【摘要】 目的为ICU患者鲍曼不动杆菌感染（ABA）合理使用比阿培南提供依据。方法收集我院105株ABA菌株,采用2倍琼脂稀释法检测比阿培南的最低抑菌浓度（MIC）,运用蒙特卡洛模拟（MCS）比阿培南在传统短时滴注（0.5 h）、延时滴注（3和4 h）和两步法（1.5⁵.5 h）滴注方式下4种给药方案300 mg,q12 h/q8 h/q6 h;600 mg,q12 h的达标概率（PTA）和累积反应分数（CFR）。结果 3种滴注方式的4种比阿培南方案对ABA的CFR均<90%;对非多重耐药的鲍曼不动杆菌（non MDRABA）,仅300 mg,q12 h,静滴0.5 h和两步法静滴1.5 h的CFR<90%,其余方案的CFR均大于90%;在MIC≥2 mg·L^-1时,所有方案的PTA<90%;在达标情况下,延时滴注与两步法在滴注时间类似时具有相似的PTA和CFR,且均显著优于短时滴注法。结论我院ICU患者ABA感染时,经验治疗应避免单用比阿培南,目标治疗或联合用药时应根据药敏结果,优先选择延时滴注或两步法。更多还原

【Abstract】 OBJECTIVE To provide the basis for biapenem against Acinetobacter baumannii infection in ICU patients in our hospital. METHODS One hundred-five strains of ABA were collected. The MICs of biapenem against bacteria were measured by double broth dilution method. Four therapeutics regimens( 0. 3 g,q12 h; 0. 3 g,q8 h; 0. 3 g,q6 h; 0. 6 g,q12 h)in traditional short-time infusion,extended infusion( 3,4 h) and two-step infusion( 1. 5-5. 5 h) were simulated by using the Monte Carlo simulation,then the PTAs and CRFs were calculated. RESULTS CFRs of all treatments of biapenem against ABA infection in ICU subjects were < 90 %; but for non MDR-ABA,all biapenem regimens ’CFR were > 90 % except biapenem0. 3 g,q12 h( 0. 5 h) and 0. 3 g,q12 h( two-step infusion for 1. 5 h). PTAs of the whole regimens were > 90 % when MIC≥2 mg·L-1. Extended infusion and two-step infusion got the similar PTAs and CFRs with a similar time when the regimens obtained target,more than short infusion obviously. CONCLUSION Biapenem alone should avoid for ABA infection as expiry therapy in ICU population in our hospital. Extended infusion and two-step infusion should be priority selection as target therapy according to sensitivity test.更多还原