摘要
目的 探讨肾功能亢进患者美罗培南药动学(PK)/药效学(PD)达标情况及谷浓度影响因素,为肾功能亢进患者合理使用美罗培南提供参考。方法 采用回顾性研究方法,收集某院2018年1月-2021年12月使用美罗培南并监测浓度的肾功能亢进患者的资料,分析美罗培南PK/PD达标情况,采用多重线性回归分析探讨美罗培南谷浓度的影响因素。结果 共58例患者纳入研究,谷浓度为1.35[0.23,1.86]μg·mL^(-1),以100%fT>最低抑菌浓度(MIC)为PK/PD靶值,达标率为20.69%;日剂量<3 g·d^(-1)的达标率为8.70%,≥3 g·d^(-1)的达标率为31.43%。当MIC为0.5、1、2、4、8μg·mL^(-1)时,PK/PD达标率分别为62.07%、48.28%、20.69%、8.62%、0。多因素分析显示日剂量是美罗培南谷浓度的独立影响因子。结论 肾功能亢进患者美罗培南PK/PD达标率较低,即使MIC≤0.5μg·mL^(-1),常规剂量也难以达理想PK/PD,临床应尽早识别肾功能亢进,尽早行治疗药物监测,以指导肾功能亢进患者美罗培南的用药方案。
Objective To explore the pharmacokinetics/pharmacodynamics(PK/PD)parameters and influencing factors in patients with augmented renal clearance(ARC)to provide the basis for the rational use of meropenem.Methods Using the method of retrospective study,the patients with increased renal clearance who used meropenem monitored the concentration from January 2018 to December 2021.The PK/PD parameters of meropenem were analyzed,and multiple linear retrospective analyses discussed the influencing factors of meropenem valley concentration.Results A total of 58 patients were included in the study,and the trough concentration was 1.35[0.23,1.86]μg·mL^(-1),taking 100%fT>MIC as PK/PD target value,the compliance rate was 20.69%.The compliance rate of daily dose<3 g·d^(-1) was 8.70%,and≥3 g·d^(-1) was 31.43%,the difference was statistically significant.With MIC of 0.5,1,2,4,and 8μg·mL^(-1),PK/PD compliance rates were 62.07%,48.28%,20.69%,8.62%and 0.Respectively.Multiple linear retrospective analyses showed that dose was an independent factor affecting meropenem valley concentration.Conclusion The PK/PD compliance rate of meropenem in patients with augmented renal clearance is low,even if MIC≤0.5μg·mL^(-1),the routine dose is difficult to achieve the ideal PK/PD,so the clinical should recognize ARC and perform TDM as soon as possible,and use TDM to guide the medication regimen of meropenem for ARC patients.
作者
陈沈珏
李昕
伍敏益
刘丽华
何鑫
李美云
CHEN Shenjue;LI Xin;WU Minyi;LIU Lihua;HE Xin;LI Meiyun(Department of Pharmacy,the Third Hospital of Changsha City,Changsha 410015,China;Antibiotic Clinical Application Research Institute of Changsha City,Changsha 410015,China;Department of Intensive Care Unit,the Third Hospital of Changsha City,Changsha 410015,China)
出处
《医药导报》
CAS
北大核心
2024年第1期122-126,共5页
Herald of Medicine
基金
湖南省感染性疾病合理用药临床医疗技术示范基地基金资助项目(2016SK4008)
湖南省卫生健康委课题(202113011891)。
关键词
美罗培南
肾功能亢进
血药浓度
药动学
药效学
Meropenem
Augmented renal clearance
Blood concentration
Pharmacokinetics
Pharmacodynamics
