万古霉素治疗84例革兰阳性球菌感染的效果与肾毒性评价

目的 :评价万古霉素治疗革兰阳性 (G+ )球菌感染的疗效及肾毒性。方法 :回顾性分析北京协和医院加强医疗病房 (ICU )应用万古霉素治疗 84例 G+ 球菌感染患者的临床资料。结果 :临床有效率为 90 % ,下呼吸道感染以及万古霉素治疗前感染持续时间较长是临床疗效不佳的危险因素。细菌学清除率 90 % (76例 ) ;下呼吸道感染患者细菌学疗效较差 ,且细菌学疗效较差的患者万古霉素用量较大。肾毒性发生率为 11% (9/ 84 )～14 % (12 / 84 ) ;采用不同的肾毒性定义时 ,肾毒性的发生率并无显著差异 (P>0 .0 5 )。在发生肾毒性的患者中 ,2 2 %～ 4 4 %肾功能可以恢复正常。肾毒性的发生与下呼吸道感染及细菌学疗效不佳密切相关 (P<0 .0 5 )。结论 :万古霉素是治疗 G+ 球菌感染的安全可靠的抗生素。

Efficacy and nephrotoxicity of vancomycin in the treatment of Gram positive infections

Objective:To evaluate the efficacy and nephrotoxicity of vancomycin in the treatment of Gram positive infections.Methods:A retrospective study of 84 patients with Gram positive infections who were treated with vancomycin in intensive care unit of Peking union medical college hospital.Results:Clinical effective rate was 90% (76/84),and bacterial eradication rate was also 90% (76/84).By univariate analysis, lower respiratory tract infection (LRTI) and longer duration of infection prior to vancomycin treatment were associated with poor clinical response,while LRTI and higher total dose of vancomycin were associated with poor bacteriologic response.The prevalence of nephrotoxicity ranged from 11% (9/84) to 14% (12/84).There was no significant difference in terms of nephrotoxicity prevalence whichever criteria of nephrotoxicity was applied. Nephrotoxicity could be reversed,either during or after treatment,in 22% to 44% of patients.The development of nephrotoxicity was associated with LRTI and poor bacteriological response.Conclusion: Vancomycin is a reliable and safe antibiotic in the treatment of Gram positive infections.