利奈唑胺治疗老年患者革兰阳性球菌感染的疗效及安全性

目的探讨利奈唑胺治疗老年患者革兰阳性（G+）球菌感染的疗效及安全性。方法收集某院2013年1月-2014年12月所有住院患者中年龄＞60岁、因G+球菌感染使用利奈唑胺治疗10 d以上患者的病历资料，分析利奈唑胺的疗效，并比较利奈唑胺治疗前及用药后14 d实验室指标，分析其可能的不良反应。结果共纳入70例老年患者，感染部位以下呼吸道为主（占62.86%），病原菌以金黄色葡萄球菌为主（占42.86%，其中MRSA19株）。80%以上的患者年龄＞70岁、住院时间＞30 d、入住重症监护病房（ICU），70%以上患者有深静脉置管及留置导尿管。使用利奈唑胺治疗14 d后患者的血小板（PLT）计数为（132.00±45.00）×109/L，低于治疗前的（156.00±78.00）×109/L，差异有统计学意义（P=0.009）；总的治疗有效率为81.43%（57/70），不良反应发生率为17.14%（12/70）。结论应用利奈唑胺治疗老年患者G+球菌感染疗效较好，可作为临床医生经验性抗感染选用药物之一，但在治疗过程中应加强对患者PLT计数的监测。

Efficacy and safety of linezolid in the treatment of gram positive coccus infection in the elderly

ObjectiveTo evaluate the efficacy and safety of linezolid in the treatment of gram positive coccus infection in the elderly.MethodsClinical data of patients (>60 years old) infected with gram positive coccus and treated with linezolid for 10 days between January 2013 and December 2014 were collected, the therapeutic efficacy of linezolid were analyzed, laboratory indexes before and 14 days after linezolid treatment were compared, possible adverse effects were analyzed.ResultsA total of 70 old patients were enrolled, the majority of patients were infected in lower respiratory tract (62.86%) and were infected with Staphylococcus aureus (42.86%, of which 19 were MRSA), more than 80% of the patients were >70 years old, had length of stay > 30 days, and admitted in ICU, more than 70% of the patients were with deep venous catheterization and indwelling urinary catheterization. Platelet count (PLT) after 14 days of linezolid treatment was significantly lower than before treatment（［132.00±45.00］×109/L vs ［156.00±78.00］ ×109/L, P=0.009); the total therapeutic efficacy of linezolid was 81.43%(57/70), while the rate of adverse effects was 17.14% (12/70).ConclusionLinezolid is effective for treatment of gram positive coccus infection in the elderly, and may be a good choice of empirical treatment. PLT should be intensively monitored during the process of linezolid therapy.