Taşbakan Mehmet Sezai, Korkmaz Ekren Pervin, Pullukçu Hüsnü, Başarık Burcu, Susur Alev, Aydemir Söhret, Başoğlu Ozen Kaçmaz, Bacakoğlu Feza
Ege Üniversitesi Tıp Fakültesi, Göğüs Hastalıkları Anabilim Dalı, İzmir, Türkiye.
Mikrobiyol Bul. 2010 Jul;44(3):357-66.
Methicillin-resistant Staphylococcus aureus (MRSA) is one of the high-risk and potential multi-drug resistant microorganisms that leads to infection in intensive care unit (ICU). Although standard antibiotics used for its treatment are glycopeptides, linezolid is considered as an alternative treatment especially in hospital-acquired pneumonia (HAP). The aim of this retrospective study was to compare the results of linezolid and teicoplanin treatments in patients with MRSA isolated from their respiratory samples in ICU. In our respiratory ICU, 41 consecutive patients (28 males, mean age 66.0 ± 16.0 years) diagnosed as HAP due to MRSA were included in the study. Teicoplanin was used in 22 patients and linezolid treatment was given to 19 patients. In the linezolid group, mean age and Acute Physiology Assessment and Chronic Health Evaluation (APACHE) II score were found higher (68.9 ± 12.5 vs. 63.5 ± 18.5 and 25.7 ± 6.4 vs. 23.2 ± 4.9, respectively), and PaO2/FiO2 ratio was lower (176.4 ± 58.2 vs. 191.6 ± 91.3) however, the differences between the two groups were not statistically significant. There was no difference between the two groups in terms of hospitalization indications, co-morbid diseases, other baseline findings and risk factors for development of HAP caused by MRSA. Invasive mechanical ventilation was applied to 86.4% of the patients in teicoplanin group and 84.2% in linezolid group (p> 0.05). The rates of bacteremia were found as 22.7% and 31.6% in teicoplanin and linezolid groups, respectively (p>0.05). Bacteriological eradication was achieved in all patients given linezolid, whereas this rate was 72.7% in patients on teicoplanin therapy (p= 0.048). There was no difference with regards to durations of ICU and hospital stay between the two groups. The mortality rate was found lower in the linezolid group than the teicoplanin group (42.1% vs. 63.6%), however this difference was not found statistically important (p> 0.05). In conclusion; the present study demonstrated that better microbiological eradication was achieved by linezolid therapy in pneumonia caused by MRSA in ICU, however, the clinical efficacy and survival rates were similar to teicoplanin therapy.
耐甲氧西林金黄色葡萄球菌（MRSA）是导致重症监护病房（ICU）感染的高风险且具有潜在多重耐药性的微生物之一。尽管用于治疗MRSA的标准抗生素是糖肽类，但利奈唑胺被认为是一种替代治疗药物，尤其是在医院获得性肺炎（HAP）的治疗中。这项回顾性研究的目的是比较利奈唑胺和替考拉宁对ICU中从呼吸道样本分离出MRSA的患者的治疗效果。在我们的呼吸ICU中，41例连续诊断为因MRSA导致HAP的患者（28例男性，平均年龄66.0±16.0岁）被纳入研究。22例患者使用替考拉宁，19例患者接受利奈唑胺治疗。在利奈唑胺组中，平均年龄和急性生理与慢性健康状况评估（APACHE）II评分较高（分别为68.9±12.5 vs. 63.5±18.5和25.7±6.4 vs. 23.2±4.9），而氧合指数（PaO2/FiO2）较低（176.4±58.2 vs. 191.6±91.3），然而，两组之间的差异无统计学意义。两组在住院指征、合并疾病、其他基线检查结果以及MRSA引起HAP的危险因素方面无差异。替考拉宁组86.4%的患者和利奈唑胺组84.2%的患者接受了有创机械通气（p>0.05）。替考拉宁组和利奈唑胺组的菌血症发生率分别为22.7%和31.6%（p>。05）。所有接受利奈唑胺治疗的患者均实现了细菌学清除，而替考拉宁治疗患者的这一比例为72.7%（p=0.048）。两组在ICU住院时间和住院时间方面无差异。利奈唑胺组的死亡率低于替考拉宁组（42.1% vs. 63.6%），然而，这一差异无统计学意义（p>0.05）。总之，本研究表明，利奈唑胺治疗对ICU中由MRSA引起的肺炎能实现更好的微生物学清除，然而，其临床疗效和生存率与替考拉宁治疗相似。
