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  

Effect evaluation of β-lactam antibiotic in treatment of bloodstream infections with Escherichia coli

作　　者：展冠军[1] 戢群芳 顾宗华[1] 孙进华[1] 刘静[1] 陆瑾[1] 

机构地区：[1]东南大学附属中大医院药学部,江苏南京210009

出　　处：《中华医院感染学杂志》2017年第24期5584-5587,共4页Chinese Journal of Nosocomiology

基　　金：南京市药学会科研基金资助项目(2016YX009)

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CFR<80%。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。OBJECTIVE To evaluate the dosage regimen ofβ-lactam in the treatment of bloodstream infections（BSI）with Escherichia coli based on pharmacokinetic/pharmacodynamic（PK/PD）models.METHODS The distribution of BSI in hospital and antimicrobial resistance of E.coli from Jul.2013 to Jun.2016 were retrospectively investigated.According to the standard edition of Clinical Laboratoratory Standards Institute（CLSI）2013 in American,the minimum inhibitory concentration（MIC）of E.coli was established and 16 administrative schemes with 4 antimicrobial agents were determined.The best initial dosing regimen was decided based on PK/PD models with Monte Carlo simulation（MCS）to analyze standard probability and cumulative fraction of response（CFR）of10000 ＂real patients＂.RESULTS All of the CFRs of four kinds of dosing regimen of piperacillin tazobactam（3.375 g,q8 h;3.375 g,q6 h;4.5 g,q8 h;4.5 g,q6 h）,four kinds of dosing regimen of ceftazidime（1.0 g,q12 h;1.0 g,q8 h;2.0 g,q12 h;2.0 g,q8 h）,and four kinds of dosing regimen of cefepime（1.0 g,q12 h;1.0 g,q8 h;2.0 g,q12 h;2.0 g,q8 h）were〈80%.Only the CFR of four kinds of dosing regimen of impenem/cilastatinfor（0.5 g,q8 h;0.5 g,q6 h;1.0 g,q8 h;1.0 g,q6 h）of 0.5 g,q6 hand 1.0 g,q6 htreatment regimens were 85.30% and 92.75%,respectively.Other two kinds of dosing regimen of impenem/cilastatinfor were〈80%.CONCLUSIONIt is suggested that different regimens can be used for target therapy of antibiotics on the basis of MIC,1.0 g q6 hdosing regimen of impenem/cilastatinfor as optimal dosing regimen and 0.5 g q6 hdosing regimen of impenem/cilastatinfor as suboptimal dosing regimen or combined treatment regimen can be used for experiential therapy of BSI with E.coli in our hospital.

关 键 词：PK/PD模型 蒙特卡洛模拟 大肠埃希菌 血流感染 初始给药方案 

分 类 号：R378.21[医药卫生—病原生物学]