急性肾损伤并肺部感染患者的抗菌方案阶段性调整探析

Staged Adjustment Mode of Antimicrobial Regimen for Acute Kidney Injury Patients with Pulmonary Infection

目的:对急性肾损伤并肺部感染患者临床抗菌方案进行评价和调整。方法:利用PK/PD理论优化抗菌治疗的综合评价参数的定量范围,以及根据CCr值(内生肌酐清除率)对用药方案进行调整。结果及结论:急性肾损伤初期处于肾衰阶段的患者,CCr大幅下降,全程使用PIP/TAZ(哌拉西林/他唑巴坦)4.5 g q8h的给药方案,其给药剂量或给药频次明显超量。对该类患者,建议初期采用PIP/TAZ 4.5 g q24h^q36h的给药方案,逐步过渡到4.5 g q8h。

Objective: To discuss and analyze the rationality of antimicrobial regimen for the acute kidney injury patients with pulmonary infection, and to provide a rational reference for the staged adjustment of antimicrobial regimen. Methods: The quantitative range of comprehensive evaluation parameters were optimized using the PK/PD theory for antimicrobial therapies, and the endogenous creatinine clearance rate(CCr) was also considered. Results and Conclusion: For the acute kidney injury patients with the renal function at the stage of renal failure incipiently, with poor CCr, the regimen of PIP/TAZ as 4.5 g q8 h is obviously higher than the optimal dosage or interval time based on the PK/PD theory.The dosage of PIP/TAZ is suggested to initiate from 4.5 g qd or q36 h, and gradually transit to 4.5 g q8 h.