宋斐　王素宁

[摘要] 目的 评价利奈唑胺与万古霉素在治疗重症感染方面的疗效。 方法 筛选2020年2—5月入住ICU的确诊或高度怀疑革兰阳性球菌感染患者共19例，随机分为利奈唑胺组及万古霉素组，分别给予常规剂量治疗，比较两组炎症指标、临床疗效及不良反应。 结果 治疗后，利奈唑胺组相对于万古霉素组在白细胞、降钙素原、C反应蛋白、白介素-6变化的差异无统计学意义，利奈唑胺组临床显效率为55.56%，万古霉素组为60.00%，组间比较差异无统计学意义，两组不良反应发生率比较，差异无统计学意义。 结论 利奈唑胺对革兰阳性球菌重症感染的疗效与万古霉素无明显差异，临床疗效肯定。

[关键词] 利奈唑胺;万古霉素;革兰阳性球菌;重症感染

[中图分类号] R978.16          [文献标识码] B          [文章编号] 1673-9701（2021）11-0096-04

R515 evaluation on the efficacy of linezolid versus vancomycin in the treatment of severe infections

SONG Fei  WANG Suning

Department of Critical Care Medicine， the First Affiliated Hospital of Guangzhou Pharmaceutical University， Guangzhou   510080， China

[Abstract] Objective To evaluate the efficacy of linezolid and vancomycin in the treatment of severe infections. Methods A total of 19 patients with confirmed or highly suspected Gram-positive cocci infection who were admitted to the ICU from February 2020 to May 2020 were screened. They were randomly divided into linezolid group and vancomycin group， and were given conventional doses of treatment. The inflammation indicators， clinical efficacy and adverse reactions were compared between the two groups. Results After treatment， there was no statistically significant difference in the changes of leukocytes， procalcitonin， C-reactive protein， and interleukin-6 in the linezolid group compared with the vancomycin group. The clinically significant rate in the linezolid group was 55.56% and that in the vancomycin group was 60.00%. There was no statistically significant difference between the groups. The incidence rate of adverse reactions between the two groups was poor and the difference was not statistically significant. Conclusion The curative effect of linezolid on severe Gram-positive cocci infections is not significantly different from that of vancomycin， and the clinical curative effect is positive.

[Key words] Linezolid; Vancomycin; Gram-positive cocci; Severe infections

不論是社区获得性还是医院获得性感染革兰阳性球菌都是目前非常常见的致病菌[1-3]。其中金黄色葡萄球菌是最常见的革兰阳性球菌，也是医院获得性肺炎的常见致病菌，占医院获得性感染监测研究中所分离出致病菌中的17%[4]，而在分离的金黄色葡萄球菌中，尤其在重症患者中，耐药菌株日渐增多，耐甲氧西林金黄色葡萄球菌（MRSA）的检出率为57.5%，耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）的检出率为83.7%，此外，另一种常见的阳性球菌致病菌—肠球菌的耐药率也逐渐增高[5]。由耐药菌所导致的感染大大增加了病死率且增加了医疗资源的使用及治疗费用[6-8]，故迫切需要我们积极寻找应对方式。

万古霉素一直是治疗重症革兰阳性球菌感染患者的一线药物，但近年来，越来越多的研究报道了对万古霉素中介或耐药的金黄色葡萄球菌、肠球菌[9-10]。……