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.

Retrospective Analysis of the Gram-positive Bacteria-infected Cases in the Department of Hematology

This study was purposed to evaluate the efficacy and safety of linezolid, vancomycin and teicoplanin for the treatment of patients infected by Gram-positive bacteria in the Department of Hematology by retrospective analysis. The patients with fever in our department from January to December in 2011 were selected for blood culture with Gram- positive bacteria and treated with linezolid, vancomycin or teicoplanin alone. Various parameters were recorded before and after treatment, such as fever time, respiratory symptoms, physical signs, radiographic changes, blood and biochemical routine, and adverse reactions. The efficacy and safety of linezolid, vancomycin and teicoplanin were compared according to the fever abating time, bacterial clearance rate, clinical efficiencies and adverse events. The patients were divided into linezolid group （15 patients）, vancomycin group （17 patients） and teicoplanin group （20 patients）. The results showed that the mean time of fever abating in linezolid group was （4. 43 ± 3. 15 ）d, bacterial clearance rate and clinical efficiency in linezolid group were 55.56% and 86.67%, respectively. The above three data in vancomycin group were （6. 83 ± 4. 67）d, 54. 54% and 76.47% respectively, and were （5.57 ± 4. 16）d, 41.67 % and 80. 00% in teicoplanin group respectively. There was no statistically significant difference between three groups （P 〉 0.05 ）. There were one case of diarrhea and two cases of thrombocytopenia in the linezolid group, and one case of nausea and two cases of creatinine increase in the vancomycin group. There were three cases of thrombocytopenia in the teicoplanin group. The thrombocytopenia in five cases and the hemogram drop in patients with leukemia after treatment were overlapped, their drug treatment did not stop, but their thrombocytopoiesis recovered to normal-level, thus the drug treatment were considered as no relation with thrombocytopenia. It is concluded that the treatment efficacy between linezolid,vancomycin and teicoplanin for Gram-positive bacterial infections is not statistically different, but linezolid maybe have advantage over vancomycin and teicoplanin in fever abating time, bacterial clearance rate and clinical efficiency.