The Clinical Application Of Linezolid In Severe Intra-abdominal Infection

BackgroundIntra-abdominal infection(IAI)is the second most common infectious disease among ICU patients,it is divided into mild-moderate and severe intra-abdominal infection(SIAI)according to the severity.It is often accompanied with sepsis,septic shock,abdominal compartment syndrome(ACS)and multiple organ dysfunction(MODS),which is difficult to treat,and its mortality rate can be as high as 20%.SIAI is mostly a mixed infection,Escherichia coli is the main gram-negative(G~-)bacteria;and Enterococcus is the main gram-positive(G~+)bacteria,which is highly sensitive to vancomycin,teicoplanin,tigecycline and linezolid(LZD).LZD has a small molecular weight(337.35 Daltons),it can penetrate into the tissues easily to achieve effective inhibitory concentration because of the strong tissue penetration,and less impact on liver and kidney function.Therefore,LZD should be beneficial to the treatment of IAI because of its pharmacological characteristics.But there is no indication for IAI in LZD instructions right now,and the guidelines only recommend that LZD can be used to treat SIAI in MRSA infections,but not as a first-line anti-G~+bacteria option.In addition,SIAI patients are often associated with thrombocytopenia due to sepsis,and the LZD instructions indicate that it has the side effects of bone marrow suppression in individual patients(including leukopenia,pancytopenia and thrombocytopenia).In view of the above three reasons,many clinicians have safety concerns about using LZD in SIAI treatment.ObjectiveTo evaluate the effectiveness,safety and prognosis of LZD in the treatment of SIAI.Method2014.01.01-2020.01.01,A total of 208 IAI patients were admitted to the ICU of the Second Affiliated Hospital of Fujian Medical University for 6 years.Among them,58adult patients with SIAI who used anti-G~+bacteria drugs for more than 7 days were selected as the research objects.On the basis of infection source control(such as surgery,incision and drainage,puncture and drainage),all patients were routinely given imipenem/cilastatin or meropenem for anti-G~-bacterial treatment,and rehydration and norepinephrine Boost(if necessary)and other treatments were given.All patients were divided into A group(LZD group,28 cases)and B group(non-LZD group,used Vancomycin 5 cases/Teicoplanin 1 case/Tigecycline 24 cases,30 cases)according to whether LZD was used or not.Then we evaluated the effectiveness of LZD in the treatment of SIAI by analyzing the changes in white blood cell(WBC)and procalcitonin(PCT)of patients in groups A and B,evaluated the safety of LZD by analyzing the changes in PLT,creatinine(CREA),prothrombin time(PT),activated partial thromboplastin time(APTT),plasma fibrinogen(Fib),D-Dimer(DDi),and evaluated the prognosis by analyzing the length of hospital stay,length of ICU stay and the clinical improvement rate.Among the 58 SIAI patients treated with Anti-G~+bacteria drugs,16 patients had thrombocytopenia.Then 16 patients were divided into C group(thrombocytopenia treated with LZD group,6 cases)and D group(thrombocytopenia treated without LZD group,10 cases)according to whether LZD was used or not.Then we evaluated the safety of LZD by analyzing the changes in PLT of patients in groups C and D.Among the 58 SIAI patients,42 patients had normal PLT.Then 42 patients were divided into E group(normal PLT treated with LZD group,22 cases)and F group(normal PLT treated without LZD group,20 cases)according to whether LZD was used or not.Then we evaluated the safety of LZD by analyzing the changes in PLT of patients in groups E and F.Results(1)The decrease in WBC in group A was significantly lower than that in group B on the15th day after anti-G~+bacteria treatment(9.35±3.57 VS 13.46±6.62,P<0.05).(2)The PCT of group A was significantly lower than that of group B on the 11th day(1.43±1.25 VS 4.69±3.39,P<0.05)and 15th day(3.38±0.23 VS 10.92±17.89,P<0.05).(3)There was no significant difference in the changes of PLT,PT,Fib,DDi between group A and group B,but the decrease of APTT of group A was significantly lower than that of group B(37.29±8.71 VS 51.25±15.96,P<0.05)after the 13th day.(4)The changes of CREA in group A were statistically different from those in group B on the second,third,and sixth day of treatment with anti-G~+bacteria.(5)There was no statistical difference in the changes of PLT between group C and group D(P>0.05).(6)There was no significant difference in PLT changes between group E and group F(P>0.05).(7)The clinical improvement rate of group A was better than that of group B(75%VS 60%,P<0.05).ConclusionIn the anti-infective treatment of SIAI,LZD has good anti-infective effect,higher safety,and it can improve the prognosis,which is worthy of clinical promotion.