Sirvent Josep-Maria, Piñeiro Laura, de la Torre Mari, Motjé Montse, de Batlle Jordi, Bonet Alfons
Servicio de Medicina Intensiva (UCI), Hospital Universitari de Girona Doctor Josep Trueta, Avda. França, s/ n, 17007 Girona, Spain.
Rev Esp Quimioter. 2010 Mar;23(1):27-35.
A prospective and observational study has been conducted to analyze the efficacious of linezolid compared to vancomycin to eradicate the infecting organism in critically ill patients with Gram-positive infections.
Prospective, observational and non-controlled study in a medical-surgical intensive care unit (ICU) in a university hospital. A total number of 53 critically ill patients with therapy to proven Gram-positive bacterial infection were studied. Infected patients were diagnosed and treated according to international guidelines, following standard protocol for the critically ill infected patients. Microbiologic eradication of the infecting organism at the seventh day of treatment and patients' clinical outcome were analysed.
Twenty-seventh patients received linezolid and twenty-six received vancomycin. Infection-site diagnoses were: hospital-acquired pneumonia (21 cases: 39.6%), complicated surgical-site infection (19 cases: 35.8%) and catheter-related bacteraemia (13 cases: 24.5%). The most important isolated microorganism was methicillin-resistant Staphylococcus aureus (MRSA) (28 cases: 52.8%). Clinical success was 20/ 27 (74.1%) in the linezolid group and 16/ 26 (61.5 %) in the vancomycin group, with p = 0.3. The adjusted logistic regression model demonstrated that the treatment with linezolid is associated to microbiologic eradication of the infecting organism at the seventh day of treatment [OR = 7.88 (95% CI 1.86-33.52)] and p = 0.005. In this model, the length of hospital stay was lower in the group with microbiologic eradication at the seventh day (p = 0.015). Drug-related adverse events were comparable in both groups of treatment.
Treatment with linezolid in critically ill patients with Gram-positive infections was equivalent to vancomycin in terms of efficacy and safety, but linezolid was associated to a higher rate of microbiologic eradication of the infecting organism at the seventh day of treatment.
开展一项前瞻性观察性研究，以分析利奈唑胺与万古霉素相比，在根除革兰氏阳性感染重症患者体内感染病原体方面的疗效。
在一所大学医院的内科-外科重症监护病房（ICU）进行前瞻性、观察性且非对照研究。共研究了53例确诊接受革兰氏阳性细菌感染治疗的重症患者。感染患者依据国际指南进行诊断和治疗，遵循重症感染患者的标准方案。分析治疗第7天时感染病原体的微生物学清除情况以及患者的临床结局。
27例患者接受利奈唑胺治疗，26例接受万古霉素治疗。感染部位诊断结果为：医院获得性肺炎（21例：39.6%）、复杂手术部位感染（19例：35.8%）以及导管相关菌血症（13例：24.5%）。分离出的最重要微生物是耐甲氧西林金黄色葡萄球菌（MRSA）（28例：52.8%）。利奈唑胺组的临床成功率为20/27（74.1%），万古霉素组为16/26（61.5%），p = 0.3。校正后的逻辑回归模型表明，利奈唑胺治疗与治疗第7天时感染病原体的微生物学清除相关[比值比（OR）= 7.88（95%置信区间1.86 - 33.52）]，p = 0.005。在此模型中，治疗第7天微生物学清除组的住院时间较短（p = 0.015）。两组治疗中与药物相关的不良事件相当。
在革兰氏阳性感染重症患者中，利奈唑胺治疗在疗效和安全性方面与万古霉素相当，但利奈唑胺与治疗第7天时感染病原体的微生物学清除率较高相关。
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