β-内酰胺类药物治疗大肠埃希菌所致血流感染的疗效评价

发布时间：2018-03-18 07:12

本文选题：PK/PD模型　切入点：蒙特卡洛模拟　出处：《中华医院感染学杂志》2017年24期 　论文类型：期刊论文

【摘要】：目的根据药动学/药效学(PK/PD)理论评价β-内酰胺类药物治疗大肠埃希菌(E.coli)所致的血流感染的给药方案。方法回顾性调查医院2013年7月-2016年6月血流感染的细菌分布及耐药监测报告,按照美国临床实验室标准化协会(CLSI)2013版标准,对大肠埃希菌的最低抑菌浓度设置为离散均匀分布,确定4种抗菌药物的16种给药方案,运用PK/PD模型和蒙特卡洛模拟10 000例"真实患者"的累积反应分数(CFR),优化出最佳初始给药方案。结果哌拉西林他唑巴坦4种给药方案(3.375g,q8h;3.375g,q6h;4.5g,q8h;4.5g,q6h)、头孢他啶4种给药方案(1.0g,q12h;1.0g,q8h;2.0g,q12h;2.0g,q8h)、头孢吡肟4种给药方案(1.0g,q12h;1.0g,q8h;2.0g,q12h;2.0g,q8h)的CFR均80%;亚胺培南西司他丁4种给药方案(0.5g,q8h;0.5g,q6h;1.0g,q8h;1.0g,q6h)中0.5g,q6h的CFR为85.30%,1.0g,q6h的CFR为92.75%,其它两种给药方案CFR80%。结论医院大肠埃希菌所致的血流感染的经验治疗,建议选择最佳给药方案亚胺培南西司他丁1.0g,q6h,或次佳给药方案亚胺培南西司他丁0.5g,q6h,选择联合治疗方案,目标治疗则应根据大肠埃希菌MIC值选用相应的给药方案。
[Abstract]:Objective to evaluate the efficacy of 尾 -lactams in the treatment of blood stream infection caused by Escherichia coli according to the pharmacokinetic / pharmacodynamic theory of PKP / PD.Methods the bacterial distribution of blood stream infection in hospitals from July 2013 to June 2016 was retrospectively investigated. And drug resistance monitoring reports, According to the CLSI 2013 standard of American Association of Clinical Laboratory Standardization, the minimum inhibitory concentration of Escherichia coli was set as discrete and uniform distribution, and 16 drug delivery schemes of 4 antimicrobial agents were determined. The PK/PD model and Monte Carlo model were used to simulate the cumulative response fraction (CFR) of 10 000 "real patients", and the optimal initial administration scheme was optimized. Results piperacillin, tazobactam, 4 kinds of drug administration protocols were 3.375 g / q8h (3.375g / g), 4.5g / q8h / h, 4.5g / g / h, 4.5g / g / h, respectively. Ceftazidime was used to give 4 kinds of drug administration regimen (1.0g / q12hU 1.0g / 12hU 1.0g / q8h-1), and the results showed that the dosage of piperacillin and tazobactam were 1.0g / 12hU 1.0g / 12g / h and 1.0g / 12g / h, respectively. The CFR of each of the four dosages of cepime was 1.0 g / q12h / 1.0g / q8h / 1.0g / q8h) and the CFR of the other two regimens were all 80, respectively. Conclusion the CFR of 0.5g / q8h1 / 1.0gq8h / 1.0g / q6h of the four dosages of imipimipenem is 1.0g / q8h1.0g / q6h, and the CFR of the other two regimen is 92.75b / h, respectively. Conclusion\\\. It was suggested to choose the best regimen of imipenem 1.0 g / q6 h or the second best regimen of imipenem 0.5 g / q6 h, and to choose the combination regimen, and the target treatment should be based on the MIC value of Escherichia coli.
【作者单位】：东南大学附属中大医院药学部;
【基金】：南京市药学会科研基金资助项目(2016YX009)
【分类号】：R51

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