摘要
目的评价哌拉西林/他唑巴坦、头孢哌酮/舒巴坦及亚胺培南延长、持续、传统输注给药方案对产超广谱β-内酰胺酶(ESBLs)细菌的药效学。方法测定医院产ESBLs菌株(大肠埃希菌、肺炎克雷伯菌)的MIC,应用蒙特卡洛模拟(MCS)分析比较哌拉西林/他唑巴坦、头孢哌酮/舒巴坦及亚胺培南延长输注(PI)、持续输注(CI)和传统输注(TI)方案的药效学目标到达。结果对于传统输注给药方案,只有亚胺培南3种方案获得了>90%的累积反应分数(CFR),其次为哌拉西林/他唑巴坦4.5 g 1次/6 h和4.5 g 1次/8 h方案,分别为84.3%、63.7%延长输注方案,亚胺培南的3种给药方案均获得了100.0%的CFR,其次哌拉西林/他唑巴坦4.5 g 1次/6 h为95.7%,24 h持续输注时,只有亚胺培南的给药方案能达到>90%的CFR;哌拉西林/他唑巴坦9 g CI和13.5 gCI获得72.9%、76.6%CFR;然而,头孢哌酮/舒巴坦的任何给药方案获得的CFR均<60%。结论亚胺培南仍然为治疗产ESBLs细菌的最佳药物,哌拉西林/他唑巴坦的延长输注和持续输注较传统方案更优,以高剂量延长输注方案最优,可以作为经验治疗方案。
OBJECTIVE To evaluate pharmacodynamic of prolonged（PI）,continuous（CI） and traditional infusion（TI） regimens of piperacillin/tazobactam,cefoperazone/sulbactanm and imipenem against extended spectrum β-lactamases（ESBLs） producing isolates.METHODS The minimum inhibitory concentrations for Escherichia coli and Klebsiella pneumoniae that produced ESBLs in hospital were determined from Jan 2008 to Jun 2008.Monte Carlo simulation was performed to calculate pharmacodynamic target attainment for PI,CI and TI regimens of piperacillin/tazobactam,cefoperazone/sulbactam and imipenem.RESULTS Versus TI the three regimens of imipenem achieved cumulative fraction of response（CFR） of greater than 90%,followed by piperacillin-tazobactam 4.5g every 6 hours（84.3%） and 4.5g every 8 hours（63.7%）,respectively.Versus PI,all imipenem regimens yielded CFRs of 100.0%,followed by piperacillin/tazobactam 4.5g every 6 hours（95.7%）.Versus CI,only imipenem regimens of 1.5g CI and 2g CI attained optimum CFRs,followed by piperacillin/tazobactam regimens of 9g CI（72.9%） and 13.5g CI（76.6%）,respectively.However,no regimen of cefoperazone/sulbactam achieved CFR of greater than 60%.CONCLUSIONS The imipenem remains the first-line drug for infections caused by ESBLs producing bacteria.The PI and CI regimens for piperacillin/tazobactam are better than TI regimen.And the high-dose regimen of PI for piperacillin/tazobactam is the best and should be recommended as empirical therapy against ESBLs-producing bacteria.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2010年第14期2110-2113,共4页
Chinese Journal of Nosocomiology
基金
浙江省医药卫生科技计划(2006B116)
宁波市自然科学基金(2006A610037)
