利奈唑胺与万古霉素对不同肾功能开颅术后肺部感染患者的有效性及安全性
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摘要
目的探讨利奈唑胺与万古霉素对于不同肾功能状态下耐甲氧西林金黄色葡萄球菌(MRSA)所致开颅术后肺部感染患者的有效性及安全性。方法回顾性分析不同肾功能状态下MRSA所致开颅术后肺部感染患者使用利奈唑胺与万古霉素治疗后的临床有效性、细菌学有效性以及安全性;并通过Logistic回归分析有效性及安全性的可能影响因素。结果利奈唑胺组在正常肾功能、轻/中、重度肾功能受损患者中的临床有效率显著高于万古霉素组(P <0. 05);在正常肾功能、轻度或中度肾功能受损患者中的细菌清除率显著高于万古霉素组(P <0. 05)。2组患者急性肾损伤的发生率无显著差异(P>0. 05)。结论利奈唑胺对于MRSA所致的开颅术后肺部感染患者的临床有效率及细菌学有效率高于万古霉素,而且不受患者肾功能状态的影响。
Objective To investigate the efficacy and safety of linezolid and vancomycin in different renal function patients with pneumonia after craniotomy caused by methicillin-resistant staphylococcus aureus( MRSA). Methods Clinical efficacy,bacteriological efficacy and safety of linezolid and vancomycin in pulmonary infection patients after craniotomy caused by MRSA in different renal functions. Multivariate logistic regression analysis were performed to identify independent influencing factors. Results The clinical efficacy in normal renal function,mild/moderate,severe renal impairment patients in linezolid group were higher than vancomycin group( P < 0. 05). Bacterial clearance in patients with normal renal function,mild or moderate renal impairment was significantly higher than vancomycin group( P < 0. 05). There was no significant difference in the incidence of acute kidney injury between the two groups( P > 0. 05). Conclusion Linezolid has higher clinical and bacteriological efficacy than vancomycin in patients after craniotomy caused by MRSA,and different renal functions have no impact on clinical and bacteriological efficacy.
Objective To investigate the efficacy and safety of linezolid and vancomycin in different renal function patients with pneumonia after craniotomy caused by methicillin-resistant staphylococcus aureus( MRSA). Methods Clinical efficacy,bacteriological efficacy and safety of linezolid and vancomycin in pulmonary infection patients after craniotomy caused by MRSA in different renal functions. Multivariate logistic regression analysis were performed to identify independent influencing factors. Results The clinical efficacy in normal renal function,mild/moderate,severe renal impairment patients in linezolid group were higher than vancomycin group( P < 0. 05). Bacterial clearance in patients with normal renal function,mild or moderate renal impairment was significantly higher than vancomycin group( P < 0. 05). There was no significant difference in the incidence of acute kidney injury between the two groups( P > 0. 05). Conclusion Linezolid has higher clinical and bacteriological efficacy than vancomycin in patients after craniotomy caused by MRSA,and different renal functions have no impact on clinical and bacteriological efficacy.
引文
[1] American Thoracic Society,Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired,ventilator-associated,and healthcare-associated pneumonia[J]. Am J Respir Crit Care Med,2005,171(4):388-416.
[2]卫生部.抗菌药物临床试验技术指导原则(第三稿)[S].2007.
[3] Wunderink R G,Niederman M S,Kollef M H,et al. Linezolid in methicillin-resistant Staphylococcus aureus nosocomial pneumonia:a randomized,controlled study[J]. Clin Infect Dis,2012,54(5):621-629.
[4] Stalker D J,Jungbluth G L. Clinical pharmacokinetics of linezolid,a novel oxazolidinone Antibacterial[J]. Clin Pharmacokinet,2003,42(13):1129-1140.
[5] Stalker D J,Jungbluth G L. Clinical pharmacokinetics of vancomycin[J]. Clin Pharmacokinet,1986,11(4):257-282.
[6] Docobo-Pérez F,López-Rojas R,Domínguez-Herrera J,et al. Efficacy of linezolid versus a pharmacodynamically optimized vancomycintherapy inan experimental pneumonia model caused by methicillin-resistantStaphylococcus aureus[J]. J Antimicrob Chemother,2012,67(8):1961-1967.
[7] Moise-Broder P A,Forrest A,Birmingham M C,et al. Pharmacodynamics of vancomycin and other antimicrobials in patients with Staphylococcus aureus lower respiratory tract infections[J]. Clin Pharmacokinet,2004,43(13):925-942.
[8] Kullar R,Davis S L,Levine D P,et al. Impact of vancomycin exposure on outcomes in patients with methicillin-resistant Staphylococcus aureus bacteremia:support for consensus guidelines suggested targets[J]. Clin Infect Dis,2011,52(8):975-981.
[9] Bosso J A,Nappi J,Rudisill C,et al. Relationship between vancomycin trough concentrations and nephrotoxicity:a prospective multicenter trial[J]. Antimicrob Agents Chemother,2011,55(12):5475-5479.
[10] Jeffres M N,Isakow W,Doherty J A,et al. Predictors of mortality for methicillin-resistant Staphylococcus aureus health-care-associated pneumonia:specific evaluation of vancomycin pharmacokinetic indices[J]. Chest,2006,130(4):947-955.
[11] Barriere S L,Stryjewski M E,Corey G R,et al. Effect of vancomycin serum trough levels on outcomes in patients with nosocomial pneumonia due to Staphylococcus aureus:a retrospective,posthoc,subgroup analysis of the Phase 3 ATTAIN studies[J]. BMC Infect Dis,2014,14:183-185.
[12] Wunderink R G,Rello J,Cammarata S K,et al. Linezolid vs vancomycin:analysis of two double blind studies of patients with methicillin-resistant Staphylococcus aureus nosocomial pneumonia[J]. Chest,2003,124(5):1789-1797.
[13] Kullar R,Mc Clellan I,Geriak M,et al. Efficacy and safety of daptomycin in patients with renal impairment:a multicenter retrospective analysis[J]. Pharmacotherapy,2014,34(6):582-589.
[14] Yagi T,Naito T,Doi M,et al. Plasma exposure of free linezolid and its ratio to minimum inhibitory concentration varies in critically ill patients[J]. Int J Antimicrob Agents,2013,42(4):329-334.
[2]卫生部.抗菌药物临床试验技术指导原则(第三稿)[S].2007.
[3] Wunderink R G,Niederman M S,Kollef M H,et al. Linezolid in methicillin-resistant Staphylococcus aureus nosocomial pneumonia:a randomized,controlled study[J]. Clin Infect Dis,2012,54(5):621-629.
[4] Stalker D J,Jungbluth G L. Clinical pharmacokinetics of linezolid,a novel oxazolidinone Antibacterial[J]. Clin Pharmacokinet,2003,42(13):1129-1140.
[5] Stalker D J,Jungbluth G L. Clinical pharmacokinetics of vancomycin[J]. Clin Pharmacokinet,1986,11(4):257-282.
[6] Docobo-Pérez F,López-Rojas R,Domínguez-Herrera J,et al. Efficacy of linezolid versus a pharmacodynamically optimized vancomycintherapy inan experimental pneumonia model caused by methicillin-resistantStaphylococcus aureus[J]. J Antimicrob Chemother,2012,67(8):1961-1967.
[7] Moise-Broder P A,Forrest A,Birmingham M C,et al. Pharmacodynamics of vancomycin and other antimicrobials in patients with Staphylococcus aureus lower respiratory tract infections[J]. Clin Pharmacokinet,2004,43(13):925-942.
[8] Kullar R,Davis S L,Levine D P,et al. Impact of vancomycin exposure on outcomes in patients with methicillin-resistant Staphylococcus aureus bacteremia:support for consensus guidelines suggested targets[J]. Clin Infect Dis,2011,52(8):975-981.
[9] Bosso J A,Nappi J,Rudisill C,et al. Relationship between vancomycin trough concentrations and nephrotoxicity:a prospective multicenter trial[J]. Antimicrob Agents Chemother,2011,55(12):5475-5479.
[10] Jeffres M N,Isakow W,Doherty J A,et al. Predictors of mortality for methicillin-resistant Staphylococcus aureus health-care-associated pneumonia:specific evaluation of vancomycin pharmacokinetic indices[J]. Chest,2006,130(4):947-955.
[11] Barriere S L,Stryjewski M E,Corey G R,et al. Effect of vancomycin serum trough levels on outcomes in patients with nosocomial pneumonia due to Staphylococcus aureus:a retrospective,posthoc,subgroup analysis of the Phase 3 ATTAIN studies[J]. BMC Infect Dis,2014,14:183-185.
[12] Wunderink R G,Rello J,Cammarata S K,et al. Linezolid vs vancomycin:analysis of two double blind studies of patients with methicillin-resistant Staphylococcus aureus nosocomial pneumonia[J]. Chest,2003,124(5):1789-1797.
[13] Kullar R,Mc Clellan I,Geriak M,et al. Efficacy and safety of daptomycin in patients with renal impairment:a multicenter retrospective analysis[J]. Pharmacotherapy,2014,34(6):582-589.
[14] Yagi T,Naito T,Doi M,et al. Plasma exposure of free linezolid and its ratio to minimum inhibitory concentration varies in critically ill patients[J]. Int J Antimicrob Agents,2013,42(4):329-334.