| Objective Through a single center retrospective study,we explored the relationship between the efficacy,adverse reactions with the plasma concentration of linezolid,and studied the risk factors for the deviation of linezolid concentration.Methods The patients who were treated with linezolid in our hospital from January 2018 to December 2019 and whose concentrations were detected were analyzed retrospectively.Cure,effect and progress were regarded as valid,and the reduction of platelet and hemoglobin counts by 25% compared with the baseline value after medication was regarded as thrombocytopenia and anemia.The "determined" and "probable" adverse reactions were classified as the adverse reactions related to linezolid using the Naranjo’s evaluation method.The clearance rate of pathogenic bacteria,adverse reactions and linezolid concentration were analyzed.The concentration of linezolid exceeds the recommended range(2-8mg/L)was defined as concentration deviation.The risk factors for deviation of linezolid concentration were studied by binary logistic regression.Results From January 2018 to December 2019,231 linezolid concentrations were measured,belonging to 154 patients.Among them,142 patients were hospitalized,136 patients were treated with drugs for therapeutic use,and 6 patients were for preventive use.The clinical efficacy of 136 patients treated with drugs was evaluated.120 cases were considered effective with an overall effective rate was 88.2%.Among the 16 invalid patients,13 patients were infected by other pathogens at the same time.The recommended trough concentration of linezolid was 2-8mg/L.The steady-state trough concentration of linezolid was divided into groups of<2mg/L and 2-8mg/L,and the probability of continuous and assumed continuous occurrence of pathogenic bacteria in patients in the low concentration group was 4.7 times higher than that in patients in the group with standard valley concentration.Among inpatients,the incidence of thrombocytopenia was 24.6%,and anemia was 7.5%.Thrombocytopenia and anemia were significantly related to the trough concentration of linezolid in patients(Kendall’s tau-b=0.431,P<0.001;Kendall’s tau-b=0.172,P=0.017).Moreover,thrombocytopenia and anemia were significantly related to the days of linezolid used(Kendall’s tau-b=0.186,P=0.014;Kendall’s tau-b=0.174,P=0.022).The trough concentration of linezolid was more than 30mg/L in two patients,both had thrombocytopenia and anemia,and one of them developed hyperlactatemia.The combination of P-gp inhibitors was an important risk factor for higher concentrations(>8mg/L),OR=3.856 CI95% 1.277-11.644.Creatinine clearance rate(OR=0.988 CI95% 0.981-0.996,P=0.009)was also independent risk factor.The lower the creatinine clearance rate,the more likely to lead to higher concentrations of linezolid.On the other hand,creatinine clearance rate(OR=1.009 CI95% 1.002-1.017,P=0.016)and dosage/body weight(OR=0.743 CI95% 0.603-0.915,P=0.005)were independent risk factors for the low concentration of linezolid(<2mg/L).The higher the creatinine clearance rate,the smaller the dosage/body weight,the more likely to lead to the low concentration,which will weaken the antibacterial effect of linezolid.Conclusion The efficacy and adverse reactions of linezolid were related to the concentration of linezolid.Creatinine clearance rate,concomitant use,dosage/body weight were closely related to the deviation of linezolid concentration.Clinical pharmacists should pay attention to the individual conditions of patients,adjust the dosage according to the concentration,improve the efficacy of linezolid and reduce adverse drug reactions. |
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