亚胺培南治疗肺炎克雷伯菌肺部感染的药代动力学及其与临床疗效的关系  

Pharmacokinetics of imipenem on treatment of Klebsiella pneumoniae pulmonary infection and its correlation with clinical effect

作　　者：洪丽明 李乐辉 田秘 林先萍 吴国平 HONG Li-ming;LI Le-hui;TIAN Mi;LIN Xian-ping;WU Guo-ping(The First Affiliated Hospital of Hainan Medical College,Haikou,Hainan 570000,China)

机构地区：[1]海南医学院第一附属医院医院急诊ICU,海南海口570000 [2]海南医学院第一附属医院皮肤科,海南海口570000 [3]三沙市人民医院内科,海南三沙570000

出　　处：《中华医院感染学杂志》2021年第9期1343-1347,共5页Chinese Journal of Nosocomiology

基　　金：海南省重点研发基金资助项目(ZDYF2019125)。

摘　　要：目的分析肺炎克雷伯菌肺部感染患者亚胺培南血药浓度和药效学(PD)达标率及其与临床疗效之间的关系。方法选取2018年6月-2019年12月海南医学院第一附属医院收治的43例肺炎克雷伯菌肺部感染患者,对临床分离的肺炎克雷伯菌进行药敏试验检测最低抑菌浓度(MIC),根据亚胺培南治疗剂量分为500 mg组(n=16)和1 g组(n=27),静脉滴注亚胺培南4次后,采集静脉血标本,采用高效液相色谱检测血浆中亚胺培南给药间隔40%时间点的浓度(C_(40%)T)和给药间隔100%时间点的浓度(C_(100%)T),治疗7 d后,评估患者治疗的临床疗效。采用Pearson相关性分析亚胺培南的血药浓度与临床疗效之间的相关性。结果亚胺培南对肺炎克雷伯菌的MIC_(50)为0.015~4μg/ml,MIC_(50)50为1μg/ml;500 mg剂量组患者血浆中亚胺培南C_(40%)T浓度高于1 g组,C_(100%)T浓度低于1 g组(P<0.05);500 mg组患者100%T>MIC_(50)和40%T>4×MIC_(50)的PD达标率分别为56.25%和81.25%,1 g组患者100%T>MIC_(50)和40%T>4×MIC_(50)的PD达标率分别为70.37%和85.19%,两组无显著差异;500 mg组患者治疗的有效率为68.75%,1 g组患者治疗的有效率为74.07%,两组无显著差异;500 mg剂量和1 g剂量亚胺培南C_(100%)T和C_(40%)T浓度均与临床治疗疗效呈正相关关系(P<0.05)。结论500 mg和1 g亚胺培南对肺炎克雷伯菌肺部感染患者的PD达标率无差异,但其血药浓度与临床疗效具有显著的相关性。OBJECTIVE To analyze the relationship between blood imipenem concentration,pharmacodynamic(PD)compliance rate of the patients with Klebsiella pneumoniae pulmonary infection and clinical efficacy.METHODS A total of 43 patients with K.pneumoniae pulmonary infection who were treated in the First Affiliated Hospital of Hainan Medical College from Jun.2018 to Dec.2019 were enrolled in the study,and the drug susceptibility testing was performed for the clinical isolates of K.pneumoniae so as to detect the minimum inhibitory concentration(MIC).The patients were divided into the 500 mg group with 16 cases and the 1 g group with 27 cases according to the dosage of imipenem,the venous blood specimens were collected after intravenous drip of imipenem for 4 times,the concentrations of imipenem at 40%time point(C_(40%)T)and 100%time point(C_(100%)T)were determined by high performance liquid chromatography,and the clinical curative effects were evaluated after the treatment for 7 days;Pearson correlation analysis was performed for the correlation between the blood imipenem concentration and the clinical efficacy.RESULTS MIC_(50)of imipenem against K.pneumoniae was 0.015~4μg/ml,MIC_(50)50 was 1μg/ml;the concentration of plasma imipenem C_(40%)T of the 500 mg group was significantly higher than that of the 1 g group,while the concentration of C_(100%)T of the 500 mg group was significantly lower than that of the 1 g group(P<0.05).The target rates of 100%T>MIC_(50)and 40%T>4×MIC_(50)PD of the 500 mg group were respectively 56.25%and 81.25%,the target rates of 100%T>MIC_(50)and 40%T>4×MIC_(50)PD of the 1 g group were respectively 70.37%and 85.19%,and there were no significant differences.The effective rate of treatment was 68.75%in the 500 mg group,74.07%in the 1 g group,and there was no significant difference between the two groups.The C_(100%)T and C_(40%)T concentrations in the 500 mg group and the 1 g group were positively correlated with the clinical therapeutic effects(P<0.05).CONCLUSION There is no significant differenc

关 键 词：肺部感染 亚胺培南 血药浓度 药效学 

分 类 号：R563.1[医药卫生—呼吸系统]