重症医学科耐甲氧西林金黄色葡萄球菌肺部感染老年患者的药物治疗

目的比较3种抗耐甲氧西林金黄色葡萄球菌(MRSA)药物治疗重症医学科(ICU)MRSA肺部感染老年患者的疗效及对细菌清除率和不良反应的影响。 方法选取2015年3月至2017年5月青岛市中心医院ICU收治的114例老年MRSA肺部感染者作为研究对象，根据患者治疗药物不同分为万古霉素组、替考拉宁组和利奈唑胺组，每组各38例患者。比较各组患者的疗效、细菌清除率、治疗前后血清C-反应蛋白(CRP)、降钙素原(PCT)、白细胞计数、中性粒细胞比值变化以及不良反应发生率。 结果利奈唑胺组患者治疗总有效率显著优于万古霉素组和替考拉宁组(χ²= 7.018、P = 0.008，χ²= 4.070、P = 0.044)。利奈唑胺组患者细菌清除率显著高于万古霉素组和替考拉宁组(χ²= 5.182、P = 0.023，χ²= 4.211、P = 0.040)。各组患者治疗后CRP、PCT、白细胞计数、中性粒细胞比值均显著低于治疗前，且利奈唑胺组患者治疗后CRP、PCT、白细胞计数、中性粒细胞比值低于万古霉素组和替考拉宁组(P均< 0.05)。各组患者治疗后均发生恶心、呕吐、肝功能异常、肾毒性、血肌酐水平异常、血小板下降、贫血不良反应，各组不良反应总发生率差异无统计学意义(χ²= 0.647、P = 0.723)。 结论ICU MRSA肺部感染老年患者治疗药物中，利奈唑胺临床疗效、细菌清除率均优于万古霉素和替考拉宁，且临床安全性相当，为治疗MRSA肺部感染较为理想的选择。

The treatment of elderly patients with pulmonary infections caused by methicillin-resistance Staphylococcus aureus in intensive care unit

ObjectiveTo compare the efficacy, bacterial clearance and adverse reactions of three kinds of anti-methicillin-resistanceStaphylococcus aureus(MRSA) drugs on the treatment of elderly pulmonary infection caused by MRSA in intensive care unit (ICU). MethodsTotal of 114 elderly patients with pulmonary infection caused by MRSA in ICU from March 2015 to May 2017 in Qingdao Central Hospital were selected, and were divided into vancomycin group, teicoplanin group, and linezolid group according to the drugs, 38 cases in each group. The treatment effect, bacterial clearance rate, serum C-reactive protein (CRP), procalcitonin (PCT), count of WBC, neutrophil ratio and adverse reactions were compared, respectively among the three groups. ResultsThe clinical total effective rate of linezolid group was better than that of vancomycin group and teicoplanin group (χ²= 7.018,P = 0.008;χ²= 4.070,P= 0.044). The bacterial clearance rate of linezolid group was significantly higher than that of vancomycin group and teicoplanin group (χ²= 5.182,P= 0.023;χ²= 4.211,P = 0.040). After treatment, CRP, PCT, count of WBC and neutrophil ratio in each group were significantly lower than those before treatment, and the levels of CRP, PCT, count of WBC and neutrophil ratio in linezolid group were significantly lower than those of vancomycin group and teicoplanin group, with significant differences (allP< 0.05). Nausea, vomiting, liver dysfunction, kidney toxicity, abnormal serum creatinine, thrombocytopenia and anemia occurred in the three groups after treatment, with no significant difference in total incidence of adverse reactions among the three groups (χ²= 0.647,P= 0.723). ConclusionsIn the treatment of elderly patients with pulmonary infection casused by MRSA in ICU, linezolid is superior to vancomycin and teicoplanin in clinical efficacy and bacterial clearance, and its clinical safety is comparable. It is an ideal choice for the treatment of pulmonary infection casused by MRSA.