张成汉

摘要：目的  对比夫西地酸钠和万古霉素用于ICU病房耐甲氧西林金黄色葡萄球菌（MRSA）患者中的临床效果。方法  选取我院2018年3月～12月收治的ICU病房MRSA患者42例，随机分为参照组和研究组，各21例。参照组给予万古霉素治疗，研究组给予夫西地酸钠治疗，比较两组患者的治疗效果及细菌清除率。结果  参照组与研究组的治疗总有效率分别为90.48%、85.71%，差异无统计学意义（P>0.05）。参照组与研究组的细菌清除分别为95.24%、90.48%，差异无统计学意义（P>0.05）。结论  应用夫西地酸钠对ICU病房MRSA患者进行治疗，获得了与万古霉素治疗效果相当的结果，两者细菌清除率也比较接近，因此对此类患者治疗过程中可应用夫西地酸钠作为替代药物。

关键词：夫西地酸钠;万古霉素;ICU病房;耐甲氧西林;金黄色葡萄球菌

中图分类号：R459.7                                  文献标识码：A                                DOI：10.3969/j.issn.1006-1959.2019.18.051

文章编号：1006-1959（2019）18-0149-02

Abstract：Objective  To compare the clinical effects of sodium fusidate and vancomycin in patients with methicillin-resistant Staphylococcus aureus （MRSA） in the ICU ward. Methods  42 patients with ICU wards MRSA admitted to our hospital from March to December 2018 were randomly divided into reference group and study group， 21 cases each. The reference group was treated with vancomycin， and the study group was treated with sodium fusidate. The treatment effect and bacterial clearance rate of the two groups were compared. Results  The total effective rate of the reference group and the study group was 90.48% and 85.71%， respectively，the difference was not statistically significant （P>0.05）. The bacterial clearance of the reference group and the study group were 95.24% and 90.48%， respectively，the difference was not statistically significant （P>0.05）. Conclusion  The treatment of MRSA patients in ICU ward with sodium fusidate has achieved comparable results with vancomycin. The bacterial clearance rate is similar. Therefore， fusidic acid can be applied to the treatment of such patients. Sodium is used as an alternative medicine.

Key words：Sodium citrate;Vancomycin;ICU ward;Methicillin-resistant;Staphylococcus aureus

金黄色葡萄球菌（vancomycin-resistant staphylococcus aureus，VRSA）是革兰氏阳性病原菌中最主要的一种，也是最为常见的病原菌。因大量使用新型广谱抗生素，目前感染最为突出的菌种是耐甲氧西林金黄色葡萄球菌（methicillin-resistant staphylococcus aureus，MRSA）。因MRSA的MecA基因表达和PBP变异，耐受全部的β-内酰胺类抗生素，同时耐受喹诺酮类以及氨基糖苷类多种药物，仅仅对万古霉素敏感[1]。但随着万古霉素的大量使用，已经出现VRSA对其耐药。因此，为了预防出现无药针对MRSA治疗的局面，需要积极开发其他药物的治疗方案。夫西地酸钠这种抗生素机理迥异，对MRSA有效且能够穿透血-脑脊液屏障，本院应用此药进行相应治疗后取得了较为理想的应用效果，现报道如下。