Sander A, Beiderlinden M, Schmid E N, Peters J
Abteilung für Anästhesiologie und Intensivmedizin, Evangelisches und Johanniter Klinikum, Fahrner Strasse 133-135, 47169 Duisburg, Germany.
Intensive Care Med. 2002 Aug;28(8):1157-60. doi: 10.1007/s00134-002-1358-7. Epub 2002 Jun 20.
To describe the efficacy and safety of quinupristin-dalfopristin (Q-D) as rescue therapy in critically ill patients with severe infections caused by methicillin-resistant staphylococci unresponsive to vancomycin treatment.
Observational study in the context of the compassionate use programme for Q-D.
Twelve mechanically ventilated patients suffering from severe staphylococcal infections, pretreated unsuccessfully with vancomycin despite in vitro sensitivity, were included. Patients received, intravenously, Q-D 7.5 mg/kg body weight 3 times daily. The duration of Q-D therapy averaged 11.8 days (range: 1-26 days). The outcome variables were clinical efficacy and bacteriological eradication.
Methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus epidermidis (MRSE) were isolated in three patients each, and both bacteria were isolated from six patients. Eradication of pathogen(s) was achieved in 7 of 12 patients (66%). Five patients (42%) died due to severe co-morbidity. Adverse events related to Q-D were not observed and neither renal nor liver function was adversely affected.
Quinupristin-dalfopristin appears to be an efficient and safe antimicrobial drug for the rescue treatment of staphylococcal infections in critically ill patients. It may be considered as a treatment option in cases of vancomycin treatment failure.
描述奎奴普丁-达福普汀（Q-D）作为挽救疗法用于对万古霉素治疗无反应的耐甲氧西林葡萄球菌引起的严重感染的重症患者的疗效和安全性。
在Q-D同情用药计划背景下的观察性研究。
纳入12例机械通气的严重葡萄球菌感染患者，尽管体外药敏显示敏感，但万古霉素预处理无效。患者静脉给予Q-D 7.5mg/kg体重，每日3次。Q-D治疗持续时间平均为11.8天（范围：1-26天）。观察指标为临床疗效和细菌清除情况。
12例患者中，3例分离出耐甲氧西林金黄色葡萄球菌（MRSA），3例分离出表皮葡萄球菌（MRSE），6例同时分离出这两种细菌。12例患者中有7例（66%）病原体被清除。5例患者（42%）因严重合并症死亡。未观察到与Q-D相关的不良事件，肾功能和肝功能均未受到不利影响。
奎奴普丁-达福普汀似乎是一种有效且安全的抗菌药物，可用于重症患者葡萄球菌感染的挽救治疗。在万古霉素治疗失败的情况下，可将其视为一种治疗选择。
