利奈唑胺治疗老年髓系白血病患者合并革兰阳性球菌感染的疗效

目的探讨利奈唑胺治疗老年白血病化疗后患者合并革兰阳性(G+)球菌感染的临床疗效。方法选择54例老年白血病(≥60岁)确诊G+球菌感染患者,随机分为治疗组26例,对照组28例,对照组常规抗感染治疗,治疗组在对照组的基础上,加用利奈唑胺治疗对比两组的临床治疗效果。结果经抗感染治疗,治疗组总有效率(92.31%)高于对照组(64.29%)(P<0.05);治疗组的平均用药时间〔(8.19±2.08)d〕短于对照组〔(11.85±2.75)d〕(P<0.05)。结论利奈唑胺治疗老年白血病患者合并G+菌感染的疗效显著,安全性高。     

利奈唑胺治疗血液科院内感染患者33例临床分析

目的评价血液科利奈唑胺注射液治疗患者院内感染的临床疗效及安全性。方法对2009年4月至2010年5月上海瑞金医院血液科使用利奈唑胺治疗的33例发生院内感染的住院患者进行回顾性分析和总结。结果用药前16例患者检出革兰阳性菌株14株(77.8%),其中葡萄球菌属4株(12.1%),VRE3株(9.1%),屎肠球菌2株(6.1%),粪肠球菌3株(9.1%),鸟肠球菌2株(6.1%)。33例患者中,初始使用利奈唑胺4例(12.1%),换用利奈唑胺治疗29例(87.9%)。细菌清除率达86.7%。33例患者均在治疗后3～5d感染症状缓解,临床有效率75.8%。6例(18.2%)在使用利奈唑胺期间出现了不良反应,1例轻度呕吐,1例恶心,1例面部水肿,1例视物模糊,2例患者轻度腹泻。结论利奈唑胺可有效治疗血液科患者院内感染,部分病例为使用其他抗菌药物治疗效果不佳或无效时换用利奈唑胺,在本研究中未观察到利奈唑胺对于血液疾病患者化疗后的骨髓有明显的抑制作用。患者耐受性良好,疗效确切。     

利奈唑胺和替考拉宁治疗住院高龄革兰阳性菌感染患者的临床应用分析

目的调查和比较利奈唑胺和替考拉宁治疗住院高龄革兰阳性球菌感染患者的疗效和安全性。方法回顾性分析2008年1月至2011年8月我科住院的高龄革兰阳性球菌感染患者的临床资料,共58例[年龄84-98岁,平均（91．2±4．0）岁],分为利奈唑胺组（30例）和替考拉宁组（28例）,设定临床疗效评价（痊愈、显效、进步、无效）和细菌学疗效评价标准（清除、假设清除、未清除,替换、再感染）,了解利奈唑胺和替考拉宁的疗效和不良反应。结果临床总有效率利奈唑胺组为93．3％,替考拉宁组为78．5％,二者无统计学差异（P=0．103）;细菌清除率利奈唑胺组为86．7％,明显高于替考拉宁组的53．6％（P〈0．05）。治疗过程中利奈唑胺组主要不良反应为血小板减少,替考拉宁组主要不良反应为血肌酐升高。结论利奈唑胺和替考拉宁在临床上治疗高龄革兰阳性球菌感染患者疗效肯定,利奈唑胺在临床疗效和细菌清除率方面优于替考拉宁。在选择用药时,要严格掌握适应证。需注意监测血小板和血肌酐的变化。     

利奈唑胺治疗恶性血液病并革兰阳性菌感染18例临床研究

目的探讨利奈唑胺治疗恶性血液病患者合并革兰阳性菌感染的疗效与安全性。方法选择2009年3—8月福建省立医院血液科收治的临床诊断为合并革兰阳性细菌感染的恶性血液病患者18例,采用利奈唑胺600mg静脉滴注,每12h1次,直至临床感染症状缓解和影像学改善时停药。结果 18例患者中12例有明确感染灶,包括肺部8例,皮肤软组织3例,牙龈1例。所有患者中8例合并粒细胞缺乏,4例合并粒细胞低下。所有患者均在治疗14d后获得临床症状改善,其中8例肺部感染明显好转,3例皮肤感染痊愈。未发现明显的临床不良反应。结论利奈唑胺用于恶性血液病患者革兰阳性菌感染的治疗有较好临床疗效,且副反应小,安全性好。     

含利奈唑胺化疗方案治疗术后耐多药脊柱结核患者的效果分析

目的 评价含利奈唑胺化疗方案治疗术后耐多药脊柱结核患者的临床疗效及安全性。方法 收集2013年5月至2017年4月北京胸科医院骨科收治的16例耐多药脊柱结核患者,手术后经不含利奈唑胺方案行抗结核药物治疗6个月后无效,后改为含利奈唑胺方案行抗结核药物治疗。通过对比抗结核药物治疗方案调整前后的化疗成功率、植骨融合率、疼痛视觉模拟评分(visual analogue scale, VAS)变化情况,以及与利奈唑胺相关的不良反应发生情况,评价含利奈唑胺方案治疗耐多药脊柱结核的临床疗效及安全性。结果 含利奈唑胺方案抗结核药物治疗的成功率为75.0%(12/16),治疗失败率为25.0%(4/16);植骨融合率为81.3%(13/16);使用含利奈唑胺方案抗结核药物治疗前VAS得分平均为(5.8±1.4)分;使用含利奈唑胺方案后VAS得分平均为(2.3±1.5)分,差异有统计学意义(t=6.546,P=0.000);12例患者椎体感染及椎旁脓肿逐渐吸收。与利奈唑胺相关的不良反应发生率为56.3%(9/16),胃肠道反应的发生率31.3%(5/16),末梢神经炎的发生率43.8%(7/16),贫血的发生率37.5%(6/16),头晕的发生率12.5%(2/16),皮疹的发生率6.3%(1/16)。减少利奈唑胺剂量后,与利奈唑胺相关的药物不良反应严重程度减轻。结论 含利奈唑胺方案治疗耐多药脊柱结核的临床疗效确切,但与利奈唑胺剂量相关的药物不良反应的发生率较高。     

口服利奈唑胺在治疗耐药结核中疗效及安全性临床观察

目的对口服利奈唑胺在治疗耐药结核病中疗效及安全性进行系统评估。方法将我院收治的45例耐多药结核病/广泛耐药结核病患者随机分为对照组(共27例)实验组(共18例),对照组给予多药联合化疗,而实验组在对照组多药联合化疗基础上加用利奈唑胺片口服,排除非医疗因素干扰中断治疗及因药物副作用不能耐受的患者,实验组加用利奈唑胺口服至少10个月,如治疗过程因不良反应出现利奈唑胺减量,则治疗时间延长到16个月。对比两组患者临床疗效及不良反应发生率。结果实验组患者临床病症改善情况、空洞闭合率以及痰菌转阴率均较对照组有明显提高,两组比较差异有统计学意义(P0.05),实验组患者药物不良反应发生率高于多药联合对照组,差异有显著性(P0.05)。结论口服利奈唑胺治疗耐药结核病临床疗效显著,配合减量及支持治疗后不良反应可控,值得临床推广。     

利奈唑胺和万古霉素治疗重症医学科MRSA肺部感染的疗效及安全性评价

目的分析评价利奈唑胺和万古霉素对重症医学科患者耐甲氧西林金黄色葡萄球菌(MRSA)肺部感染的治疗效果及安全性。方法选取重症医学科MRSA肺部感染患者85例,随机分为利奈唑胺组(43例)和万古霉素组(42)例,分别给予利奈唑胺(0.6g/次,2次/d)和万古霉素(1.0g/次,2次/d)治疗,疗程均为10-14d,比较两组的临床疗效、细菌清除率及不良反应发生率。结果利奈唑胺与万古霉素对MRSA肺部感染的治愈率分别为27.91%和26.19%,总有效率分别为72.09%和71.43%;细菌清除率分别为79.07%和64.29%;不良反应分别为6.98%和7.14%。两组患者的MRSA肺部感染治愈率、总有效率、肺部感染相关指标比较、无显著统计学差异(P0.05),细菌清除率比较差异具有显著统计学差异(P0.05)。结论利奈唑胺和万古霉素治疗ICU MRSA肺部感染均具有较高的敏感性,临床疗效和安全性相当,利奈唑胺的细菌清除率略高于万古霉素。     

利奈唑胺治疗老年重症感染性疾病13例临床分析

目的评价利奈唑胺注射液对老年重症感染性疾病的临床疗效及安全性。方法对2008年6月至2009年5月陕西省人民医院老年呼吸科使用利奈唑胺治疗的13例重症感染性疾病住院患者进行回顾性分析和总结。结果用药前13例患者均检出革兰阳性菌株,使用或换用利奈唑胺治疗,用药后清除13株(86.7%)。13例均在治疗后3～5d取得明显效果,有效率100%。有3例出现不良反应,其中1例有轻度呕吐,1例皮肤红疹,1例轻度腹泻。结论利奈唑胺可有效治疗老年重症感染性疾病,有些病例是在使用其他抗菌药物治疗效果不佳时换用利奈唑胺,患者耐受性良好,疗效确切。     

利奈唑胺治疗耐甲氧西林金黄色葡萄球菌感染的疗效及安全性分析

目的观察利奈唑胺的疗效及安全性。方法选择接受利奈唑胺治疗的22例患者,观察患者临床症状、体征、影像学改变等。结果 22例中10例治愈,7例好转,有效率77.27%,无效5例,其中2例死亡,2例自动出院,1例白细胞进行性升高出现黄疸后考虑为血液病而转科治疗。3例白细胞降低至正常范围以下,2例血小板降低,3例合并肾功能异常及9例合并肝功能异常患者,在应用利奈唑胺后肝肾功结果未见明显升高。结论利奈唑胺是治疗耐甲氧西林金黄色葡萄球菌感染既有效又安全的药物。     

利奈唑胺治疗革兰阳性菌呼吸机相关性肺炎的疗效观察

目的探讨利奈唑胺治疗革兰阳性（G^＋）菌呼吸机相关性肺炎（VAP）的疗效和安全性。方法分析2007年6月-2010年7月在我院住院的52例G^＋菌感染的VAP患者临床资料,分为治疗组25例和对照组27例。所有患者下呼吸道标本中3次以上培养出G^＋菌。两组分别给予利奈唑胺注射液和万古霉素注射液,治疗疗程为7-14 d。按卫生部颁发的抗菌药物临床研究指导原则判定疗效。结果治疗组有效率高于对照组（52.0%vs 37.0%）;病死率低于对照组（28.0%vs 44.4%）;G^＋菌清除率高于对照组（72.0%vs 55.6%）;使用机械通气时间明显短于对照组,差异均有统计学意义（P〈0.05）。治疗组和对照组的不良反应发生率（16.0%vs 29.6%）,差异有统计学意义（P〈0.05）。结论利奈唑胺治疗G^＋的VAP疗效显著,安全性好。     

利奈唑胺治疗广泛耐药结核病的临床疗效评价

目的评价利奈唑胺治疗广泛耐药结核病的临床疗效。方法我院收治的24例广泛耐药结核病患者,随机分为两组,对照组12人采用常规化疗,试验组12人加用利奈唑胺,比较不良反应和疗效。结果试验组试验组症状改善、病灶吸收、空洞闭合、抗酸染色涂片阴性、痰结核分枝杆菌阴性、痰定量PCR阴性例数均明显高于对照组,试验组不良反应发生率高于对照组,差异均有统计学意义（P〈0.05）,经对症治疗后均痊愈。结论利奈唑胺治疗广泛耐药结核病疗效显著。     

常规实验室检查对不明原因发热的诊断价值

目的 探讨6项常规实验室检查项目在不明原因发热(fever of unknown origin,FUO)诊断中的价值,为提高发热待查患者的确诊率提供参考.方法 回顾性分析我院2002年1月-2009年12月确诊的132例FUO患者入院时白细胞、中性粒细胞、淋巴细胞、红细胞沉降率、C-反应蛋白及免疫球蛋白(IgG、IgM...     

Nafamostat mesilate inhibits linezolid metabolism via its antioxidant effects

Patients who undergo renal replacement therapy often exhibit a high plasma linezolid concentration. Linezolid is metabolized via oxidation. Nafamostat mesilate has antioxidant effects and is frequently used as an anticoagulant during renal replacement therapy. We aimed to investigate the effect of nafamostat mesilate on plasma linezolid concentration. We examined whether the co‐administration of linezolid and nafamostat had any effect on plasma linezolid concentration. Mice were randomly allocated to two groups (n = 18/group): linezolid (100 mg kg^?1, subcutaneous injection) + nafamostat (30 mg kg^?1, intraperitoneal injection) and linezolid + saline. At 5 hours, the linezolid concentration was significantly higher in the linezolid + nafamostat co‐administration group than that in the linezolid + saline group (20.6 ± 9.8 vs 3.6 ± 1.2 μg/mL, respectively P < .001). The antioxidant effects of nafamostat may inhibit linezolid metabolism, resulting in the adverse event of high linezolid concentration if both are administered concurrently during renal replacement therapy.     

Efficacy and safety of linezolid in liver transplant patients

S. Radunz, B. Juntermanns, G.M. Kaiser, J. Treckmann, Z. Mathe, A. Paul, F.H. Saner. Efficacy and safety of linezolid in liver transplant patients
Transpl Infect Dis 2011: 13: 353–358. All rights reserved Abstract: Bacterial infections are the main cause of death within the first year after liver transplantation, and the increased incidence of multidrug‐resistant gram‐positive pathogens has created a major challenge in the treatment of these patients. Linezolid, the first US Food & Drug Administration‐approved oxazolidinone, offers a valuable novel treatment option for serious gram‐positive infections. Linezolid is relatively non‐toxic but prolonged treatment with linezolid was associated with thrombocytopenia. Here we report on the experience of linezolid treatment in adult liver transplant patients, who are at an increased risk for thrombocytopenia because of hypersplenism. From November 2003 until December 2009, we evaluated the clinical course of 46 liver transplant patients (27 male/19 female) in our surgical intensive care unit. For proven or probable gram‐positive infection, all patients received linezolid 600 mg intravenously every 12 h. On clinical improvement, treatment was changed to oral linezolid 600 mg twice daily. Treatment duration was 11 ± 7 days. Treatment indications were pneumonia (n=8), blood stream infection (n=30), and surgical site/abdominal infection (n=3). Clinical cure was achieved in 43 out of 46 patients. During the course of treatment, no cases of severe thrombocytopenia occurred and a statistically significant platelet count increase was seen from day 1 (110 ± 73/nL) to day 7 (165 ± 116/nL) and day 14 (180 ± 140/nL). We did not observe any further adverse events, especially no severe neurological complications (e.g., serotonin syndrome) or signs of lactate acidosis. Two patients died from uncontrolled vancomycin‐resistant Enterococcus faecium sepsis with septic shock and one due to uncontrolled methicillin‐resistant Staphylococcus aureus pneumonia. These deaths were considered to be unrelated to linezolid treatment, and linezolid was regarded as the optimal treatment choice in these patients. A subgroup analysis of patients treated for >14 days revealed no statistically significant differences when compared with patients on shorter treatment. In particular, no cases of thrombocytopenia occurred during longer treatment. In conclusion, linezolid is a safe and effective treatment for adult liver transplant patients with gram‐positive infections.     

High frequency of thrombocytopenia in patients with acute-on-chronic liver failure treated with linezolid

BACKGROUND:Linezolid is an effective antibiotic reagent for Gram-positive bacterial infection;its most common side effect is thrombocytopenia.However,the incidence of thrombocytopenia in patients with acute-on-chronic liver failure(ACLF)who underwent linezolid therapy was unclear.The present study was to evaluate the incidence of thrombocytopenia in ACLF and non-ACLF patients treated with linezolid and the risk factors of thrombocytopenia in these patients.METHODS:Thirty-five patients with ACLF who had been subjected to intravenous administration of 600 mg linezolid every 12 hours for more than 7 days were categorized as a ACLF treatment(ACLF-T)group,72 patients without ACLF treated with the same dosage of linezolid were recruited as a non-ACLF treatment(NACLF-T)group,and 70 patients with ACLF without linezolid treatment served as an ACLF control(ACLF-C)group.The incidences of thrombocytopenia in different groups were compared at day 14.Risk factors were investigated using logistic regression analysis.RESULTS:The incidence of thrombocytopenia at day 14 was significantly higher in the ACLF-T group than in the ACLF-C group(20/35 vs 24/70,P=0.025)and in the NACLF-T group(20/35 vs 9/72,P0.001).Multivariate analysis showed that the ratio of platelet count(day 7/day 0)1(OR=10.021;P=0.012) and the baseline platelet count(OR=0.985;P=0.036)were independent risk factors of thrombocytopenia at day 14 of linezolid therapy.CONCLUSIONS:The benefits of linezolid treatment should outweigh the risk of thrombocytopenia in patients with ACLF Moreover,it is necessary to closely monitor the platelet count during linezolid therapy especially in the patients with de creased platelet count at day 7 of linezolid therapy.     

Use of linezolid, an oxazolidinone, in the treatment of multidrug-resistant gram-positive bacterial infections.

We report our experience with linezolid in an investigation of its use against resistant gram-positive bacterial infections. Fifteen patients who had renal failure (n=6), recent liver transplantation (n=5) or surgery (n=6), cancer (n=3), endocarditis (n=2), or human immunodeficiency virus infection (n=1), along with infections due to vancomycin-resistant enterococcus (VRE), and 2 patients with infections due to methicillin-resistant Staphylococcus species who had adverse reactions to vancomycin were treated with linezolid (600 mg every 12 h for 5-42 days (mean+/-SD, 20.5+/-3.5 days). Abscess drainage or prosthetic device removal was undertaken. Microbiological cure occurred in all 10 patients who completed therapy, and all 7 patients alive at follow-up were free of infection. No deaths were attributable to the index infection. Adverse events associated with linezolid use were mild leukopenia in 1 patient and nausea in another. It appears that administration of linezolid, in conjunction with surgical intervention or device removal, is an effective treatment option for serious resistant gram-positive bacterial infections.     

248株肠球菌对抗菌药物的敏感性分析

目的了解全身感染和伤口分泌物感染的粪肠球菌、屎肠球菌对抗菌药物的敏感性,为临床提供治疗依据。方法采用微量稀释法对248株自临床送检的血液、尿液及其他标本分离的肠球菌进行药敏试验,测定其MIC值。结果248株肠球菌属中,粪肠球菌187株、屎肠球菌61株,两者的比例为3.06∶1。粪肠球菌对氨苄西林、环丙沙星、左氧氟沙星、青霉素G的敏感率为63.2%～99.1%,高于屎肠球菌的16.7%～31.9%;屎肠球菌对四环素的敏感率为40.3%,高于粪肠球菌的19.3%;2种肠球菌对红霉素的敏感率分别是13.9%和8.3%,对利奈唑烷和万古霉素的敏感性均＆gt;95%;分离自伤口分泌物的粪肠球菌对氨苄西林、环丙沙星、左氧氟沙星、青霉素G、四环素的敏感性略高于血液分离菌,分离自伤口分泌物的屎肠球菌对氨苄西林、红霉素、高浓度庆大霉素、青霉素G、四环素的敏感性低于血液分离菌,伤口分泌物和血液分离得到屎肠球菌对利奈唑烷均100.0%敏感。结论粪肠球菌、屎肠球菌对不同的抗菌药物的敏感性差异较大,治疗时应根据耐药特点及菌种间的耐药性差异选择相应的药物和方案,目前万古霉素和利奈唑烷仍然是治疗肠球菌属感染的有效药物。     

Successful treatment of pulmonary Nocardia farcinica infection with linezolid: case report and literature review

Nocardia infection is rare but potentially fatal. Therapy of Nocardia infection remains difficult. Linezolid, a novel oxazolidinone antibiotic, has proven to be effective, but clinical data are limited. Here we describe a case of a 45-year-old man with pulmonary N. farcinica infection following a liver transplantation. The initial therapy was trimethoprim-sulfamethoxazole, which showed no effect. According to susceptibility test, linezolid was administered with clearly improving the patient's condition. The treatment was stopped for anemia as drug related adverse event, and the therapy lasted for as long as 5 months. At the end of treatment clinical cure was confirmed and anemia reversed after discontinuation of linezolid. We also analyzed the clinical data of previously published reports by literature review, focusing on the efficacy and safety of linezolid treatment for Nocardia infection.