摘要
目的:评估重症肺炎患者使用亚胺培南后血药浓度监测、临床有效率、细菌清除率,分析谷浓度与临床疗效的相关性,为亚胺培南个体化用药提供参考。方法:前瞻性收集某院重症医学科(ICU)使用亚胺培南抗感染治疗的重症肺炎患者,在用药4~5剂后测定亚胺培南血药谷浓度,记录患者的基础疾病、感染性诊断、病原学分布,分析亚胺培南谷浓度达标情况,并进行临床疗效评估。结果:共入选43例患者,亚胺培南日剂量为2.00(1.90,3.00)g,疗程(9.31±4.38)d,谷浓度为2.41(0.74,3.94)mg·L^(-1),目标性治疗谷浓度的达标率为31.91%,经验性治疗谷浓度的达标率为68.42%,肌酐清除率高的患者谷浓度偏低(P<0.001)。24例患者为革兰阴性菌目标性治疗,共检出47株革兰阴性菌,其中13株(27.66%)为耐碳青霉烯病原菌。临床有效率54.17%(13/24),革兰阴性菌清除率42.55%(20/47),不良反应发生率11.63%(5/43)。临床治愈组的谷浓度达标率较无效组高,差异有统计学意义(50.00%vs.16.00%,P=0.013)。培养出耐碳青霉烯病原菌患者的谷浓度较碳青霉烯敏感患者更高[(2.88±2.06)mg·L^(-1)vs.1.12(0.54,3.58)mg·L^(-1),P=0.049],但谷浓度达标率显著低于碳青霉烯敏感组(0.00%vs.47.06%,P=0.007)。结论:危重症感染患者亚胺培南谷浓度达标率低,谷浓度与肌酐清除率具有相关性。临床疗效与谷浓度达标率相关,耐碳青霉烯组MIC升高与谷浓度未达标显著相关。
Objective:To evaluate the therapeutic drug monitoring(TDM),clinical efficacy,and bacterial clearance rate of imipenem treatment in patients with severe pneumonia,in order to analyze the correlation between trough concentration and clinical efficacy,and to provide a reference for individualized use of imipenem.Methods:Severe pneumonia patients with imipenem treatment in intensive care unit(ICU)were prospectively collected in our study.The blood trough concentrations of imipenem were determined after 4-5 doses of imipenem.The basic diseases,infectious diagnosis and etiological distribution of the patients were recorded,and the target attainment of trough concentrations was analyzed,and the clinical efficacy was evaluated.Results:A total of 43 patients were enrolled.The daily dose of imipenem was 2.00(1.90,3.00)g,the course of imipenem treatment was(9.31±4.38)days,the trough concentration was 2.41(0.74,3.94)mg·L^(-1),and target attainment of trough concentrations in target treatment group and empirical therapy group was 31.91%and 68.42,respectively.Patients with higher creatinine clearance achieved lower trough concentrations(P<0.001).A total of 47 strains of gram-negative bacteria were cultured in 24 patients.Among them,13 strains(27.66%)were carbapenem resistant pathogens.The clinical efficacy rate was 54.17%(13/24),gram-negative bacteria clearance rate was 42.55%(20/47),and the adverse reaction rate was 11.63%(5/43).The proportion of trough concentration>MIC in cured group was significantly higher than that of the invalid group(50.00%vs.16.00%,P=0.013).The trough concentration of imipenem in patients cultured with carbapenems resistant bacteria was significantly higher than that of patients with carbapenems sensitive bacteria[2.88±2.06 vs.1.12(0.54,3.58),P=0.049],but the rate of trough concentration>MIC was significantly lower(0.00%vs.47.06%,P=0.007).Conclusion:The rate of trough concentrations>MIC or 1 mg·L^(-1)in critically infected patients was low,and trough concentration was correlated with creatinine clearance.The clinical efficacy was related to target attainment of trough concentrations,and the increase of MIC was significantly correlated with the trough concentration not achieve target attainment.
作者
徐金慧
唐莲
石璐
陈芳
张曦
庄智伟
陆件
袁云龙
刘馨
刘纪松
孙坚彤
周琴
Xu Jinhui;Tang Lian;Shi Lu;Chen Fang;Zhang Xi;Zhuang Zhiwei;Lu Jian;Yuan Yunlong;Liu Xing;Liu Jisong;Sun Jiantong;Zhou Qin(Department of Pharmacy,the Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou 215002,China;Department of Intensive Care Unit,the Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou 215002,China;Department of Clinical Laboratory,the Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou 215002,China;Hangzhou Baichen Medical Laboratory)
出处
《药物流行病学杂志》
CAS
2021年第3期164-169,共6页
Chinese Journal of Pharmacoepidemiology
基金
苏州市科技局项目(编号:SYSD2019189)
江苏省药学会医院药学科研项目(编号:A201915)。
关键词
亚胺培南
重症肺炎
血药浓度
临床疗效
细菌清除率
Imipenem
Severe pneumonia
Blood drug concentration
Clinical efficacy
Bacterial clearance
