亚胺培南用于重症肺炎患者的血药浓度监测及临床疗效评估  

Therapeutic Drug Monitoring of Imipenem in Patients with Severe Pneumonia and Evaluation of Clinical Efficacy

作　　者：徐金慧 唐莲[1] 石璐 陈芳[1] 张曦 庄智伟[2] 陆件[2] 袁云龙 刘馨 刘纪松 孙坚彤[1] 周琴[1] Xu Jinhui;Tang Lian;Shi Lu;Chen Fang;Zhang Xi;Zhuang Zhiwei;Lu Jian;Yuan Yunlong;Liu Xing;Liu Jisong;Sun Jiantong;Zhou Qin(Department of Pharmacy,the Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou 215002,China;Department of Intensive Care Unit,the Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou 215002,China;Department of Clinical Laboratory,the Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou 215002,China;Hangzhou Baichen Medical Laboratory)

机构地区：[1]南京医科大学附属苏州医院药剂科,江苏苏州215002 [2]南京医科大学附属苏州医院重症医学科,江苏苏州215002 [3]南京医科大学附属苏州医院检验医学科,江苏苏州215002 [4]杭州佰辰医学检验所

出　　处：《药物流行病学杂志》2021年第3期164-169,共6页Chinese Journal of Pharmacoepidemiology

基　　金：苏州市科技局项目(编号:SYSD2019189);江苏省药学会医院药学科研项目(编号:A201915)。

摘　　要：目的:评估重症肺炎患者使用亚胺培南后血药浓度监测、临床有效率、细菌清除率,分析谷浓度与临床疗效的相关性,为亚胺培南个体化用药提供参考。方法:前瞻性收集某院重症医学科(ICU)使用亚胺培南抗感染治疗的重症肺炎患者,在用药4~5剂后测定亚胺培南血药谷浓度,记录患者的基础疾病、感染性诊断、病原学分布,分析亚胺培南谷浓度达标情况,并进行临床疗效评估。结果:共入选43例患者,亚胺培南日剂量为2.00(1.90,3.00)g,疗程(9.31±4.38)d,谷浓度为2.41(0.74,3.94)mg·L^(-1),目标性治疗谷浓度的达标率为31.91%,经验性治疗谷浓度的达标率为68.42%,肌酐清除率高的患者谷浓度偏低(P<0.001)。24例患者为革兰阴性菌目标性治疗,共检出47株革兰阴性菌,其中13株(27.66%)为耐碳青霉烯病原菌。临床有效率54.17%(13/24),革兰阴性菌清除率42.55%(20/47),不良反应发生率11.63%(5/43)。临床治愈组的谷浓度达标率较无效组高,差异有统计学意义(50.00%vs.16.00%,P=0.013)。培养出耐碳青霉烯病原菌患者的谷浓度较碳青霉烯敏感患者更高[(2.88±2.06)mg·L^(-1)vs.1.12(0.54,3.58)mg·L^(-1),P=0.049],但谷浓度达标率显著低于碳青霉烯敏感组(0.00%vs.47.06%,P=0.007)。结论:危重症感染患者亚胺培南谷浓度达标率低,谷浓度与肌酐清除率具有相关性。临床疗效与谷浓度达标率相关,耐碳青霉烯组MIC升高与谷浓度未达标显著相关。Objective:To evaluate the therapeutic drug monitoring(TDM),clinical efficacy,and bacterial clearance rate of imipenem treatment in patients with severe pneumonia,in order to analyze the correlation between trough concentration and clinical efficacy,and to provide a reference for individualized use of imipenem.Methods:Severe pneumonia patients with imipenem treatment in intensive care unit(ICU)were prospectively collected in our study.The blood trough concentrations of imipenem were determined after 4-5 doses of imipenem.The basic diseases,infectious diagnosis and etiological distribution of the patients were recorded,and the target attainment of trough concentrations was analyzed,and the clinical efficacy was evaluated.Results:A total of 43 patients were enrolled.The daily dose of imipenem was 2.00(1.90,3.00)g,the course of imipenem treatment was(9.31±4.38)days,the trough concentration was 2.41(0.74,3.94)mg·L^(-1),and target attainment of trough concentrations in target treatment group and empirical therapy group was 31.91%and 68.42,respectively.Patients with higher creatinine clearance achieved lower trough concentrations(P<0.001).A total of 47 strains of gram-negative bacteria were cultured in 24 patients.Among them,13 strains(27.66%)were carbapenem resistant pathogens.The clinical efficacy rate was 54.17%(13/24),gram-negative bacteria clearance rate was 42.55%(20/47),and the adverse reaction rate was 11.63%(5/43).The proportion of trough concentration>MIC in cured group was significantly higher than that of the invalid group(50.00%vs.16.00%,P=0.013).The trough concentration of imipenem in patients cultured with carbapenems resistant bacteria was significantly higher than that of patients with carbapenems sensitive bacteria[2.88±2.06 vs.1.12(0.54,3.58),P=0.049],but the rate of trough concentration>MIC was significantly lower(0.00%vs.47.06%,P=0.007).Conclusion:The rate of trough concentrations>MIC or 1 mg·L^(-1)in critically infected patients was low,and trough concentration was correlated with creatinine cl

关 键 词：亚胺培南 重症肺炎 血药浓度 临床疗效 细菌清除率 

分 类 号：R978.1[医药卫生—药品]