蒙特卡洛模拟评价老年人鲍曼不动杆菌感染中比阿培南的给药方案

Evaluation of therapeutic regimens on biapenem against acinetobacter baumannii infection in the elderly by Monte Carlo simulation

目的为本院老年患者鲍曼不动杆菌(ABA)感染合理使用比阿培南提供依据。方法收集本院105株ABA菌株,采用二倍琼脂稀释法检测比阿培南的最低抑菌浓度(MIC),运用蒙特卡洛模拟(MCS)评价比阿培南6种给药方案300 mg(q24 h/q12 h/q8 h/q6 h)及600 mg(q24 h/q12 h),计算达标概率(PTA)和累积反应分数(CFR)。结果对老年人ABA菌群,比阿培南所有方案的CFR均不达标,最高为25.1%;对MDRAB菌群,比阿培南方案能达到的最高CFR为12.95%;对S-AB菌群,600mg(q12 h)和300 mg(q12 h/q 8 h/q6 h)方案的CFR>90%。结论本院老年人鲍曼不动杆菌感染的经验治疗,不建议使用比阿培南单药给药方案,目标治疗时,65~74岁的老年人,当MIC≤1 mg·L^(-1)时可选择;≥75岁的老年人,当MIC≤4 mg·L^(-1)时才可选用比阿培南。

Objective To identify rational dosage regimen of biapenem against acinetobacter baumannii infecti on in the elderly subjects in our hospital. Methods Totally 105 strains of Acinetobacter baumannii（ABA） were collected. The minimum inhibitory concentration（MIC） of biapenem against bacteria were measured by double broth dilution method. Six therapeutic regimens（300 mg, q24 h; 300 mg, q12 h; 300 mg, q8 h; 300 mg, q6 h;600 mg, q24 h; 600 mg, q12 h） were simulated with the Monte Carlo simulation, and the standard probability（PTA） and cumulative fraction of response（CFR） were calculated. Results CFRs of all treatments of biapenem against ABA infection in the elderly subjects were not standard, with the maximum of 25.1%; for MDRAB, the maximum was 12.95%; but for S-AB, CFRs of biapenem 600 mg, q12 h and 300 mg, q12 h/q8 h/q6 h were all over 90%. Conclusion Biapenem alone is not recommended in ABA infection for experiential therapy for the elderly in our hospital. We suggest biapenem at MIC ≤ 1 mg·L^（-1） for 65-74 year olds in the target therapy and at MIC ≤ 4 mg·L^（-1） for ≥ 75 year olds.