【摘要】 目的通过探讨肠道非急性感染期反复粪便培养金黄色葡萄球菌阳性的老年患者口服万古霉素的效果,为此类患者提供一种潜在的治疗方案。方法前瞻性分析吉林大学第一医院干部病房2015年9月～2018年12月收治的186例肠道非急性感染期反复粪便培养金黄色葡萄球菌阳性的老年患者。根据是否口服万古霉素治疗分为万古组和对照组。收集两组患者的一般临床资料,比较两组患者试验前后万古霉素血药浓度、血常规、降钙素原(PCT)、C反应蛋白(CRP),试验期间粪便培养结果、体温、抗生素使用情况。结果试验治疗期间,万古组便培养转阴率高于对照组,差异有统计学意义(P<0.05);万古组发热率(29.75%)低于对照组的34.77%,差异有高度统计学意义(P<0.01);万古组抗生素使用率(4.49%)低于对照组的19.23%,差异有高度统计学意义(P<0.01)。试验前两组白细胞、中性粒细胞计数、中性粒细胞比例、PCT、CRP比较,差异无统计学意义(P>0.05);试验后万古组白细胞、中性粒细胞计数、中性粒细胞比例、CRP低于对照组,差异有高度统计学意义(P<0.01)。试验后万古组白细胞、中性粒细胞计数、中性粒细胞比例、CRP低于试验前,差异有高度统计学意义(P<0.01)。结论口服万古霉素可能提高肠道非急性感染期反复粪便培养金黄色葡萄球菌阳性的老年患者粪便转阴率,减少发热及抗生素的应用,降低炎症细胞水平,可能是此类患者一种潜在的临床治疗方案。更多还原

【Abstract】 Objective To investigate the effect of oral vancomycin in elderly patients with repeated positive fecal cultures of Staphylococcus aureus during non-acute infection of the intestinal tract, and to provide a potential treatment plan for such patients. Methods A total of 186 elderly patients with repeated positive fecal culture of Staphylococcus aureus in non-acute intestinal infection in the cadre ward in the First Hospital of Jilin University from September 2015 to December 2018 were prospectively analyzed. According to whether or not vancomycin was administered orally, they were divided into the vancomycin group and the control group. The general clinical data, blood concentration of vancomycin, blood routine, procalcitonin(PCT), C-reactive protein(CRP) before and after the test, and fecal culture results,body temperature, and antibiotic use during the test were collected and compared between the two groups. Results During the experimental treatment period, the fecal negative rate of the vancomycin group was higher than that of the control group, and the difference was statistically significant(P<0.05). The fever rate of vancomycin group(29.75%)was lower than 34.77% of the control group, and the difference was statistically significant(P<0.01). The percentage of antibiotics use in the vancomycin group(4.49%) was lower than 19.23% of the control group, and the difference was statistically significant(P<0.01). There were no significant differences in the white blood cells, neutrophil counts, neutrophil ratio, PCT, and CRP between the two groups before the test(P>0.05). After the test, the white blood cells, neutrophil counts, neutrophil ratio and CRP of the vancomycin group were lower than those of the control group, and the differences were statistically significant(P<0.01). After the test, the white blood cell and neutrophil counts, the proportion of neutrophils, and the CRP of the vancomycin group were lower than those before the test, and the differences were statistically significant(P<0.01). Conclusion Oral vancomycin may increase the fecal negative rate of elderly patients with repeated positive fecal culture of Staphylococcus aureus during non-acute infection of the intestinal tract, reduce fever and antibiotics,and reduce inflammatory cell levels, which may be a potential clinical treatment options.更多还原