【摘要】 目的优化ICU中抗菌药物治疗常见葡萄球菌感染的给药方案。方法收集抗菌药物药动学、药效学参数,结合卫生部全国细菌耐药监测网(Mohnarin)医院ICU细菌耐药监测报告及临床实验室标准协会(CLSI)制定的2013版抗微生物药物敏感试验执行标准,对葡萄球菌属病原菌的最低抑菌浓度(MIC)运用离散均匀分布的方法进行设置,拟定出6种抗菌药物的16种给药方案,运用药效/药动学(PK/PD)模型和蒙特卡洛模拟5 000例患者的累积反应分数(CFR),优化出最佳的初始给药方案。结果对感染菌可选择的初始给药方案分别是:金黄色葡萄球菌感染应用利奈唑胺0.40g每天2次,万古霉素0.75g每天2次;溶血葡萄球菌和表皮葡萄球菌感染应用阿米卡星0.60g每天1次,利奈唑胺0.40g每天2次,万古霉素0.75g每天2次;甲氧西林耐药葡萄球菌感染应用利奈唑胺0.40g每天2次,万古霉素0.75g每天2次;甲氧西林敏感葡萄球菌感染应用氨苄西林/舒巴坦1.50g每天4次,头孢呋辛0.75g每天4次,阿米卡星0.60g每天1次,莫西沙星0.40g每天1次。结论对发生在ICU中的葡萄球菌感染,如能明确为甲氧西林敏感葡萄球菌感染可选用氨苄西林/舒巴坦、头孢呋辛、阿米卡星、和莫西沙星治疗;如为甲氧西林耐药葡萄球菌或不能确定是否甲氧西林耐药菌感染,可选用利奈唑胺或万古霉素治疗。更多还原

【Abstract】 Objective To optimize the antibacterial drug regimen in ICU common staphylococcal infection.Methods The pharmacokinetic and pharmacodynamic parameters of antibacterial drugs were collected in combination with the hospital ICU antimicrobial drug resistance monitoring reports from the national antimicrobial resistance investigation net(Mohnarin)of the Ministry of Health and the performance standards for antimicrobial susceptibility testing(2013)issued by the clinical and laboratory standards institute(CLSI),the minimum inhibitory concentration(MIC)of staphylococci was set by using the discrete uniform distribution method and 16 kinds of administration regimens with 6antimicrobial agents were worked out.The best initially antimicrobial regimen was optimized by using the pharmacokinetic and pharmacodynamic models and Monte Carlo simulations of cumulative fraction of response(CFR)from 5 000 patients.Results The alternative initially drug regimens to the infectious bacteria were:linezolid0.40 g twice daily and vancomycin 0.75 g twice daily for staphylococcus aureus;amikacin 0.60 g once daily and linezolid 0.40 g twice daily,and vancomycin 0.75 g twice daily for hemolytic staphylococci and staphylococcus epidermidis;linezolid 0.40 g twice daily and vancomycin 0.75 g twice daily for methicillin-resistant Staphylococcus aureus;ampicillin/sulbactam 1.50 g 4times daily,cefuroxime 0.75 g 4times daily,amikacin 0.60 g once daily,moxifloxacin 0.40 g once daily for methicillin-sensitive staphylococcus aureus.Conclusion In the Staphylococcus aureus infection occurred in ICU,if which being methicillin-sensitive could be determined,ampicillin/sulbactam,cefuroxime,amikacin and moxifloxacin could be selected for treatment,and linezolid or vancomycin could be selected for treating possible methicillin-resistant Staphylococcus aureus infection or undetermined whether being methicillin-resistant Staphylococcus aureus infection.更多还原