替考拉宁与万古霉素在中性粒细胞缺乏伴发热的恶性血液病患儿中的有效性和安全性分析

目的 在发生中性粒细胞缺乏伴发热(粒缺伴发热)的恶性血液病儿童患者中比较替考拉宁及万古霉素经验性覆盖革兰阳性菌时的有效性和安全性。方法 使用倾向评分匹配均衡万古霉素组和替考拉宁组患者的基线特征,进而比较两组的临床有效性、谷浓度达标率和达标时间以及肾毒性发生率。结果 最初共纳入126名粒缺伴发热的恶性血液病儿童患者。经匹配后,共纳入74名替考拉宁组患者和37名万古霉素组患者,两组的基线特征均衡可比。用药72 h和用药结束时的临床有效率在两组患者中均无显著性差异(P值分别为0.673和0.477),有效谷浓度的达标率及达标时间也均无显著性差异(P值分别为0.439和0.103)。但替考拉宁治疗组的肾毒性发生率显著低于万古霉素组(P=0.026)。结论 在粒缺伴发热的恶性血液病儿童患者中经验性覆盖革兰阳性菌时,相比万古霉素,更推荐使用肾毒性发生率较低的替考拉宁。

The Efficacy and Safety of Teicoplanin and Vancomycin in Haematological Malignancy Children with Febrile Neutropenia

OBJECTIVE To compare the efficacy and safety of teicoplanin and vancomycin in haematologicalmalignancy children with febrile neutropenia for empirically treating suspected gram-positive bacterial infections, to provide the choice for appropriately selecting the empirical antibiotics in clinical practice early.CONCLUSION The medical records of patients received teicoplanin/vancomycin were retrospectively collected. The baseline characteristics of the two groups were balanced using propensity score matching(1:2) to compare the clinical efficacy, the target attainment of trough concentration and the related time, as well as the incidence of nephrotoxicity of the two groups.RESULTS A total of 126 haematologicalmalignancy children with febrile neutropenia were enrolled. There were 89 and 37 patients in the teicoplanin and the vancomycin treatment group, respectively. After matching, a total of 74 patients in the teicoplanin group and 37 patients in the vancomycin group were enrolled, and there were no significant differences between the two groups in terms of the demographic data and baseline laboratory tests. There were no significant differences in the clinical effective rate at 72 h(P=0.673) and at the end of medication(P=0.477) between the two groups, and there were also no significant differences in the attainment rate of the target trough concentration and the reaching time between the two groups(P=0.439 and 0.103, respectively). However, the incidence of nephrotoxicity in teicoplanin group was significantly lower than that in the vancomycin group(P=0.026).CONCLUSION Teicoplanin is recommended to treat the suspected gram-positive bacterial infections in haematologicalmalignancy children with febrile neutropenia empirically.