ICU铜绿假单胞菌感染中比阿培南给药方案的优化

摘要

目的 为我院ICU铜绿假单胞菌感染患者比阿培南的合理使用提供依据.方法 收集我院64株铜绿假单胞菌(PA),采用二倍琼脂平板稀释法测定比阿培南的最低抑菌浓度(MIC),蒙特卡洛方法计算比阿培南4种方案在传统短时滴注(0.5h)、延时滴注和持续滴注方案情况下的达标概率(PTA)和累积反应分数(CFR).结果 所有传统短时滴注方案对PA的CFR均＜90％;延时滴注方案中,比阿培南300mg,q6h,静滴4h方案对PA的CFR为90.5％,其余均＜90％,持续滴注方案的CFR均＞90％;对多重耐药(MDR) PA,所有方案的CFR均＜90％;对非多重耐药的铜绿假单胞菌(non MDR-PA),300mg,q6h,静滴3h,4h,300mg,q8h,静滴4h和所有持续滴注方案的CFR＞90％.结论 我院ICU患者PA感染时不推荐比阿培南传统短时滴注方案,建议使用最大剂量,且滴注时间≥4h,持续滴注仍需进一步研究;对MDR-PA应换用或联用其他抗菌药物.%Objective To evaluate rational dosage regimens of biapenem against Pseudomonas aeruginosa (PA) infections in ICU patients in our hospital.Methods Sixty four strains of PA were collected.The MICs of biapenem against bacteria were measured by the double broth dilution method.Four regimens (300mg,ql2h;300mg,q8h;300mg,q6h;600mg,ql2h) were simulated by using the monte carlo simulation at traditional short infusion,extended infusion,continuous infusion,and then the PTAs and CFRs were calculated.Results The CFRs of all traditional regimens were less than 90％ against PA.For EI,the CFR of biapenem 300mg q6h over 4h was 90.5％ while other regimens were less than 90％;CFRs of all the solutions by CI were larger than 90％.However,CFRs of all the solutions were less than 90％ against MDR-PA.For non MDR-PA strains,CFRs of biapenem 300mg q6h over 3h or 4h,q8h over 4h and every CI regimens were larger than 90％.Conclusion Biapenem SI regimens were not recommended for PA infections for experiential therapy in ICU population in our hospital.It suggested EI by maximum dose with over 4h infusion,CI regimens needs more researches;some other antibiotics should be used or combined for MDR-PA infection.