利奈唑胺治疗多重耐药革兰氏阳性菌所致人工瓣膜感染性心内膜炎
Treatment of prosthetic valve infective endocarditis due to multi-resistant Gram-positive bacteria with linezolid.
作者信息
Wareham D W, Abbas H, Karcher A M, Das S S
机构信息
Department of Medical Microbiology, Barts and The London NHS Trust, London E1 1BB, UK.
出版信息
J Infect. 2006 Apr;52(4):300-4. doi: 10.1016/j.jinf.2005.05.022. Epub 2005 Aug 15.
OBJECTIVES
Clinical experience with linezolid in the treatment of infective endocarditis either alone or in combination with other agents is limited. We describe our experience in the treatment of two patients with IE due to multi-resistant Gram-positive bacteria.
METHODS
One patient with MRSE and one with VRE endocarditis were treated with regimens containing linezolid. The killing kinetics of linezolid in combination with gentamicin or vancomycin against isolates of Staphylococcus epidermidis and Enterococcus faecalis were analysed in vitro.
RESULTS
Clinical response and eradication of bacteraemia was achieved with linezolid therapy in both patients. Time-kill curve studies showed that linezolid was bacteriostatic against the MRSE and VRE isolates used. Combination with gentamicin or vancomycin did not produce synergy or antagonism but at best only marginal additive effect.
CONCLUSIONS
Although bacteriostatic, linezolid provides an important therapeutic option in IE due to multi-resistant Gram-positive pathogens. It challenges the conventional wisdom that bactericidal synergy is required for the effective treatment of most cases of IE due to Gram-positive organisms.
目的
利奈唑胺单独或与其他药物联合治疗感染性心内膜炎的临床经验有限。我们描述了我们治疗两例由多重耐药革兰氏阳性菌引起的感染性心内膜炎患者的经验。
方法
1例耐甲氧西林表皮葡萄球菌（MRSE）和1例耐万古霉素肠球菌（VRE）心内膜炎患者接受了含利奈唑胺的治疗方案。体外分析了利奈唑胺与庆大霉素或万古霉素联合对表皮葡萄球菌和粪肠球菌分离株的杀菌动力学。
结果
两名患者接受利奈唑胺治疗后均获得临床缓解并清除菌血症。时间杀菌曲线研究表明，利奈唑胺对所使用的MRSE和VRE分离株具有抑菌作用。与庆大霉素或万古霉素联合使用未产生协同或拮抗作用，充其量仅产生微弱的相加作用。
结论
尽管利奈唑胺具有抑菌作用，但它为多重耐药革兰氏阳性病原体引起的感染性心内膜炎提供了重要的治疗选择。它挑战了传统观念，即大多数革兰氏阳性菌引起的感染性心内膜炎有效治疗需要杀菌协同作用。
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