| Objective:According to the training requirements of Master of Pharmacy(Clinical Pharmacy and Drug Evaluation),based on clinical pharmacy practice of Yantai Yuhuangding hospital,the study investigated the infection status and resistance trend of multidrug-resistant organism(MDRO),explored the risk factors of vancomycin-resistant enterococci(VRE)infection,and compared the clinical efficacy and safety of linezolid and daptomycin in the treatment of enterococcal bloodstream infection(EBSI)including vancomycin-resistant enterococcal bloodstream infection(VRE-BSI),in order to provide theoretical reference and evidence-based basis for clinical rational use and drug selection.Methods:Retrospectively investigated the case data of MDRO infection in Yantai Yuhuangding hospital in the past four years,and analyzed the risk factors of VRE infection;the better treatment options for EBSI from the clinical and evidence-based perspectives were explored:on the one hand,based on real-world data to retrospectively analyze clinical efficacy and safety of linezolid and daptomycin in the treatment of EBSI,and the efficacy and safety of linezolid in the treatment of ICU and general ward patients;on the other hand,Meta analysis was used to evaluate the efficacy and safety of linezolid and daptomycin in the treatment of VRE-BSI.(1)The data of MDRO infection cases in the hospital from January 2017 to December2020 were retrospectively collected,and the WHONET 5.6 was used to analyze the trend of MDRO,the detection situation,the source and distribution of specimens,and drug resistance.(2)Using a case-control method,we selected 66 adult inpatients admitted to our hospital from January 2017 to December 2020,and divided them into VRE group and vancomycin-sensitive enterococcus(VSE)according to whether the bacteria were VRE,investigated the trend of VRE infection,collected basic data of VRE patients.The risk factors of VRE infection by univariate and Logistic regression were analyzed.(3)Retrospectively collected the basic data and drug sensitivity results of EBSI patients treated with linezolid and daptomycin.The χ~2 test and t test/rank-sum test were used to analysis indicators of laboratory tests,efficacy and safety outcome,in order to compare the efficacy and safety of linezolid and daptomycin in the treatment of EBSI.At the same time,the clinical effects of linezolid in the ICU group and the general ward group were assessed.(4)Searched of PubMed,The Cochrane Library,Embase,CNKI,VIP,Wanfang and other databases,set the search time limit to build the database to October 2020,and screened the literature according to the inclusion and exclusion criteria,extracted the data,used the NOS table to evaluate the quality of the included research.Later,the Rev Man software was used to conduct a Meta analysis of the efficacy and safety of linezolid and daptomycin for VRE-BSI.Results:(1)A total of 3449 non-repetitive strains isolated from our hospital from January 2017 to December 2020,the Gram-negative bacteria accounted for 82.1%,of which carbapenems-resistant acinetobacter baumannii was the highest,accounted for 49.3%.Gram-positive bacteria accounted for 17.9%,which was divided into methicillin-resistant staphylococcus aureus(MRSA)(16.4%)and VRE(1.7%).The main type of VRE specimen was bile.The detection rate of VRE has fluctuated around 1.0%.The drug susceptibility results showed that the sensitivity of enterococcus faecium and enterococcus faecalis to linezolid and daptomycin was 100%.(2)From January 2017 to December 2020,the VRE infection rate in the hospital has been on the rise.Enterococcus faecium accounted for the highest proportion of bacteria.The proportion of patients over 65 years old was 76.4%and the distribution of departments was mainly neurology.Urinary tract infection accounted for the highest proportion of infection sites.The proportion of mixed infections was greater than that of simple infections.The rate of improvement after treatment was up to 58.8%.Univariate analysis showed that VRE infection was linked to all of the following:urinary tract infection,the history of vancomycin use within 90 days,the use of carbapenem antibacterial drugs,and tracheal intubation.Further logistic multivariate regression analysis showed that urinary tract infection,previous use of carbapenem antibiotics and tracheal intubation were independent risk factors for VRE infection.(3)The clinical study of linezolid and daptomycin in the treatment of EBSI enrolled 147patients,106 in the linezolid group and 41 in the daptomycin group.The clinical research results of two drugs in the treatment of EBSI showed that the white blood cell count(WBC),procalcitonin(PCT),and C-reactive protein(CRP)after the two treatments were significantly lower than before treatment,with statistical differences(P<0.05).In addition,the two groups had no statistical difference on rate of efficiency rate,bacterial clearance rate,and adverse drug reaction(ADR)incidence rate(P>0.05).Further analysis of the data of patients in the ICU and general ward group treated with linezolid showed that the WBC,PCT,CRP of the general ward group and PCT of the ICU group were significantly lower than before treatment(P<0.05)),at the same time,there was no statistical difference between the two groups of all indicators(P>0.05).In terms of efficacy and safety,there was no statistical difference in the duration of fever,effective rate,and ADR incidence between the two groups with linezolid treatment(P>0.05),but in terms of bacterial clearance rate,the general ward was higher than the ICU group,and there were statistical difference(P<0.05).(4)In the meta-analysis,a total of 18 high-quality English full-text articles were included,with a total of 4830 patients.The results showed that there was no statistically significant difference between linezolid and daptomycin in all-cause mortality,30-day mortality,clinical cure,bacterial clearance,recurrence,and incidence of creatine kinase(P>0.05).Compared with linezolid,daptomycin has the advantage of a low incidence of thrombocytopenia.Conclusion:The detection rate of MDRO is high and the situation is severe.The detection rate of VRE was stable at a low level;Urinary tract infections,history of carbapenem antibiotic use,and tracheal intubation were independent risk factors for VRE infection,so in the clinical diagnosis and treatment process,the use of carbapenem antibiotics and tracheal intubation should be minimized as much as possible,and urinary tract infections should be vigilant against the possibility of enterococci,especially VRE infections.In retrospective clinical studies,the results of linezolid and daptomycin in the treatment of EBSI showed that both have good efficacy and safety and can be used as a better choice for patients with EBSI who were ineffective in vancomycin treatment or cannot tolerate vancomycin.The comparison of linezolid in the treatment of ICU and general ward patients showed that linezolid can be mainly used for the treatment of ICU patients of EBSI with severe infection,multiple organ dysfunction,and low immunity.The results of Meta analysis of two drugs for VRE-BSI showed that the incidence of thrombocytopenia of daptomycin was lower than that of linezolid,but more high-quality studies are still needed for further verification.Innovation:(1)This study combined a real-world retrospective research with Meta analysis for the first time to explore the clinical effects of linezolid and daptomycin in the treatment of EBSI including VRE-BSI.(2)At present,there is little report on the efficacy and safety of linezolid in the treatment of EBSI.The project collected clinical data of patients with EBSI treated with linezolid and divided them into ICU group and general ward group.The laboratory indicators,as well as clinical efficacy,safety and other indicators are statistically analyzed,which had certain reference for clinical rational use of drugs. |
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