大肠埃希菌血流感染治疗方案的设计与优化  

Design and Optimization of Treatment Plan for Escherichia Coli Bloodstream Infection

作　　者：陈文倩[1] 鲁炳怀 杜雯雯[1] 张丹[1] 张相林[1] 李朋梅[1] CHEN Wenqian;LU Binghuai;DU Wenwen;ZHANG Dan;ZHANG Xianglin;LI Pengmei(Dept .of Pharmacy,China-Japan Friendship Hospital,Beijing 100029,China;Dept.of Pulmonary and Critical Care Medicine,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院药学部,北京100029 [2]中日友好医院呼吸与危重症医学科,北京100029

出　　处：《中国医院用药评价与分析》2019年第6期656-658,共3页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：国家自然科学基金青年项目(No.81302843);人社部留学人员科技活动计划启动项目(2015年)

摘　　要：目的:设计与优化中日友好医院(以下简称“该院”)大肠埃希菌( Escherichia Coli,E. coli )血流感染的治疗方案。方法:收集该院2018年血标本培养出的大肠埃希菌113株,测定氨苄西林舒巴坦、哌拉西林他唑巴坦、亚胺培南西司他丁及美罗培南的最低抑菌浓度。采用蒙特卡洛方法模拟计算不同方案的达标概率(probability of target attainment,PTA)和累积反应分数(cumulative fraction of response,CFR)。结果:“氨苄西林舒巴坦3 g,每6 h给药1次”对大肠埃希菌的CFR为35.48%,“哌拉西林他唑巴坦4.5 g,每6 h给药1次”和“哌拉西林他唑巴坦4.5 g,每8 h给药1次”的CFR分别为95.05%和92.84%。“美罗培南0.5/1/2 g,每8 h给药1次”方案的CFR>99%,“亚胺培南西司他丁 0.5 g ,每8/6 h给药1次”和“亚胺培南西司他丁1 g,每8/6 h给药1次”方案的CFR<99%。结论:该院在治疗大肠埃希菌血流感染时,经验治疗可选择“哌拉西林他唑巴坦4.5 g,每8/6 h给药1次”和“美罗培南0.5/1/2 g,每8 h给药1次”方案。目标治疗可根据最低抑菌浓度情况选择方案。OBJECTIVE: To design and optimize the treatment plan for Escherichia coli bloodstream infection in China-Japan Friendship Hospital(hereinafter referred to as "the hospital"). METHODS: Totally 113 strains of E. coli cultured from the blood samples of the hospital in 2018 were collected, and the minimum inhibitory concentration against ampicillin sulbactam, piperacillin tazobactam, imipenem cilastatin and meropenem was determined. The Monte Carlo method was used to simulate the probability of target attainment(PTA) and cumulative fraction of response(CFR) for different scenarios. RESULTS: The CFR of "ampicillin sulbactam at 3 g, once every 6 h" for E. coli was 35.48%, that of "piperacillin tamazobactam at 4.5 g, once every 6 h" and "piperacillin tamazobactam at 4.5 g, once every 8 h" was 95.05% and 92.84%, respectively. The CFR of "meropenem 0.5/1/2 g, once every 8 h" were >99%, that of "imipenem cilastatin 0.5 g, once every 8/6 h" and "imipenem cilastatin 1 g, once every 8/6 h" were <99%. CONCLUSIONS: In the treatment of E. coli bloodstream infection in the hospital, the empirical treatment options can be "piperacillin tazobactam 4.5 g, once every 8/6 h" and "meropenem 0.5/1/2 g, once every 8 h". The target treatment can be selected according to the minimum inhibitory concentration.

关 键 词：大肠埃希菌 Β-内酰胺类抗菌药物 血流感染 蒙特卡洛模拟 

分 类 号：R978.1[医药卫生—药品]