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目的观察国产替考拉宁在重症监护病房(ICU)中治疗革兰阳性(G+)球菌重度感染的疗效和安全性。方法对收入ICU的60例诊断为重度革兰阳性菌感染患者,使用浙江省医药股份有限公司新昌制药厂生产的替考拉宁注射液,根据肌酐清除率调整用量,疗程为7~14 d;观察用药前和治疗结束后最高体温、APACHEⅡ评分、炎症反应指标、肝肾功能及微生物学检查、不良反应。结果60例患者分离到G+球菌72株,其中耐甲氧西林金黄色葡萄球菌(MRSA)占58.33%,耐甲氧西林表皮葡萄球菌(MRSE)8.33%,屎肠球菌16.67%,粪肠球菌5.56%,溶血葡萄球菌8.33%,醇鸡肠球菌2.78%;经替考拉宁治疗,59株清除,有13株未清除,细菌学清除率(按菌株计)为81.94%;患者痊愈28例,显效22例,临床总有效率83.33%;不良反应发生率低,表现为血小板数量轻微增减,且不需要临床治疗干预。结论国产替考拉宁治疗重度G+球菌感染疗效确凿,安全性高,尤其对于ICU伴有器官功能损害的脓毒症患者,如临床高度怀疑耐甲氧西林葡萄球菌或肠球菌感染时,可考虑初始经验性使用。
Objective To observe the efficacy and safety of domestic teicoplanin in the intensive care unit (ICU) for the treatment of severe Gram-positive (G +) infections. Methods Sixty ICU patients diagnosed as severe Gram-positive bacterial infections were treated with teicoplanin injection produced by Xinchang Pharmaceutical Factory of Zhejiang Pharmaceutical Co., Ltd. according to the creatinine clearance rate. The course of treatment was 7 to 14 days. Observed before treatment and after treatment, the highest body temperature, APACHE Ⅱ score, inflammatory response indicators, liver and kidney function and microbiological tests, adverse reactions. Results 72 strains of G + cocci were isolated from 60 patients, of which 58.33% were resistant to methicillin-resistant Staphylococcus aureus (MRSA), 8.33% were resistant to methicillin-resistant Staphylococcus epidermidis (MRSE), 16.67% were Enterococcus faecium, 5.56 %, Staphylococcus haemolyticus 8.33%, Enterococcus faecalis 2.78%; After teicoplanin treatment, 59 were cleared, 13 were not cleared, bacteriological clearance rate (strain) was 81.94%; 28 patients were cured, 22 cases markedly effective, the total effective rate of 83.33%; low incidence of adverse reactions, showed a slight increase or decrease in the number of platelets, and does not require clinical intervention. Conclusion Domestic teicoplanin treatment of severe G + cocci infection is effective and safe, especially for sepsis patients with ICU organ dysfunction, such as clinical suspicion of methicillin-resistant Staphylococcus aureus or enterococci infection, consider Initial empirical use.