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目的 利用蒙特卡洛模拟法优化舒巴坦在重症连续性静脉-静脉血液滤过患者中的给药方案。方法 收集舒巴坦在重症连续性静脉-静脉血液滤过患者的药动学/药效学(PK/PD)参数与鲍曼不动杆菌最低抑菌浓度(MIC)，进行5 000次蒙特卡洛模拟，评估给药方案的合理性。鲍曼不动杆菌的PK/PD靶值为40%f T> MIC和60%f T> MIC。结果 对于鲍曼不动杆菌引起的重症连续性静脉-静脉血液滤过患者，当MIC=4 mg·L-1时，推荐给药方案分别为0.5 h传统静脉输注1 g,q8h和1 g,q6h。在2种PK/PD靶值下推荐的经验性给药方案分别是24 h连续性静脉输注9 g,q24h和12 g,q24h。结论 针对敏感率较低的鲍曼不动杆菌菌株，推荐采用3 h延长静脉输注或24 h连续性静脉输注的给药方案。
Abstract：AIM To optimize sulbactam regimens for intensive care unit(ICU) continuous veno-venous hemofiltration(CVVH) patients using the Monte Carlo simulation method.METHODS Pharmacokinetic/pharmacodynamic(PK/PD) parameters of sulbactam in ICU CVVH patients and the minimum inhibitory concentration(MIC) of Acinetobacter baumannii(AB) were collected.Monte Carlo simulations(n=5 000) were conducted to assess the rationality of the dosing regimen.The PK/PD target values for AB were 40% fT> MIC and 60% fT> MIC.RESULTS For ICU patients with CVVH caused by AB,when the MIC was 4 mg·L-1,the recommended dosing regimens were traditional intravenous infusions of 1 g,q8h and 1 g,q6h(with each dose infused over 0.5 h).The empiric dosing regimens recommended under 2 PK/PD target values were 24-hour continuous intravenous infusion of 9 g,q24h and 12 g,q24h.CONCLUSION It is recommended to use either a 3-hour extended intravenous infusion or a 24-hour continuous intravenous infusion regimen for the treatment of AB strains with lower susceptibility.
[1] VIEHMAN J A, NGUYEN M H, DOI Y. Treatment options for carbapenem-resistant and extensively drug-resistant Acinetobacter baumannii infections[J]. Drugs, 2014, 74(12):1315.
[2] YOKOYAMA Y, MATSUMOTO K, IKAWA K, et al. Population pharmacokinetic-pharmacodynamic target attainment analysis of sulbactam in patients with impaired renal function:dosing considerations for Acinetobacter baumannii infections[J]. J Infect Chemother, 2015, 21(4):284.
[3] RODRíGUEZ-HERNáNDEZ M J, CUBEROS L, PICHARDO C, et al. Sulbactam efficacy in experimental models caused by susceptible and intermediate Acinetobacter baumannii strains[J].J Antimicrob Chemother, 2001, 47(4):479.
[4] ROHDE B, WERNER U, et al. Pharmacokinetics of mezlocillin and sulbactam under continuous veno-venous hemodialysis(CVVHD)in intensive care patients with acute renal failure[J]Eur J Clin Pharmacol, 1997,53(2):111.
[5] REITBERG D P, MARBLE D A, SCHULTZ R W, et al.Pharmacokinetics of cefoperazone(2.0 g)and sulbactam(1.0 g)coadministered to subjects with normal renal function, patients with decreased renal function, and patients with end-stage renal disease on hemodialysis[J]. Antimicrob Agents Chemother,1988, 32(4):503.
[6] GAO C L, TONG J, YU K J, et al. Pharmacokinetics of cefoperazone/sulbactam in critically ill patients receiving continuous venovenous hemofiltration[J]. Eur J Clin Pharmacol,2016, 72(7):823.
[7] WANG H, ZHANG B, NI Y X, et al. Pharmacodynamic target attainment of seven antimicrobials against Gram-negative bacteria collected from China in 2003 and 2004[J]. Int J Antimicrob Agents, 2007, 30(5):452.
[8] YOKOYAMA Y, MATSUMOTO K, IKAWA K, et al.Pharmacokinetic/pharmacodynamic evaluation of sulbactam against Acinetobacter baumannii in in vitro and murine thigh and lung infection models[J]. Int J Antimicrob Agents, 2014, 43(6):547.
[9] VALTONEN M, TIULA E, BACKMAN J T, et al. Elimination of meropenem during continuous veno-venous haemofiltration and haemodiafiltration in patients with acute renal failure[J]. J Antimicrob Chemother, 2000, 45(5):701.
[10] VALTONEN M, TIULA E, TAKKUNEN O, et al. Elimination of the piperacillin/tazobactam combination during continuous venovenous haemofiltration and haemodiafiltration in patients with acute renal failure[J]. J Antimicrob Chemother, 2001, 48(6):881.
[11] BETROSIAN A P, FRANTZESKAKI F, XANTHAKI A, et al.High-dose ampicillin-sulbactam as an alternative treatment of lateonset VAP from multidrug-resistant Acinetobacter baumannii[J].Scand J Infect Dis, 2007, 39(1):38.
[12] CHOPRA T, MARCHAIM D, AWALI R A, et al. Epidemiology of bloodstream infections caused by Acinetobacter baumannii and impact of drug resistance to both carbapenems and ampicillin sulbactam on clinical outcomes[J]. Antimicrob Agents Chemother, 2013, 57(12):6270.
[13] HIGGINS P G, WISPLINGHOFF H, STEFANIK D, et al. In vitro activities of the beta-lactamase inhibitors clavulanic acid,sulbactam, and tazobactam alone or in combination with betalactams against epidemiologically characterized multidrugresistant Acinetobacter baumannii strains[J]. Antimicrob Agents Chemother, 2004, 48(5):1586.
[14] JONES R N, FLONTA M, GURLER N, et al. Resistance surveillance program report for selected European nations(2011)[J]. Diagn Microbiol Infect Dis, 2014, 78(4):429.
[15] HOUSMAN S T, HAGIHARA M, NICOLAU D P, et al. In vitro pharmacodynamics of human-simulated exposures of ampicillin/sulbactam, doripenem and tigecycline alone and in combination against multidrug-resistant Acinetobacter baumannii[J]. J Antimicrob Chemother, 2013, 68(10):2296.
[16] JARURAANASIRIKUL S, WONGPOOWARAK W,WATTANAVIJITKUL T, et al. Population pharmacokinetics and pharmacodynamics modeling to optimize dosage regimens of sulbactam in critically ill patients with severe sepsis caused by Acinetobacter baumannii[J]. Antimicrob Agents Chemother,2016, 60(12):7236.
[17] JARURATANASIRIKUL S, WONGPOOWARAK W, AEINLANG N, et al. Pharmacodynamics modeling to optimize dosage regimens of sulbactam[J]. Antimicrob Agents Chemother, 2013, 57(7):3441.
[18] GOLPER T A, MARX M A. Drug dosing adjustments during continuous renal replacement therapies[J]. Kidney Int Suppl,1998, 66:165.
[19] SCHETZ M, FERDINANDE P, VAN DEN BERGHE G, et al.Pharmacokinetics of continuous renal replacement therapy[J].Intensive Care Med, 1995, 21(7):612.
[20] REITBERG D P, WHALL T J, CHUNG M, et al. Multiple-dose pharmacokinetics and toleration of intravenously administered cefoperazone and sulbactam when given as single agents or in combination[J]. Antimicrob Agents Chemother, 1988, 32(1):42.
基本信息:
DOI：10.19577/j.1007-4406.2024.01.005
中图分类号:R969
引用信息:
[1]李颖,余佩,薛飞,等.蒙特卡洛模拟法优化舒巴坦在重症连续性静脉-静脉血液滤过患者的给药方案研究[J].中国临床药学杂志,2024,33(01):30-35.DOI:10.19577/j.1007-4406.2024.01.005.
基金信息:
陕西省自然科学基础研究计划青年基金(编号2019JQ-475); 西安市第三医院国科金青年培训项目(编号Y2023qn0008)
2024-01-25
2024-01-25