利奈唑胺治疗ICU革兰阳性球菌感染的疗效及安全性观察

目的探讨ICU革兰阳性球菌感染给予利奈唑胺治疗的临床疗效和安全性。方法选取ICU革兰阳性球菌感染患者124例作为研究对象,根据随机数字表法分为研究组和对照组,每组62例。研究组给予利奈唑胺治疗,对照组给予万古霉素治疗,观察两组患者的临床疗效及不良反应发生率,并进行统计学分析。结果治疗后,研究组总有效58例,总有效率为93.55%,对照组总有效50例,总有效率为80.65%,差异有统计学意义(P0.05);研究组发生不良反应2例,不良反应发生率为3.24%,对照组发生不良反应7例,不良反应发生率为11.29%,差异有统计学意义(P0.05)。结论利奈唑胺可有效控制革兰阳性球菌感染患者,提升临床治疗疗效,且治疗过程中安全性较高,值得临床推广应用。     

利奈唑胺治疗新生儿化脓性脑膜炎的疗效和安全性

目的探讨利奈唑胺治疗新生儿化脓性脑膜炎的疗效及安全性。方法收集单用或联合使用利奈唑胺治疗的14例化脓性脑膜炎患儿的资料,根据使用利奈唑胺治疗前后患儿的症状、体征、脑脊液检查及细菌培养结果等指标,评价利奈唑胺治疗新生儿化脓性脑膜炎的疗效及安全性。结果 14例化脓性脑膜炎患儿经脑脊液培养明确革兰阳性球菌感染或经前期治疗怀疑合并革兰阳性球菌感染,使用利奈唑胺治疗后的总有效率为92.9%(13/14)。治疗后患儿的体温、脑脊液细胞总数、白细胞计数及脑脊液蛋白质水平均较治疗前降低,脑脊液葡萄糖水平升高(P均<0.05),2例患儿治疗后出现白细胞下降,12例患儿未见利奈唑胺相关不良反应。结论利奈唑胺可有效治疗新生儿革兰阳性球菌所致化脓性脑膜炎,且安全性较高。     

利奈唑胺治疗革兰阳性球菌感染的疗效及安全性

目的:观察利奈唑胺治疗革兰阳性球菌感染的临床疗效及安全性.方法:回顾分析复旦大学附属金山医院2008年12月-2010年12月收治的29例革兰阳性球菌感染的危重病患者的临床资料,根据细菌培养结果或经验性用药给予利奈唑胺治疗,评价其临床疗效及安全性.结果:29例患者中痊愈12例(41.4％),显效10例(34.5％),进步4例(13.8％),无效3例(10.3％),临床总有效率75.9％(22/29).其中屎肠球菌的清除率以菌株数计为80.0％(4/5);表皮葡萄球菌为60.0％(6/10);耐甲氧西林金黄色葡萄球菌为81.3 ％(13/16);溶血葡萄球菌为100.0％(2/2).不良反应率24.1％(7/29),经对症处理后均好转.结论:利奈唑胺治疗革兰阳性球菌感染的临床效果显著,不良反应少,安全可靠.     

革兰阳性球菌对利奈唑胺等抗菌药物体外药敏分析

目的了解临床分离革兰阳性球菌种类及其对抗菌药物的敏感性。方法统计2010年1~9月临床标本中分离的革兰阳性球菌及其药敏情况。结果所有分离菌株中葡萄球菌占70%,居首位;其次为肠球菌21.4%、链球菌8.3%。体外药敏试验表明所有革兰阳性球菌对利奈唑胺敏感,出现1株耐万古霉素的屎肠球菌(VRE)。结论葡萄球菌、肠球菌是临床最常见的革兰阳性球菌;利奈唑胺是治疗多重耐药阳性球菌感染的又一新型药物。     

血液病房革兰阳性球菌感染病例回顾分析

本研究回顾性分析了利奈唑胺、万古霉素、替考拉宁治疗血液科革兰阳性球菌患者的疗效和安全性.选择解放军总医院2011年1月-12月细菌培养为革兰阳性球菌并使用利奈唑胺、万古霉素或替考拉宁单药治疗的血液科住院发热患者.记录用药前后各种参数包括退热时间、呼吸道症状、体征、影像学改变、血常规指标、生化常规指标、不良反应发生情况.比较利奈唑胺、万古霉素、替考拉宁3种药物的退热时间、细菌清除率、临床有效率及不良反应发生情况.三组患者分别为利奈唑胺15例,万古霉素17例,替考拉宁20例.结果表明,利奈唑胺治疗组平均退热时间（4.43 ±3.15）d,细菌清除率55.56％,临床有效率86.67％;万古霉素治疗组平均退热时间（6.83±4.67）d,细菌清除率54.54％,临床有效率76.47％;替考拉宁组平均退热时间（5.57±4.16）d,细菌清除率41.67％,临床有效率80.00％.三组组间比较无统计学差异,P＞ 0.05.利奈唑胺组中发生腹泻1例,血小板减少2例;万古霉素组中发生恶心1例,肌酐升高2例;替考拉宁组中发生血小板减少3例.5例血小板下降均与白血病患者治疗后血象下降重叠,未停药,血小板随造血功能恢复而正常,与用药无关.结论：利奈唑胺、万古霉素、替考拉宁三组药物治疗革兰阳性球菌感染疗效相当,并无统计学差异,但利奈唑胺的退热时间、细菌清除率及临床有效率有优于万古霉素和替考拉宁的趋势.     

某地区小儿血流感染病原菌分布及耐药性分析

目的探讨北海地区小儿患者血流感染(BSI)病原菌分布及其耐药性。方法回顾性分析2013年1月至2016年6月发生BSI的小儿患者临床资料。结果本地区95.3%的小儿BSI为社区获得性感染。革兰阳性球菌与阴性杆菌所占比例分别为53.5%、46.5%。万古霉素、利奈唑胺对阳性球菌耐药率均为0.0%;哌拉西林、哌拉西林/他唑巴坦、头孢吡肟、美罗培南对革兰阴性杆菌的耐药率分别9.3%、0.0%、9.1%、5.0%。结论革兰阳性球菌与阴性杆菌感染比例基本一致。万古霉素、利奈唑胺可作阳性球菌BSI的经验用药;哌拉西林、哌拉西林/他唑巴坦、头孢吡肟、美罗培南可作革兰阴性杆菌BSI的经验用药。     

2株耐利奈唑胺肠球菌的分离与分析

利奈唑胺属于噁唑烷酮类抗菌药,对大多数革兰阳性球菌引起的感染具有较好的治疗作用。2007年12月进入中国市场被临床应用后,对利奈唑胺耐药的肠球菌就开始出现。2009年12月～2010年7月我们分别分离到2株耐利奈唑胺的肠球菌,现报道如下。     

利奈唑胺治疗老年血液病患者并发革兰阳性菌感染的临床疗效及安全性观察

目的 评价利奈唑胺注射液对老年血液病患者并发革兰阳性菌感染的临床疗效及安全性.方法 51例老年血液病并发革兰阳性菌患者,给予利奈唑胺600 mg,1次/12小时治疗,分析评价临床疗效及安全性.结果 临床总有效率为80.39%(41/51),细菌清除率为83.33%;不良反应主要表现为血小板降低(21.57%).结论 利奈唑胺对老年血液病患者并发革兰阳性菌感染的治疗是安全有效的.     

利奈唑胺治疗儿童革兰阳性球菌肺炎的疗效观察及护理

对5例革兰阳性球菌肺炎患儿采用利奈唑胺治疗,并从用药、病情观察、心理、药物不良反应等方面给予护理,治疗1周后4例患儿感染症状、体征逐渐消失,1例患儿治疗2d后体温降至正常,第4天~第6天患儿发热反复,家长对疗效不满意,要求出院。认为利奈唑胺能够有效治疗儿童革兰阳性球菌肺炎,严密病情观察和积极有效的预防和护理措施,能够减少并发症,减轻患儿痛苦,提高临床治愈率。     

利奈唑胺治疗老年感染重症患者引起血小板减少的观察

目的观察利奈唑胺在老年感染重症患者临床用的药疗效及安全性。方法采用回顾性研究方法,收集ICU 2009～2011年使用利奈唑胺静脉滴注600 mg,1次/12 h的22例老年感染重症患者的用药资料,对其治疗前后血白细胞、血小板计数、血红蛋白肝肾功能的变化进行统计学回归分析。结果临床治疗有效率为72.72%,治疗后血小板计数明显下降,差异有统计学意义。结论利奈唑胺对老年感染重症患者革兰阳性球菌感染的临床疗效显著,但其导致血小板减少症及可能相关的影响因素应引起注意。     

利奈唑胺治疗恶性血液病患者粒细胞减少期并发革兰阳性菌感染的疗效观察

目的评价恶性血液病患者化疗后中性粒细胞减少期并发革兰阳性菌感染利奈唑胺治疗的疗效和安全性。方法28例化疗后中性粒细胞减少的恶性血液病患者,在明确诊断并发革兰阳性菌感染后,给予利奈唑胺注射液治疗。同时观察用药前后疗效和不良反应。结果患者经利奈唑胺治疗,痊愈50%(14/28),显效28.3%(8/28),进步7.1%(2/28),无效14.2%(4/28),临床有效率78.6%。细菌清除率78.6%(21/28)。药物相关不良反应发生率为14.2%(4/28),其中临床不良反应2例(7.1%,2/28),主要为胃纳减退等胃肠道反应,实验室检测异常2例(7.1%,2/28),表现为一过性血小板减少。结论利奈唑胺是治疗恶性血液病患者中性粒细胞减少期并发革兰阳性菌感染的良好选择,患者耐受性好。     

左氧氟沙星联合阿奇霉素治疗老年难治性呼吸道感染的临床分析

目的探讨左氧氟沙星联合阿奇霉素治疗老年难治性呼吸道感染的疗效及安全性。方法选择2005年2月-2010年9月收治的高龄难治性呼吸道细菌感染患者68例,随机分为治疗组和对照组。治疗组34例,给予左氧氟沙星联合阿奇霉素;对照组34例,给予左氧氟沙星,两组总疗程皆为15d。观察两组患者的临床疗效、细菌清除率和不良反应。结果治疗组的总有效率为64．71％,对照组总有效率为32．35％,两组差异有统计学意义（P〈0．05）。治疗组细菌清除率为76．19％,对照组细菌清除率为36．36％,两组差异有统计学意义（P〈0．05）。治疗组和对照组的不良反应发生率分别为5．88％和8．82％,差异无统计学意义（P〉0．05）。结论左氧氟沙星联合阿奇霉素治疗老年难治性呼吸道感染疗效高,能有效清除细菌,不良反应较少,值得临床推广应用。     

Linezolid for the treatment of resistant gram-positive cocci

OBJECTIVE: To provide a comprehensive review of linezolid, the first of a new class of antibiotics, the oxazolidinones. Therapeutic issues regarding the emergence of multidrug-resistant bacteria and a brief history of the oxazolidinones are also discussed. DATA SOURCES: A MEDLINE search (1966-March 2001) was conducted to identify pertinent literature, including preclinical trials, clinical trials, and reviews. Unpublished clinical data, adverse effects, and dosing information were abstracted from product labeling. STUDY SELECTION: Clinical efficacy data were extracted from clinical trials, case reports, and abstracts that mentioned linezolid. Additional information concerning antibiotic resistance, the oxazolidinones, in vitro susceptibility and the pharmacokinetic profile of linezolid also was reviewed. DATA SYNTHESIS: Linezolid exhibits activity against many gram-positive organisms, including vancomycin-resistant Enterococcus faecium, methicillin-resistant Staphylococcus aureus, and penicillin-resistant Streptococcus pneumoniae. Linezolid inhibits bacterial protein synthesis at an early step in translation and is rapidly and completely absorbed from the gastrointestinal tract following oral administration. Efficacy has been demonstrated in a number of unpublished clinical trials in adults with pneumonia, skin and skin structure infections, and vancomycin-resistant E. faecium infections. The adverse effect profile is similar to that of comparator agents (beta-lactams, clarithrornycin, vancomycin). CONCLUSIONS: Linezolid is the first oral antimicrobial agent approved for the treatment of vancomycin-resistant enterococci. Since the oxazoildinones have a unique mechanism of action and expanded spectrum of activity against virulent and highly resistant gram positive pathogens, linezolid is a valuable alternative to currently available treatment options. Clinical trials evaluating linezolid and other oxazolidinones for antibiotic-resistant gram-positive infections, as well as comparator studies comparing linezolid with other candidate drugs, such as quinupristin/dalfopristin and choramphenicol, will further define the role of linezolid.     

Linezolid: its role in the treatment of gram-positive, drug-resistant bacterial infections

While the choices available for the management of gram-positive, drug-resistant bacterial infections are becoming limited, antimicrobial resistance is becoming increasingly problematic because of the widespread overuse of antibiotics. Linezolid is a synthetic antibiotic belonging to a new class of antimicrobials called the oxazolidinones. Linezolid disrupts bacterial growth by inhibiting the initiation process of protein synthesis--a mechanism of action that is unique to this class of drugs. It is well absorbed with high bioavailability that allows conversion to oral therapy as soon as the patient is clinically stable. It has been approved for certain gram-positive infections including certain drug-resistant enterococcus, staphylococcus, and pneumococcus strains. It is generally well tolerated, with myelosuppression being the most serious adverse effect. As a nonselective inhibitor of monoamine oxidase, caution is recommended when used with adrenergic or serotonergic agents (e.g., tyramine, dopamine, pseudoephedrine, and selective serotonin reuptake inhibitors). Judicious use of this medication should help physicians treat patients with multidrug-resistant infections.     

Linezolid: an oxazolidinone antimicrobial agent

BACKGROUND: Linezolid is the first oxazolidinone anti-infective agent marketed in the United States. It is indicated for the treatment of nosocomial pneumonia, complicated skin and skin-structure infections caused by methicillin-sensitive or methicillin-resistant Staphylococcus aureus and other susceptible organisms, and vancomycin-resistant Enterococcus faecium infections. It also is indicated for the treatment of uncomplicated skin and skin-structure infections caused by methicillin-sensitive S. aureus or Streptococcus pyogenes, and community-acquired pneumonia caused by penicillin-sensitive Streptococcus pneumoniae. OBJECTIVE: This article reviews the pharmacologic properties and clinical usefulness of linezolid. METHODS: Using the terms linezolid, PNU-100766, and oxazolidinone, we performed a literature search of the following databases: MEDLINE (1966 to September 2000), HealthSTAR (1993 to September 2000), Iowa Drug Information Service (1966 to September 2000), International Pharmaceutical Abstracts (1970 to September 2000), PharmaProjects (January 2000 version), and meeting abstracts of the Infectious Diseases Society of America and the Interscience Conference on Antimicrobial Agents and Chemotherapy (1996 to 2000). RESULTS: Linezolid has a unique structure and mechanism of action, which targets protein synthesis at an exceedingly early stage. Consequently, cross-resistance with other commercially available antimicrobial agents is unlikely. It is primarily effective against gram-positive bacteria. To date, resistance to linezolid has been reported in patients infected with enterococci. The pharmacokinetic parameters of linezolid in adults are not altered by hepatic or renal function, age, or sex to an extent requiring dose adjustment. Linezolid is metabolized via morpholine ring oxidation, which is independent of the cytochrome P450 (CYP450) enzyme system; as a result, linezolid is unlikely to interact with medications that stimulate or inhibit CYP450 enzymes. Compassionate-use trials and other clinical studies involving mainly adult hospitalized patients with gram-positive infections have shown that linezolid administered intravenously or orally is effective in a variety of nosocomial and community-acquired infections, including those caused by resistant gram-positive organisms. Reported adverse effects include thrombocytopenia. diarrhea, headache, nausea, vomiting, insomnia, constipation, rash, and dizziness. Preliminary pharmacoeconomic data indicate that a significantly higher percentage of patients receiving linezolid therapy versus comparator could be discharged from the hospital by day 7 (P = 0.005). CONCLUSIONS: Linezolid appears to be effective while maintaining an acceptable tolerability profile. Due to the risk of bacterial resistance, linezolid should be reserved for the treatment of documented serious vancomycin-resistant enterococcal infections.     

吉非替尼治疗晚期非小细胞肺癌的疗效分析

目的：观察吉非替尼治疗晚期非小细胞肺癌（non-small cell lung cancer,NSCLC）的临床疗效及不良反应。方法：回顾分析2008年5月—2010年5月期间口服吉非替尼250mg每日1次,并获得随访的43例晚期NSCLC患者的临床资料,评价其临床疗效及不良反应。结果：总有效率为23.25%,完全缓解（CR）2例（4.65%）,部分缓解（PR）8例（18.60%）,疾病稳定（SD）18例（41.86%）,疾病控制率为65.11%。出现的主要的不良反应为皮疹20例（46.51%）及腹泻、恶心呕吐等消化道反应16例（37.20%）,未出现Ⅲ~Ⅳ级严重不良反应。结论：吉非替尼治疗晚期NSCLC的临床疗效较好,并且不良反应小,患者耐受性良好。     

米非司酮治疗异位妊娠的临床观察

目的：探讨米非司酮治疗异位妊娠的疗效,安全性及对患者生育的影响。方法：选取符合保守治疗条件患者31例,观察米非司酮治疗异位妊娠过程中的临床症状,各项试验室指标的变化;出现不良反应的几率及严重程度;治疗后输卵管的通畅情况,以判断是否对患者生育造成影响。结果：治疗成功率为87.09%;不良反应出现率为19.35%,均为轻度不适;成功病例中未育患者输卵管通畅率为100%。结论：米非司酮是一种治疗异位妊娠的高效药物,具有安全性高,不良反应少,对生育无影响的优点。     

Linezolid versus teicoplanin in the treatment of Gram-positive infections in the critically ill: a randomized, double-blind, multicentre study

OBJECTIVES: Linezolid, the only commercially available oxazolidinone, is indicated for the treatment of Gram-positive infections, although little has been published specifically on its use in the critically ill. A randomized, prospective study was therefore performed to compare linezolid with the glycopeptide antibiotic, teicoplanin, for the treatment of suspected or proven Gram-positive infections in an intensive care population. METHODS: Using a double-blind, double-dummy, prospective design, patients were randomized to (i) intravenous linezolid (600 mg/12 h) plus teicoplanin dummy [one dose/12 h for three doses then every 24 h intravenously (iv)] or (ii) teicoplanin (400 mg/12 h for three doses then 400 mg/24 h iv) plus linezolid dummy (one dose/12 h iv). Other antibiotics were used in combination with the trial agents in empirical treatment. Clinical and microbiological assessments were made daily in the first week, and at 8 and 21 days after treatment. RESULTS: One hundred patients received linezolid plus placebo-teicoplanin, whereas 102 received teicoplanin plus placebo-linezolid. Population baseline characteristics were similar in both groups. At end of treatment, clinical success [71 (78.9%) linezolid versus 67 (72.8%) teicoplanin] and microbiological success [49 (70.0%) versus 45 (66.2%)] rates were similar, as were adverse effects, intensive care unit mortality, and success rates at short- and long-term follow-up. Linezolid was superior at initial clearance of methicillin-resistant Staphylococcus aureus (MRSA) colonization (end of treatment, 51.1% versus 18.6%, P = 0.002). Two MRSA isolates showed reduced susceptibility to teicoplanin. CONCLUSIONS: Linezolid has similar safety and efficacy to teicoplanin in treating Gram-positive infections in the critically ill. Short-term MRSA clearance achieved with linezolid suggests better skin and mucosal penetration.