摘要
目的:优化重症感染患者耐甲氧西林金黄色葡萄球菌(MRSA)感染的万古霉素给药方案。方法:收集某院2017年1月~2018年9月重症监护病房(ICU)中MRSA对万古霉素的耐药监测报告,对不同剂量万古霉素的给药方案进行蒙特卡洛模拟,计算不同给药方案的达标概率(PTA)和累积反应分数(CFR),评价疗效,优化出最佳给药方案。结果:对于老年患者,万古霉素治疗MRSA肺部感染和腹腔感染推荐的给药方案均为2 500 mg·d^-1,治疗血流感染和混合感染推荐的给药方案均为2000 mg·d^-1;对于成年患者,万古霉素治疗MRSA肺部感染和血流感染推荐的给药方案均为2 500 mg·d^-1,治疗腹腔感染和混合感染推荐的给药方案均为3 000 mg·d^-1。结论:ICU中MRSA感染时,可根据患者不同感染部位和不同年龄人群进行经验性治疗,目标治疗除了根据最低抑菌浓度(MIC)外,也可结合不同感染部位和人群来调整给药方案,进行个体化治疗。
Objective: To optimize the administration regimen of vancomycin against methicillin-resistant staphylococcus aureus( MRSA) infection in patients with severe infections. Methods: The surveillance reports of MRSA resistance to vancomycin in intensive care unit( ICU) from 2017 to the first three quarters of 2018 were collected. Different vancomycin dosage regimens were simulated by using Monte-carlo simulation,and the probability of target attainment( PTA) and cumulative fraction of response( CFR) were calculated. The efficacy was evaluated and the dosage regimen was optimized. Results: For elderly patients,the recommended dosage regimen of vancomycin in the treatment of MRSA pulmonary and abdominal infections was 2 500 mg·d^-1,and that for the treatment of bloodstream and mixed infections was 2 000 mg· d^-1. For adult patients,the recommended dosage regimen for the treatment of MRSA pulmonary and blood influenza infections was 2 500 mg·d^-1,and that for the treatment of abdominal and mixed infections was 3 000 mg·d^-1.Conclusion: Experiential treatment can be carried out according to different sites and different ages of patients with MRSA infection in ICU. In addition to the minimum inhibitory concentration( MIC) value,the targeted treatment should also be combined with different infection sites and groups of patients to adjust the drug regimen and conduct individualized treatment.
作者
刘峰
邓贵新
卢兰芬
刘锐锋
Liu Feng;Deng Guixin;Lu Lanfen;Liu Ruifeng(Department of Pharmacy,Zhongshan People's Hospital,Guangdong Zhongshan 528403,China;Department of Laboratory,Zhongshan People's Hospital,Guangdong Zhongshan 528403,China)
出处
《中国药师》
CAS
2020年第4期688-692,共5页
China Pharmacist
基金
广东省中山市科技局项目(编号:2019B1076)。
