蒙特卡洛模拟评价ICU鲍曼不动杆菌感染中比阿培南的给药方案

朱建国,杭永付,顾继红,薛领,高杰,谢诚,张险峰,缪丽燕

中国药学杂志 ›› 2017, Vol. 52 ›› Issue (24) : 2218-2222.

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中国药学杂志 ›› 2017, Vol. 52 ›› Issue (24) : 2218-2222. DOI: 10.11669/cpj.2017.24.017
论著

蒙特卡洛模拟评价ICU鲍曼不动杆菌感染中比阿培南的给药方案

  • 朱建国a,杭永付a,顾继红a,薛领a,高杰a,谢诚a,张险峰b,缪丽燕a*
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Evaluation of Therapeutic Regimens of Biapenem Against Acinetobacter Baumannii Infection in ICU Subjects by Monte Carlo Simulation

  • ZHU Jian-guoa, HANG Yong-fua, GU Ji-honga, XUE Linga, GAO Jiea, XIE Chenga, ZHANG Xian-fengb, MIAO Li-yana*
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摘要

目的 为ICU患者鲍曼不动杆菌感染(ABA)合理使用比阿培南提供依据。方法 收集我院105株ABA菌株,采用2倍琼脂稀释法检测比阿培南的最低抑菌浓度(MIC),运用蒙特卡洛模拟(MCS)比阿培南在传统短时滴注(0.5 h)、延时滴注(3和4 h)和两步法(1.5~5.5 h)滴注方式下4种给药方案300 mg,q12 h/q8 h/q6 h;600 mg,q12 h的达标概率(PTA)和累积反应分数(CFR)。结果 3种滴注方式的4种比阿培南方案对ABA的CFR均<90%;对非多重耐药的鲍曼不动杆菌(non MDR-ABA),仅300 mg,q12 h,静滴0.5 h和两步法静滴1.5 h的CFR<90%,其余方案的CFR均大于90%;在MIC≥2 mg·L-1时,所有方案的PTA<90%;在达标情况下,延时滴注与两步法在滴注时间类似时具有相似的PTA和CFR,且均显著优于短时滴注法。结论 我院ICU患者ABA感染时,经验治疗应避免单用比阿培南,目标治疗或联合用药时应根据药敏结果,优先选择延时滴注或两步法。

Abstract

OBJECTIVE To provide the basis for biapenem against Acinetobacter baumannii infection in ICU patients in our hospital. METHODS One hundred-five strains of ABA were collected. The MICs of biapenem against bacteria were measured by double broth dilution method. Four therapeutics regimens (0.3 g, q12 h; 0.3 g, q8 h; 0.3 g, q6 h; 0.6 g, q12 h) in traditional short-time infusion, extended infusion(3, 4h) and two-step infusion(1.5-5.5 h) were simulated by using the Monte Carlo simulation, then the PTAs and CRFs were calculated. RESULTS CFRs of all treatments of biapenem against ABA infection in ICU subjects were <90%; but for non MDR-ABA, all biapenem regimens’ CFR were >90% except biapenem 0.3g, q12 h(0.5 h) and 0.3 g, q12 h (two-step infusion for 1.5h). PTAs of the whole regimens were >90% when MIC≥2 mg·L-1. Extended infusion and two-step infusion got the similar PTAs and CFRs with a similar time when the regimens obtained target, more than short infusion obviously. CONCLUSION Biapenem alone should avoid for ABA infection as expiry therapy in ICU population in our hospital. Extended infusion and two-step infusion should be priority selection as target therapy according to sensitivity test.

关键词

比阿培南 / 鲍曼不动杆菌 / 蒙特卡洛模拟 / 两步法

Key words

biapenem / ABA / Monte Carlo simulation / two-steps infusion therapy

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导出引用
朱建国,杭永付,顾继红,薛领,高杰,谢诚,张险峰,缪丽燕. 蒙特卡洛模拟评价ICU鲍曼不动杆菌感染中比阿培南的给药方案[J]. 中国药学杂志, 2017, 52(24): 2218-2222 https://doi.org/10.11669/cpj.2017.24.017
ZHU Jian-guo, HANG Yong-fu, GU Ji-hong, XUE Ling, GAO Jie, XIE Cheng, ZHANG Xian-feng, MIAO Li-yan. Evaluation of Therapeutic Regimens of Biapenem Against Acinetobacter Baumannii Infection in ICU Subjects by Monte Carlo Simulation[J]. Chinese Pharmaceutical Journal, 2017, 52(24): 2218-2222 https://doi.org/10.11669/cpj.2017.24.017
中图分类号: R969.3   

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基金

苏州市科技局项目资助(SYSD2013142)
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