利奈唑胺相关血小板减少.ppt

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,MRSAVREVRSA,BACKGROUND,万古霉素vancomycin利奈唑胺linezolid,AntimicrobialresistanceinChinahasbecomeaserioushealthcareproblem,withhighresistanceratesofmostcommonbacteriatoclinicallyimportantantimicrobialagents.Methicillin-resistantS.aureus,ESBL-producingEnterobacteriaceaeandcarbapenem-resistantAcinetobacterbaumanniirepresentmorethan50%ofmicrobialisolates.,Linezolid,oxazolidinoneantibiotics2000FDA2019SFDAuniquemechanismoftheantibacterialactioninhibitionofproteinsynthesisinbacterialliposomesapprovedindicationsforlinezolidusevancomycin-resistantEnterococcusinfectionandcomorbidwithbacteremiahospital-acquiredpneumoniacomplicatedskinandskinstructureinfectionscommunity-acquiredpneumoniaandcomorbidwithbacteremiauncomplicatedskinandsofttissueinfectionssuperiorityallagesliverdiseasepoorkidneyfunctionwithorwithoutbacterialinvasionofthebloodstream,EfficacyoflinezolidonHAPandVAPcausedbyMRSAisbetterthanvancomycin,ATS/IDSA.AmJRespirCritCareMed.2019;171:388-416.ATS/IDSA(2019)guidelinesforthemanagementofadultswithHAP/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42:66-72.Brieretal.AntimicrobAgentsChemother2019;47:2775-80.,Higherincidenceinthegroupwithsevererenalimpairment,CreatinineclearanceastheindicatorofrenalfunctiontheROCcut-offpoint(Criterion2)creatinineclearance88.39mL/minMildPLTdecreasemayoccurwhencreatinineclearancerateisatitslowerlimit,whilethereisstillnosignofrenalinsufficiency.Ccr30severerenalimpairment(48%15/31vs.24%54/222,P=0.005,OR=2.9295%CI1.396.14）,结论,SituationinChinesepatientsactualincidenceismuchhigherthanindruginstructionshemorrhagictendencyRiskfactorslowpre-treatmentplateletvalueslowbodyweightlowserumalbuminlongtimeofadministrationAdvancedagerenalimpairmentPredictorsbaselineplatelet181109/Ldailydose18.75mg/kgdurationoflinezolidtherapy10dStrategystrengthenmonitoringfr