探讨利奈唑胺对高龄老年重症肺炎的疗效与安全性。

选取武汉大学中南医院2015年1月至2016年1月收治的3例男性高龄老年肺炎（均为院内获得性肺炎）患者，先选用第三代头孢菌素/β-内酰胺酶抑制剂复合制剂+碳青酶烯类广谱抗生素联合替考拉林静脉滴注进行初始经验性治疗，并行痰细菌培养，若治疗无效，则根据痰细菌培养结果以利奈唑胺（600 mg静脉滴注，2次/d）代替替考拉林继续治疗，分析利奈唑胺治疗前后的临床表现、影象学特征、药物疗效与药物不良反应，并结合文献进行分析。

3例高龄老年患者治疗前均伴有不同程度的肝肾功能障碍，无明显血小板异常。初始经验性治疗治疗5 d无效，痰培养结果示金黄色葡萄球菌、大肠埃希菌+铜绿假单胞菌、鲍曼不动杆菌+金黄色葡萄球菌各1例，遂以利奈唑胺代替替考拉林继续治疗，7 d后均临床治愈；肝功能恢复正常，肾功能障碍减轻；影象学显示肺部感染性病变吸收好转。治疗第5天时，2例患者出现血小板一过性下降，停用利奈唑胺3 d后血小板均逐渐回升至治疗前水平。

有误吸史的高龄老年重症肺炎，病原菌多为以革兰阴性杆菌感染为主的兼有厌氧菌和耐甲氧西林金黄色葡萄球菌感染的混合菌感染，先期选择替考拉林抗生素联合治疗无效时，应考虑可能存在耐糖肽类的金黄色葡萄球菌感染，此时可选择利奈唑胺代替替考拉林进行治疗，其安全性较高，可明显提高重症肺炎的治愈率，改善预后。

To investigate the curative effect and security of the Linezolid on severe pneumonia in elderly.

Three cases of male advanced aged severe pneumonia (all are hospital acquired pneumonia) from Zhongnan Hospital of Wuhan university during January 2015 to January 2016 were selected. They were first treated with the third generation cephalosporins/β-lactamase inhibitor combined with carbapenems broad-spectrum antibiotics combined with teicoplanin intravenous infusion for initial empirical treatment, and sputum bacterial culture were obtained. If ineffective, antibiotics were changed into linezolid (600 mg intravenous infusion, 2 times/d) instead of teicoplanin continued treatment according to sputum bacterial culture results. Clinical manifestations, imaging features, efficacy and adverse reactions before and after linezolid treatment, were analysis.

All patients are accompanied by liver and renal dysfunction but normal platelet. Empirical therapy resulted invalid after five days treatment. Sputum samples are respectively isolated resistant staphylococcus aureus, escherichia coli + pseudomonas aeruginosa and acinetobacter baumannii+ resistant staphylococcus aureus. After switched to linezolid 600 mg ivgtt bid for 7 days, the liver function returned to normal, renal dysfunction return to better, imaging features showed pulmonary lesions absorbed. During the treatment, two patients' platelet decline on the fifth days, but returned to normal three days after drug withdrawal.

In elderly patients of severe pneumonia with aspiration history, the pathogenic bacterium is mainly a mixture infection of gram negative bacilli, anaerobic bacteria and methicillin-resistant staphylococcus aureus. If empirical teicoplanin combining with other antibiotics is not effective, staphylococcus aureus resistant to glycopeptide antibiotics should be considered. Then use linezolid to replace teicoplanin can obviously improve the cure rate of severe pneumonia and prognosis as well as its higher security.