【摘要】 目的:优化抗菌药物治疗重症监护病房(ICU)中铜绿假单胞菌感染患者的初始给药方案。方法:基于收集到的国内外抗菌药物药动学和药效学参数,结合卫生部全国细菌耐药监测网(Mohnarin)和中国CHINET与耐药监测网关于医院ICU铜绿假单胞菌耐药监测报告及美国临床实验室标准化协会(CLSI)2013版标准,对铜绿假单胞菌的最低抑菌浓度设置为离散均匀分布,拟订出6种抗菌药物的24种给药方案,运用药效/药动学(PK/PD)模型和蒙特卡洛模拟10 000例"真实患者"的达标概率和累积反应分数,优化出最佳初始给药方案。结果:对铜绿假单胞菌感染可选择的初始给药方案分别是哌拉西林/他唑巴坦4.5 g,q6 h;头孢吡肟2.0 g,q12 h;美罗培南1.0 g,q6 h;阿米卡星17.5 mg/(kg·d);环丙沙星0.4 g,q8 h;多黏菌素150 mg,q12 h。结论:作为优化的初始给药方案,ICU中的非多重耐药铜绿假单胞菌感染建议选用头孢吡肟;多重耐药铜绿假单胞菌感染建议选用头孢吡肟+环丙沙星;全耐药铜绿假单胞菌感染则建议选用头孢吡肟+环丙沙星+多黏菌素。更多还原

【Abstract】 OBJECTIVE:To optimize initial dosing regimen in the treatment of ICU patients with pseudomonas aeruginosa infection. METHODS:Based on the collected pharmacokinetic and pharmacodynamic parameters of antibacterial drugs,monitoring reports of hospital ICU antimicrobial resistance of pseudomonas areuginose(PA)from ministry of health national antimicrobial resistance investigation net(Mohnarin) and Chinese CHINET resistance net,and the standard edition of Clinical Laboratory Standards Institute(CLSI)2013 in American,the minimum inhibitory concentration(MIC)of PA was established and 24 administrative schemes with 6 antimicrobial agents were produced. The best initial dosing regimen was decided by PK / PD models and Monte Carlo simulations to analyze standard probability and cumulative fraction of response(CFR) of 10 000"real patients". RESULTS:The alternative initial dosing regimens for PA infection were as follows,pipercillin/tazobactam 4.5 g,q6 h;cefepime 2.0g,q12 h;meropenem 1.0 g,q6 h;amikacin 17.5 mg/(kg·d);ciprofloxacin 0.4 g,q8 h;and colistin 150 mg,q12 h. CONCLUSIONS:As an optimized initial dosing regimen,non- multidrug resistant PA is suggested to treat with cefepime,multidrug resistant PA is cefepime plus ciprofloxacin,full drug resistant PA is cefepime plus ciprofloxacin and polymyxin.更多还原