| 孙璐,孟丹丹,董海燕.应用蒙特卡罗模拟优化亚胺培南在重症病人鲍曼不动杆菌感染中的给药方案[J].安徽医药,2022,26(10):2106-2110. |
| 应用蒙特卡罗模拟优化亚胺培南在重症病人鲍曼不动杆菌感染中的给药方案 |
| Evaluation of imipenem dosing regimen for Acinetobacter Baumannii infection in critically ill patients using monte carlo simulation |
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| DOI：10.3969/j.issn.1009-6469.2022.10.046 |
| 中文关键词: 亚胺培南 重症病人 蒙特卡罗模拟 药动学 /药效学 鲍曼不动杆菌 |
| 英文关键词: Imipenem Critically ill patients Monte Carlo simulation Pharmacokinetics/Pharmacodynamics Acinetobacter baumannii |
| 基金项目:西安市科技计划项目［ 20YXYJ0001(5)］；西安交通大学第一附属医院基金( 2018MS-13、2019ZYTS-01) |
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| 中文摘要: |
| 目的优化亚胺培南在接受连续肾脏替代治疗(continuous renal replacement therapy，CRRT)和非 CRRT重症病人鲍曼不动杆菌感染中的给药方案。方法依据从 1989年 1月至 2019年 12月检索到的亚胺培南在重症病人中的药动学数据，分别以血浆中游离药物浓度超过最低抑菌浓度(MIC)的时间比例(fT>MIC)和 fT>4MIC为目标值，应用蒙特卡罗模拟法评估不同给药方案下 CRRT病人及非 CRRT病人的达标概率(PTA)探索最佳给药方案。结果以 40%fT>4MIC为目标值，当 MIC≤2 mg/L时， CRRT病人和非 CRRT病人 0.5 g、6小时 /次， 0.75 g、6小时/次，0，.75 g、8小时 /次， 1g、6小时 /次和 1g、8小时 /次的给药方案的 PTA均能达到 90%以上；当 MIC为 4 mg/L或 8 mg/L时， CRRT病人和非 CRRT病人 1g、6小时 /次给药方案的 PTA能达到 90%以上。以 100%fT> MIC为目标值，当 MIC≤2 mg/L时， CRRT病人和非 CRRT病人 0.75 g、6小时 /次和 1g、6小时 /次的给药方案的 PTA能达到 90%以上；当 MIC为 4 mg/L或 8 mg/L时，仅 CRRT病人 1g、6小时/次给药方案的 PTA能达到 90%以上。结论对于鲍曼不动杆菌感染的 CRRT重症病人，当 MIC≤2 mg/L时，无论以 40%fT>4MIC或 100%fT>MIC为目标值，给予 0.5 g、6小时 /次即可获得较高 PTA(> 90%)；与 CRRT重症病人相比，非 CRRT重症病人鲍曼不动杆菌感染时则需要提高亚胺培南剂量以期达到最佳疗效。 |
| 英文摘要: |
| Objective To optimize the dosage regimens of Imipenem using Monte Carlo simulation in critically ill patients undergo.ing continuous renal replacement therapy (CRRT) and non-CRRT in Acinetobacter baumannii infections.Methods Based on the phar.macokinetic data of imipenem in critically ill patients retrieved from January 1989 to December 2019, the time ratio of free drug con. centration over minimum inhibitory concentration (MIC) in Plasma f T>MIC and f T> 4MIC was the target value. The PTA of CRRT pa. tients and non-CRRT patients under different dosing regimens was evaluated by Monte Carlo method, and the best dosing regimen was explored.Results Taking 40 % fT > 4MIC as the target value, when MIC ≤ 2 mg/L, the PTA of administration regimen (0.5 g q6h,0.75 g q6h, 0.75 g q8h, 1 g q6h and 1 g q8h) for CRRT patients and non-CRRT patients could reach more than 90 %. When MIC=4 mg/L or 8 mg/L, the PTA of administration regimen (1 g q6h) for CRRT patients and non-CRRT patients could reach more than 90 %. Tak. ing 100 % fT > MIC as the target value, when MIC≤ 2 mg/L, the PTA of administration regimen (0.75 g q6h and 1 g q6h) for CRRT pa.tients and non-CRRT patients could reach more than 90 %; when MIC=4 mg/L or 8 mg/L, only the PTA of 1 g q6h administration regi.men for CRRT patients can reach more than 90 %.Conclusion For critically ill CRRT patients with Acinetobacter baumannii infec. tion, when MIC≤2mg/L, whether 40 % fT>MIC or 100 % fT>MIC is used as the target value, both for safety, 0.5g q6h can achieve effec.tive treatment; compared with severe patients with CRRT, non-severe patients with Acinetobacter baumannii infection need to increase the dose of Imipenem in order to achieve the best effect. |
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