CAJ | 학술논문

目的初步评价利奈唑胺治疗神经外科术后患者耐甲氧西林葡萄球菌(MRS)颅内感染的临床疗效及安全性.方法回顾性总结2009年3月至2011年11月本院神经重症监护病房(NICU)及亚低温治疗中心使用利奈唑胺治疗14例MRS颅内感染患者的资料.于治疗前及治疗7d、14d取血及脑脊液(CSF)培养,进行实验室、病原学和细菌学检查,评估利奈唑胺的临床疗效及不良反应.结果给予MRS颅内感染患者静脉滴注利奈唑胺治疗14 d后,患者临床症状和CSF化验指标显著好转；CSF葡萄糖(mmol/L)由1.00(0.65)升至3.15(1.60),CSF蛋白定量(mg/L)由2238.50(2072.50)降至606.50(217.30),CSF白细胞数(×106/L)由920.00(1587.50)降至30.00(40.00),CSF中性粒细胞比例＞0.20者由14例减少至1例；血清中降钙素原(PCT)水平(μg/L)明显降低并恢复正常[由0.65(1.16)降至0.08(0.09),均P＜0.01].临床总有效率为85.7％(12/14),CSF细菌清除率达100％.给予利奈唑胺期间,患者未发生明显不良反应.结论利奈唑胺能够有效控制MRS颅内感染和缓解炎症反应,疗效明确,具有良好的安全性.
목적 초보평개리내서알치료신경외과술후환자내갑양서림포도구균(MRS)로내감염적림상료효급안전성.방법 회고성총결2009년3월지2011년11월본원신경중증감호병방(NICU)급아저온치료중심사용리내서알치료14례MRS로내감염환자적자료.우치료전급치료7d、14d취혈급뇌척액(CSF)배양,진행실험실、병원학화세균학검사,평고리내서알적림상료효급불량반응.결과 급여MRS로내감염환자정맥적주리내서알치료14 d후,환자림상증상화CSF화험지표현저호전；CSF포도당(mmol/L)유1.00(0.65)승지3.15(1.60),CSF단백정량(mg/L)유2238.50(2072.50)강지606.50(217.30),CSF백세포수(×106/L)유920.00(1587.50)강지30.00(40.00),CSF중성립세포비례＞0.20자유14례감소지1례；혈청중강개소원(PCT)수평(μg/L)명현강저병회복정상[유0.65(1.16)강지0.08(0.09),균P＜0.01].림상총유효솔위85.7％(12/14),CSF세균청제솔체100％.급여리내서알기간,환자미발생명현불량반응.결론 리내서알능구유효공제MRS로내감염화완해염증반응,료효명학,구유량호적안전성.
Objective To evaluate the efficacy and safety of linezolid in the treatment of post-neurosurgical intracranial methicillin-resistant Staphylococcus(MRS)infection.Methods The data from 14 patients,admitted to neurological intensive care unit(ICU)of Medical College of Chinese People's Armed Police Forces between March 2009 and November 2011,were retrospectively analyzed.All these cases suffered from post-neurosurgical intracranial infection by MRS and received linezolid treatment.Blood and cerebrospinal fluid(CSF)were collected before and 7 days and 14 days after treatment for routine and bacteriological examinations to assess clinical efficacy and adverse reactions of linezolid.Results After 14-day treatment with linezolid,the clinical and laboratory parameters showed significant improvement:glucose(mmol/L)in CSF rose from 1.00(0.65)to 3.15(1.60),protein(mg/L)in CSF dropped from 2238.50(2072.50)to 606.50(217.30),white blood cell count(× 106/L)in CSF fell from 920.00 (1587.50)to 30.00(40.00),and the number of patients with CSF neutrophil ratio＞0.20 was reduced from 14 to 1(all P＜0.01).In addition,serum procalcitonin level(μg/L)was significantly reduced from 0.65(1.16)to 0.08(0.09)after linezolid therapy(P＜0.01).Total effective rate was 85.7％(12/14),and CSF bacterial clearance rate reached 100％.No adverse events were found during the treatment.Conclusion Linezolid could effectively control post-neurosurgical intracranial MRS infection and alleviate the inflammatory responses with safety.