【进展】对于MRSA VAP患者而言，利奈唑胺的效果似乎优于万古霉素

蓝鱼o_0

在ATSIC会议上（American Thoracic Society International Conference）
Shorr AF。报道了他们研究团队的结果。【Andrew F. Shorr, MD, MPH, associate director of pulmonary and critical care medicine at the Washington Hospital Center in Washington, D.C. 】

他们发现,从临床微生物培养的角度，对于MRSA VAP的患者，对于与万古霉素，应用利奈唑胺有更好的临床预后。
在治疗组，利奈唑胺可以更好的临床成功率（对比与万古霉素）。

主要比较指标：clinical success rate ，临床成功率。

Linezolid was associated with better outcomes in patients with methicillin-resistant Staphylococcus aureus ventilator-associated pneumonia vs. those assigned vancomycin, according to new findings presented at the American Thoracic Society International Conference.
“At the end of the treatment period, linezolid offered statistically significant higher rates of clinical and microbiologic success in patients with MRSA ventilator-associated pneumonia (VAP) than weight-based vancomycin dosing, suggesting that in severely ill patients with MRSA VAP, linezolid performs well and is well tolerated,”


Shorr and colleagues randomly assigned 286 patients included in a larger clinical trial that assessed MRSA nosocomial pneumonia to twice-daily 15 mg vancomycin (n=147) or twice-daily 600 mg linezolid (n=139). Researchers defined VAP as clinical signs and symptoms of pneumonia and/or evolving X-ray results among those who underwent at least 2 days of mechanical ventilation.
Clinical and microbiologic successes were also measured at the end of treatment (approximately 10 days after enrollment) and at study end (approximately 28 days after enrollment.) （在进入研究的10天和28天分别进行临床微生物的培养检验）
At follow-up, researchers observed a clinical success rate of 78.6% among those assigned linezolid compared with 65.9% among those assigned vancomycin. （经过随访，研究者发现，利奈唑胺的临床成功率要高于万古霉素：78.6% vs. 65.9%)

Moreover, treatment with linezolid was associated with a clinical success rate of 52.1% vs. 43.4% with vancomycin. Microbiological success rates were 76.6% with linezolid vs. 57.7% with vancomycin by the end of treatment; and 56.2% with linezolid vs. 47.1% with vancomycin at study end.
Similar adverse events and mortality rates were observed for both treatment arms.
“Cure rates at the time of finishing treatment were higher in persons treated with linezolid as opposed to vancomycin,” Shorr said. “The difference in cure rates still favored linezolid at the end of the study, but the difference was not statistically significant. There was no difference in mortality between the two treatments and both appeared well tolerated. Our data also suggest that we remain uncertain how to optimally dose vancomycin for pneumonia.”

【Disclosure】 Dr. Shorr reports no relevant financial disclosures.

文章在最后总结了，治愈率在两组之间无差别，随访发现死亡率也无显著性水准。所以目前还不能说明利奈唑胺的效果一定优于万古霉素。
可能需要进一步的临床验证。

注：这篇文章仅仅是会议交流，没有通过peer-review,所以也只有一定的参考价值，还不能作为临床偱证指南。

男丁格尔

感谢蓝鱼，总能给我这样的学习的机会，真是很好的文章，谢谢！

蓝鱼o_0

回复 2# majiarui

小马哥，您太客气啦！新闻速递，看看无妨。

toto

回复 1# 蓝鱼o_0

仔细读下来，我没看出主要比较指标：clinical success rate到底是个什么样的指标,用什么来体现？是因为文摘不全？？？还是我自己理解失误？？！！望指教！

星火

回复 1# 蓝鱼o_0


    题目对于结论，可能有误导？应说明二者PK/PD在肺组织的对比，或研究数据等。

蓝鱼o_0

回复 4# toto


非常抱歉，看不到全文。所以他这个success rate的definition没法了解。

我一开始以为是我相关知识不够，原来临床的人也是一头雾水。呵呵

toto

回复 6# 蓝鱼o_0


    怪不得没有通过peer-review呢，呵呵！

蓝鱼o_0

回复 5# zhangfh(星火）


这个是则新闻，他们的研究团队报道了他们的研究结果。
由于在会议上进行报道，所以我看不到全文。
说实在话，对于文中success rate我也有点疑虑。是否是对于MRSA清除？我翻译的理由是这样的：
“因为他在最后也说明了，和万古霉素对比，治愈率和病人随访死亡率均无显著性差别”

他是通过两个治疗周期的微生物培养进行评价。所以在文中我进行了“直译”。
您和巴老师是这方面的专家，不知道您们对此的理解如何？

会关注这一方面研究，如果PUBMED有杂志报道，会及时黏贴相关信息。

蓝鱼o_0

回复 7# toto

是啊，也看不到他的研究设计。所以他用了个"uncertain"这个字眼，呵呵。比较谨慎