万古霉素与利奈唑胺治疗神经外科术后颅内感染的疗效、安全性及经济性对比分析-中国药房

万古霉素与利奈唑胺治疗神经外科术后颅内感染的疗效、安全性及经济性对比分析

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篇名：	万古霉素与利奈唑胺治疗神经外科术后颅内感染的疗效、安全性及经济性对比分析
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摘要：	目的：比较万古霉素与利奈唑胺治疗神经外科术后颅内感染的疗效、安全性和经济性。方法：通过病历查询系统收集空军军医大学西京医院2015年1月－2017年11月52例神经外科术后颅内感染使用万古霉素（31例）或利奈唑胺（21例）抗感染治疗的患者的病历资料，比较两组患者病原菌培养情况、临床疗效以及治疗前后脑脊液检测指标，记录两组患者不良反应发生情况，并比较抗菌药物治疗总有效患者的治疗时间和抗菌药物总费用。结果：共20例患者脑脊液细菌培养呈阳性，细菌培养阳性率为38.46％（20/52），且两组细菌培养阳性率和总有效率比较，差异均无统计学意义（P＞0.05）。除去治疗无效的患者，两组总有效患者治疗后脑脊液中白细胞计数、红细胞计数、中性粒细胞百分比、蛋白质含量显著低于治疗前，而葡萄糖含量显著高于治疗前，差异均有统计学意义（P＜0.05）；两组患者治疗后上述指标比较，差异均无统计学意义（P＞0.05）。两组患者使用抗菌药物治疗时间和不良反应发生率比较，差异均无统计学意义（P＞0.05）；而万古霉素组的抗菌药物总费用显著低于利奈唑胺组，差异有统计学意义（P＜0.05）。结论：万古霉素治疗神经外科术后革兰氏阳性菌所致颅内感染的有效性、安全性与利奈唑胺相当，经济性优于利奈唑胺；患者若无明显肝肾功能不全、过敏等情况，万古霉素应作为首选治疗药物。
ABSTRACT：	OBJECTIVE： To compare the clinical efficacy， safety and economy of vancomycin and linezolid in the treatment of intracranial infections after neurosurgery operation. METHODS： Clinical data of 53 patients with intracranial infections receiving vancomycin （32 cases） and linezolid （21 cases） after neurosurgery from Jan. 2015 to Nov. 2017 were collected from medical record inquiry system of Xijing Hospital of Air Force Medical University. Pathogen detection， clinical efficacy and cerebrospinal fluid indexes were compared between 2 groups before and after treatment. The occurrence of ADR was observed in 2 groups， and treatment duration of total effective patients and total cost of antibiotics was compared. RESULTS： The bacterial culture of cerebrospinal fluid was positive in 20 patients， with positive rate of 38.46％（20/52）. There was no statistical significance in pathogen positive rates and total effective rates between 2 groups （P＞0.05）. White blood cell count， red blood cell count， neutrophil percentage and the contents of protein in cerebrospinal fluid of 2 groups were lower than before treatment， while the contents of glucose were higher than before treatment， with statistical significance （P＜0.05）， besides patients with therapy failure. But there was no statistical significance in these indexes between 2 groups after treatment （P＞0.05）. There was no statistical significance in duration of antibiotics use and incidence of ADR between 2 groups （P＞0.05）. The total cost of antibiotics in vancomycin group was significantly lower than linezolid group， with statistical significance （P＜0.05）. CONCLUSIONS： The effectiveness and safety of vancomycin are similar to linezolid in the treatment of Gram-positive bacterial intracranial infection after neurosurgery. Vancomycin is superior to linezolid in terms of economy. If patients do not have obvious liver or kidney insufficiency， or allergies， etc.，vancomycin should still be the first choice for treatment.
期刊：	2018年第29卷第10期
作者：	杨洁，陈晴，王磊，王婧雯，党欢，张维
AUTHORS：	YANG Jie，CHEN Qing，WANG Lei，WANG Jingwen，DANG Huan，ZHANG Wei
关键字：	颅内感染；万古霉素；利奈唑胺；革兰氏阳性菌；疗效；安全性；经济性
KEYWORDS：	Intracranial infection； Vancomycin； Linezolid； Gram-positive bacteria； Clinical efficacy； Safety； Economy
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