去甲万古霉素致粒细胞缺乏症及红人综合征

1例49岁男性患者,因呼吸机相关性肺炎给予依替米星、美罗培南治疗。3d后痰培养结果显示耐甲氧西林金黄色葡萄球菌生长。停用依替米星,改用去甲万古霉素400mg加入0.9%氯化钠注射液250mL静脉泵入,1次/12h,并继续应用美罗培南。治疗13d后患者出现发热,T39.9℃,颈、胸、腹、背等部位出现片状红色皮疹,随后皮疹逐渐融合,自颈部至双侧腹股沟皮肤发红。血常规检查：WBC1.39×10^9/L,N0.06×10^9/L。停用去甲万古霉素,改为静脉泵入头孢哌酮钠-舒巴坦钠,继续使用美罗培南,同时给予西咪替丁及非格司亭。4d后皮疹基本消失,11d后白细胞及中性粒细胞计数恢复正常。以后未再应用去甲万古霉素,上述症状未再发生,随诊查血常规均在正常范围。

Norvancomycin-induced agranulocytosis and red man syndrome

A 49-year-old man with ventilator-associated pneumonia received etimicin and meropenem. Three days later,sputum culture showed methicillin resistant Staphylococcus aureus （MRSA）. Etimicin was withdrawn and then norvancomycin 400 mg dissolved in 0.9% sodium chloride 250 mL was given by an IV pump every 12 hours while meropenem was continued. After 13 days of therapy,the patient developed fever of 39.9 ℃,lamellar red rashes in his neck,chest,abdomen,and back which gradually progressed to involve his body from the neck to both groins. Routine blood tests revealed the WBC count of 1.39×10^9/L and proportion of neutrophiles of 0.06×10^9/L. Norvancomycin was withdrawn and cefoperazone sodium and sulbactam sodium was given via an IV pump,while meropenem use was maintained. Meanwhile he was given cimetidine and filgrastim. Four days later,almost all rashes disappeared. Eleven days later,the counts of WBC and proportion of neutrophiles returned to normal. Subsequently,norvancomycin was discontinued and the above-mentioned symptoms did not recur and the routine blood examination results were within the normal range.