利奈唑胺等抗菌药物对肠球菌属体外抗菌活性评价 FREE

目的了解利奈唑胺等抗菌药物对某院临床分离的肠球菌属细菌的体外抗菌活性。方法采用美国德灵Microscan WalkAway 40全自动微生物分析仪对临床标本分离培养的肠球菌属细菌进行鉴定及药物敏感试验。结果117株肠球菌属细菌中未检出对利奈唑胺耐药的菌株;屎肠球菌和粪肠球菌对万古霉素的耐药率分别为4.41%和5.71%,对青霉素、氨苄西林、红霉素、高浓度庆大霉素、左氧氟沙星、环丙沙星等药物的耐药率达70%以上。结论利奈唑胺对肠球菌属细菌具有良好的抗菌效果,尤其对多重耐药株所致感染的控制将具有重要作用。     

Linezolid-induced reversible bicytopenia in a 4-year-old boy with methicillin-resistant Staphylococcus aureus bacteremia

The authors report on a 4-year-old child with the diagnosis of tetralogy of Fallot (TOF) and infective endocarditis. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from the blood culture of the patient. While receiving imipenem, amikacin, and linezolid therapies, the boy's general condition improved, acute phase reactants decreased, and his blood culture became negative for MRSA. On his follow-up echocardiography, the vegetation had also disappeared. However, he developed progressive bicytopenia following linezolid therapy for 5 weeks. During linezolid therapy, his hemoglobin level decreased from 12.1 to 5.3 g/dL and his platelet count from 242 × 10⁹ to 14 × 10⁹/L. His white blood cell count (WBC) did not decrease during linezolid therapy. Six days following termination of linezolid therapy, his hemoglobin had increased to 8.2 g/dL and platelet count to 192 × 10⁹/L. Thus, it should be kept in mind that linezolid may induce cytopenias in children. If these side effects of linezolid are known, unnecessary laboratory investigations may be prevented and cessation of the drug may be sufficient for reversal of the cytopenias.     

Multidrug- and extensively drug-resistant tuberculosis, Germany

We evaluated risk factors and treatment outcomes associated with multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) in Germany in 2004-2006. In 177 (4%) of 4,557 culture-positive TB cases, Mycobacterium tuberculosis isolates were identified as MDR TB; an additional 7 (0.15%) met criteria for XDR TB. Of these 184 patients, 148 (80%) were born in countries of the former Soviet Union. In patients with XDR TB, hospitalization was longer (mean +/- SD 202 +/- 130 vs. 123 +/- 81 days; p = 0.015) and resistance to all first-line drugs was more frequent (36% vs. 86%; p = 0.013) than in patients with MDR TB. Seventy-four (40%) of these 184 patients received treatment with linezolid. Treatment success rates ranged from 59% for the entire cohort (59% for MDR TB and 57% for XDR TB) to 87% for those with a definitive outcome (n = 125; 89% for MDR TB and 80% for XDR TB). Extensive drug susceptibility testing and availability of second- and third-line drugs under inpatient management conditions permit relatively high treatment success rates in MDR- and XDR TB.     

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。     

利奈唑胺治疗老年耐甲氧西林金黄色葡萄球菌（MRSA）肺炎的护理干预

目的：探讨护理干预对利奈唑胺治疗老年耐甲氧西林金黄色葡萄球菌（ MRSA）肺炎的效果。方法选择2014年10月～2015年7月入住呼吸监护室的96例利奈唑胺治疗的老年MRSA肺炎患者进行的临床分析研究,均采用利奈唑胺静脉用药,随机分为对照组（常规护理）和观察组（护理干预）,对照组与常规组各48例,随机分为对照组（常规护理）和观察组（护理干预）,每组48例,对两组有效率、细菌清除率,退热时间,不良反应,咳嗽消失时间,患者满意度,平均住院时间进行观察和比较。结果与对照组相比,观察组有效率为93.8％,明显高于对照组的83.3％（ P＜0.05）;细菌清除率92.8％,明显高于对照组的73.1％（ P＜0.05）;满意度91.7％,明显高于对照组的81.2％（ P＜0.05）;退热时间,不良反应,咳嗽消失时间及平均住院时间均明显短于对照组（ P＜0.05）。结论对于利奈唑胺治疗的老年MRSA肺炎患者,有效的护理干预能明显提高治疗的效果,改善患者的预后。     

儿童患者使用利奈唑胺致高乳酸血症的风险因素分析

目的 研究在儿童患者中使用利奈唑胺(linezolid,LZD)致高乳酸血症的风险因素。方法 搜集2012年10月—2023年2月在重庆医科大学附属儿童医院接受LZD治疗的儿童住院患者信息并进行回顾性分析,采用单因素及多因素logistic回归分析其风险因素,通过限制性立方样条模型进一步分析各风险因素与LZD致高乳酸血症之间的剂量-反应关系。结果 共纳入331例儿童患者,其中145例患儿(43.8%)发生高乳酸血症,患儿年龄中位数为3(0.92,9)岁,LZD治疗天数中位数为13(8,22)d。患儿接受LZD治疗天数较长(OR=1.026,P=0.004),合用P-糖蛋白诱导剂(OR=2.023,P=0.004)、乳酸基线值较高(OR=2.408,P=0.022)和低肾小球滤过率(OR=0.997,P=0.047)为LZD致高乳酸血症的独立危险因素;随着LZD治疗天数增加,LZD致高乳酸血症的风险呈非线性增加(P-non-linear=0.041);乳酸基线值<0.92 mmol·L^-1时,LZD致高乳酸血症风险随乳酸基线值升高而持续增加,乳酸基线值>0.92 mmol·L^-1时,随着乳酸基线值的升高,LZD致高乳酸血症风险缓慢增加(P-non-linear=0.013)。结论 患儿接受LZD治疗时应关注乳酸基线水平、LZD使用时间、合用P-糖蛋白诱导剂和肾功能不全等风险因素,结合患儿的治疗需求防范高乳酸血症的发生。     

HPLC测定利奈唑胺的血药浓度

目的 建立人血浆中利奈唑胺浓度测定的高效液相色谱法。方法 以苯巴比妥为内标,血浆样品用乙腈沉淀蛋白,采用Luna C₁₈柱(250 mm×4.6 mm,5 μm)分析。流动相为乙腈-水(25∶75),流速为1.0 mL·min^-1,检测波长251 nm,柱温35 ℃。 结果 本法在0.1～40 mg·L^-1内线性关系良好(r=0.999 9),检测限为0.05 mg·L^-1,日内、日间RSD均小于4％。结论 本方法简单、灵敏、准确,适用于利奈唑胺临床血药浓度监测及人体药动学研究。     

Linezolid in the treatment of drug-resistant tuberculosis: the challenge of its narrow therapeutic index

Introduction: Linezolid is an oxazolidinone with potent activity against M tuberculosis, and improves culture conversion and cure rates when added to treatment regimens for drug resistant tuberculosis. However, linezolid has a narrow therapeutic window, and the optimal dosing strategy that minimizes the substantial toxicity associated with linezolid’s prolonged use in tuberculosis treatment has not been determined, limiting the potential impact of this anti-mycobacterial agent.

Areas covered: This paper aims to review and summarize the current knowledge on linezolid for the treatment of drug-resistant tuberculosis. The focus is on the pharmacokinetic-pharmacodynamic determinants of linezolid’s efficacy and toxicity in tuberculosis, and how this relates to defining an optimal dose. Mechanisms of linezolid toxicity and resistance, and the potential role of therapeutic drug monitoring are also covered.

Expert commentary: Prospective pharmacokinetic-pharmacodynamic studies are required to define optimal therapeutic targets and to inform improved linezolid dosing strategies for drug-resistant tuberculosis.