利奈唑胺相关性血小板减少.ppt

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1、利奈唑胺相关性血小板减少陈超解放军总医院药品保障中心临床药学室MRSAVREVRSABACKGROUND万古霉素vancomycin利奈唑胺linezolidAntimicrobialresistanceinChinahasbecomeaserioushealthcareproblem,withhighresistanceratesofmostcommonbacteriatoclinicallyimportantantimicrobialagents.Methicillin-resistantS.aure

2、us,ESBL-producingEnterobacteriaceaeandcarbapenem-resistantAcinetobacterbaumanniirepresentmorethan50%ofmicrobialisolates.Linezolidoxazolidinoneantibiotics2000FDA2007SFDAuniquemechanismoftheantibacterialactioninhibitionofproteinsynthesisinbacterialliposomes

3、approvedindicationsforlinezolidusevancomycin-resistantEnterococcusinfectionandcomorbidwithbacteremiahospital-acquiredpneumoniacomplicatedskinandskinstructureinfectionscommunity-acquiredpneumoniaandcomorbidwithbacteremiauncomplicatedskinandsofttissueinfect

4、ionssuperiorityallagesliverdiseasepoorkidneyfunctionwithorwithoutbacterialinvasionofthebloodstreamEfficacyoflinezolidonHAPandVAPcausedbyMRSAisbetterthanvancomycinATS/IDSA.AmJRespirCritCareMed.2005;171:388-416.ATS/IDSA(2005)guidelinesforthemanagementofadul

5、tswithHAP/VAP/HCAP血小板减少症-来自临床的声音上市前临床试验——说明书腹泻/头痛/恶心/呕吐/味觉异常骨髓抑制血小板减少2.4%(0.3%-10.0%)/白细胞减少/贫血/全血细胞减少乳酸酸中毒视神经病变周围神经病变安全性&耐受性上市后监测——文献主要的SAE是血小板减少其他国家高发生率(15.1-38.7%)中国个案报道没有大样本人群的发生率研究目的临床实际发生率及严重程度危险因素风险特征的预测指标住院患者使用利奈唑胺致相关血小板减少资料&方法数据来源解放军总医院(4,000beds)

6、使用利奈唑胺/口服/静注/序贯电子医疗记录512Patientswerescreened7Patientswereexcludedduetoyoungerthan18yearsold血小板减少症评价50585wereexcludedduetodiagnosisanddrugsHematologicaldisordersChemotherapyontumorSeverepancreatitisHepatoblastomaSystemicLupusErythmatosusantiplateletagent42

7、5wereeligibleandconsented171wereexcludedduetoplateletcountbaselineplateletanomalies(lessthan100×109/Lormorethan400×109/L)initialplateletswerenotrecordedorlessthanthreeplateletobservationpoints254wereincludedintheanalysis回顾性研究资料&方法Thrombocytopeniainthisstu

8、dy-lackofuniformdiagnosticcriteriaVariablesGenderAgeBodyweightDailydose(mg/kg)durationoflinezolidadministrationlaboratorydata(5factors)AlanineaminotransferaseTotalbilirubinCreatinineAlbuminBaselineplatelet标准1——严重标准2