Optimization of β lactam antibiotics regimens against bloodstream infection caused by Pseudomonas aeruginosa

Abstract

目的制定某院B内酰胺类在铜绿假单胞菌(PA)血流感染中的治疗方案。方法收集某院2015年至2016年血培养中铜绿假单胞菌共64株,测定B内酰胺类(哌拉西林/他唑巴坦,头孢他啶,头孢吡肟,亚胺培南,美罗培南)对铜绿假单胞菌的最低抑菌浓度(MIC)。用蒙特卡洛模拟计算多种治疗方案的达标率(PrA)和累积反应分数(CFR)。结果经验治疗时,哌拉西彬他唑巴坦4.5g(q6h),头孢他啶2g(q8h),头孢吡肟2g(q8h),亚胺培南1g(q6h),美罗培南1g(q8h,q6h),共6种方案的CFR值〉90%;目标治疗时,当MIC≥16μg·mL^-1时,模拟的所有方案达标概率值均(90%。结论铜绿假单胞菌血流感染经验治疗时可选哌拉西林/他唑巴坦4.5g(q6h),头孢他啶2g(q8h),头孢吡肟2g(q8h),亚胺培南1g(q6h),美罗培南1g(q8h,q6h);目标治疗当MIC≥16μg·mL^-1时需要联合用药。Objective To develop the regimens of β lactam antibiotics against bloodstream infection caused by Pseudomonas aeruginosa (PA). Methods A total of 64 strains of PA cultured by blood from 2015 to 2016, the minimum inhibitory concentration (MIC)of piperacillin/ tazobactam ( TZP ), ceflazidine ( CAZ ), cefepime ( FEP ), imipenem (IPM), meropenem(MEM) against PA were determined, probability of talget attainment ( PTA ) and cumulative fraction of response (CFR) were calculated by monte carlo simulation. Results CFRs of TZP4. 5 g (q6 h), CAZ 2 g(q8 h), FEP2 g(q8 h), IPM 1 g(q6 h) and MEM 1 g (q8 h, q6 h) were 〉 90% at experiential therapy, when MIC ≥16 μg · mL-1 at target therapy, PTA of all regimens 〈 90%. Conclusion when the patient was PA bloodstream infection, we suggest TZP 4. 5 g (q6 h), CAZ2 g(q8 h), FEP2 g(q8 h), IPM 1 g(q6 h) and MEM 1 g(q8 h, q6 h) regimens at experiential therapy, and combined with other antibiotics at target therapy when MIC ≥ 16 μg · mL-1

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