但是革兰阳性菌清除率分别为72.1%和90.0%,差异有统计学意义(P=0.039);替考拉宁治疗组和利奈唑胺治疗组的药物不良反应发生率差异有统计学意义(P<0.001);利奈唑胺治疗组的主要不良反应为血小板减少(42.5%);替考拉宁治疗组血药浓度达标率和超标率分别为79.1%和7.0%,利奈唑胺治疗组分别为2.5%和92.5%,差异具有统计学意义(均P<0.001)。结论在革兰阳性菌感染合并肾功能不全的患者中,相对于利奈唑胺,使用替考拉宁的用药安全性更高;而与替考拉宁相比较,利奈唑胺抗感染疗效更好,但血药浓度超标率及药物不良反应发生率相对较高。OBJECTIVE To explore the clinical efficacy,concentration monitoring and safety of teicoplanin and lin-ezolid in the treatment of gram-positive bacterial infection in patients with renal insufficiency.METHODS A total of 83 patients with renal insufficiency infected with gram-positive bacteria admitted to the department of intensive care medicine in Suzhou Municipal Hospital from Jun 2018 to Mar 2023 were recruited.They were divided into two groups,including the teicoplanin treatment group with 43 cases and the linezolid treatment group with 40 cases.A comparative analysis is conducted between the two cohorts,encompassing parameters such as clinical treatment efficacy,gram-positive bacterial eradication rates,blood trough concentration monitoring,and the incidence of ad-verse reactions.RESULTS The difference in the clinical efficacy and 28-day mortality rate between the teicoplanin and linezolid treatment groups was not statistical significant.However,there was significant difference in the erad-ication rate for gram-positive bacteria,with the eradication rates of 72.1%and 90.0%,respectively(P=0.039).The difference in the incidence of adverse drug reactions between the teicoplanin and linezolid treatment groups was statistically significant(P<o.o01).Platelet reduction was the predominant adverse reaction in the linezolid treatment group(42.5%).The rates of standard and elevated blood concentrations in the teicoplanin treatment group are 79.1%and 7.0%,respectively,while those in the linezolid treatment group were 2.5%and 92.5%,respectively,with statistically significant differences(all P<O.0O1).CONCLUSION In patients with renal insufficiency complicated with gram-positive bacterial infections,drug safety of teicoplanin is higher than that of linezolid,while the anti-infective efficacy of linezolid is superior than that of teicoplanin,albeit with a relatively higher incidence of elevated blood concentrations and adverse drug reactions.

关 键 词：革兰阳性菌感染 肾功能不全 替考拉宁 利奈唑胺 临床疗效 安全性 

分 类 号：R969.3[医药卫生—药理学]