多药耐药菌混合感染重症患者的个体化抗感染治疗研究

发布时间：2018-06-04 11:24

本文选题：多药耐药菌 + PK/PD　；参考：《中华医院感染学杂志》2017年13期

【摘要】：目的探讨利用抗菌药物的PK/PD特点及药物浓度监测结果指导多药耐药菌感染的重症患者的个体化抗感染治疗策略及连续性肾脏替代治疗(CRRT)治疗时药物剂量的调整,提高重症感染患者救治成功率。方法对2013年西安交通大学第一附属医院重症医学科收治的1例多药耐药菌感染的重症患者的临床、影像学及病原学资料,抗菌药物的PK/PD特点及药物浓度监测结果,以及CRRT治疗时的药物剂量调整进行分析总结。结果患者病情危重,治疗过程中痰培养为泛耐药鲍氏不动杆菌,血培养曾出现多药耐药的肺炎克雷伯菌肺炎亚种及近平滑假丝酵母菌、尿培养曾出现多药耐药的肺炎克雷伯菌肺炎亚种及多药耐药的屎肠球菌。治疗中我们根据药敏结果结合患者脏器功能选择抗菌药物,使用美罗培南对耐药菌进行治疗时,采用两步法给药,根据抗菌药物的PK/PD特点优化抗菌药物使用,分析CRRT治疗对药物浓度的影响,对治疗药物进行浓度监测,根据监测结果对抗菌药物进行个体化调整,以发挥抗菌药物的最大疗效,最终患者好转出院。结论对于多药耐药菌混合感染的重症患者,利用抗菌药物的PK/PD特点优化抗菌药物治疗。根据治疗中药物浓度监测结果调整抗菌药物剂量,实现精准化、个体化治疗,提高重症患者的救治成功率。
[Abstract]:Objective to explore the individualized anti infection treatment strategy of the severe patients with multidrug-resistant bacteria infection and the adjustment of drug dosage during the treatment of continuous renal replacement therapy (CRRT) by using the PK/PD characteristics of antimicrobial agents and the monitoring results of drug concentration, and to improve the successful rate of treatment for patients with severe infection. Methods for the First Affiliated of Xi'an Jiao Tong University in 2013. The clinical, imaging and pathogenic data of 1 cases of multidrug resistant bacteria, the PK/PD characteristics of antimicrobial agents, the results of drug concentration monitoring, and the drug dose adjustment during CRRT treatment were analyzed and summarized in the hospital. In the blood culture, there were multidrug-resistant Klebsiella pneumoniae subspecies and nearly smooth Candida. In urine culture, multidrug-resistant Klebsiella pneumoniae pneumonia subspecies and multidrug-resistant Enterococcus faecium were found. In the course of treatment, two steps were used to optimize the use of antibacterial drugs according to the PK/PD characteristics of antibiotics, to analyze the effect of CRRT therapy on the drug concentration, to monitor the concentration of the drugs, and to adjust the antimicrobial agents individually according to the monitoring results, so as to give full play to the efficacy of the antibacterial drugs and ultimately improve the discharge of the hospital. The severe patients with drug resistant bacteria mixed infection use the PK/PD characteristics of antibacterials to optimize the treatment of antibiotics. Adjust the dose of antibiotics according to the results of drug concentration monitoring in the treatment, achieve precision, individualized treatment, and improve the success rate of treatment for severe patients.
【作者单位】：西安交通大学第一附属医院重症医学科;西北妇女儿童医院重症医学科;
【分类号】：R446.5;R515

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