基于PK/PD模型与蒙特卡洛模拟对大肠埃希菌所致脓毒症休克患者抗感染治疗方案的优化分析  

Optimization Analysis of Anti-infective Treatment Plans foRSeptic Shock Patients Caused by Escherichia coli Based on PK/PD Model and Mote Carlo Simulation

作　　者：王莹[1] 姚银辉[1] 王领弟[1] 胡俊辉[1] 臧亚茹[1] WANG Ying;YAO Yin-hui;WANG Ling-di;HU Jun-hui;ZANG Ya-ru(Pharmacy Department of Affiliated Hospital of Chengde Medical University,Chengde Hebei 067000,China)

机构地区：[1]承德医学院附属医院药学部,河北承德067000

出　　处：《抗感染药学》2023年第6期597-600,共4页Anti-infection Pharmacy

基　　金：河北省药学会医院药学科研项目(编号:2020-Hbsyxhqn0030)。

摘　　要：目的:基于药动学(pharmacokinetics,PK)/药效学(pharmacodynamics,PD)模型和蒙特卡洛模拟(Mote Carlo simulation,MCS),分析大肠埃希菌所致脓毒症休克患者抗感染治疗方案的优化过程,为临床感染患者构建合理有效的治疗方案提供参考。方法:一患者因不明原因发热入院,初步诊断为尿路感染和脓毒症休克。入院后第一时间完善了相关实验室检查,随后采用PK/PD模型和MCS依据微生物培养结果及其药敏试验确定最优的抗感染治疗方案。结果:入院第3天,微生物培养检出大肠埃希菌,随后的药敏试验提示其对美罗培南、亚胺培南敏感,而对头孢哌酮-舒巴坦钠中介;采用PK/PD模型和MCS对拟定的几个抗感染治疗方案进行分析,结果发现美罗培南(1 g,q8h)和亚胺培南(0.5 g,q6h)的达标概率(probability of target attainment,PTA)均为100.00%,而头孢哌酮-舒巴坦钠(3 g,q12h)的PTA为1.14%,头孢哌酮-舒巴坦钠(3 g,q8h)的PTA为7.65%;最终,临床选择了美罗培南(1 g,q8h)治疗,1周后患者的感染指征基本消失。结论:PK/PD模型和MCS两个工具可以较好地帮助临床药师预测抗感染治疗方案的可能效果,从而更好地协助医生制定和优化治疗方案,进而最大程度保证患者的治疗效果。Objective:To analyze the optimization process of anti-infective treatment plans foRseptic shock patients caused by Escherichia coli based on pharmacokinetics(PK)/pharmacodynamics(PD)model and Mote Carlo simulation(MCS),so as to provide reference foRconstructing reasonable and effective treatment plans foRclinical infection patients.Methods:One patient was admitted with unexplained feveRand initially diagnosed with urinary tract infection and septic shock.AfteRadmission,the patient underwent relevant laboratory tests immediately,and the optimal anti-infective treatment plan was determined with PK/PD model and MCS based on microbial culture results and drug susceptibility tests.Results:On the third day of admission,Escherichia coli was detected in microbial culture,subsequent drug suscepti‐bility tests showed that the patient was sensitive to meropenem and imipenem,but mediated by cefoperazone-sulbactam sodium.PK/PD model and MCS were used to analyze several proposed anti-infective treatment plans,and the results showed that the probability of target attainment(PTA)of both meropenem(1 g,q8h)and imipenem(0.5 g,q6h)was 100.00%,while the PTA of cefoperazone-sulbactam sodium(3 g,q12h)was 1.14%,and the PTA of cefoperazone-sulbactam sodium(3 g,q8h)was 7.65%.Finally,meropenem(1 g,q8h)was chosen foRclinical treatment,and the infection indications of the patient basically disappeared afteRone week.Conclusion:The two tools of PK/PD model and MCS can effectively help clinical pharmacists predict the possible effects of anti-infective treatment plans,thereby better assisting doctors in formulating and optimizing treatment plans,and thus maximizing the treatment effect of patients.

关 键 词：PK/PD模型 蒙特卡洛模拟 脓毒症休克 大肠埃希菌 

分 类 号：R969.3[医药卫生—药理学] R97[医药卫生—药学]