血清降钙素原在重症患者个体化抗感染治疗中的价值探讨

The value of serum procalcitonin in the individualized anti-infective treatment of severe patients

目的探讨血清降钙素原在重症患者个体化抗感染治疗中的价值。方法回顾性分析2017年11月24日西安交通大学第一附属医院重症医学科收治的1例重症感染患者的临床、影像学及病原学资料,对抗菌药物的药代动力学/药效动力学(PK/PD)特点以及药物剂量调整进行分析总结。结果该例71岁男性患者入院时病情危重,感染指标升高,降钙素原> 100μg/L,并伴有肾功能不全,经验性给予美罗培南抗感染治疗,并根据肌酐清除率调整抗菌药物剂量为美罗培南1.0 g静脉点滴,1次/12 h,2017年11月27日降钙素原81.390μg/L。血及尿培养均为产超广谱β内酰胺酶大肠埃希菌,根据药敏结果结合患者脏器功能选择抗菌药物,根据抗菌药物的PK/PD特点优化抗菌药物使用,使用美罗培南时,采用两步法给药,前0.5 g静脉点滴0.5 h,后0.5 g静脉点滴2.5 h,并对抗菌药物进行个体化调整,以发挥最大疗效,2017年12月15日降钙素原0.200μg/L。最终患者好转出院,随访3个月未复发。结论对于重症感染患者,在降钙素原指导下制定并调整抗感染策略,利用抗菌药物的PK/PD特点优化抗菌药物治疗,实现精准化、个体化治疗,能提高重症患者的救治成功率。

Objective To explore the value of procalcitonin in the anti-infective treatment of severe individual patients. Methods The clinical,imaging and etiological data of a severe patient admitted to the intensive care unit,First Affiliated Hospital of Xi’an Jiaotong University on November 24,2017,were analyzed.The pharmacokinetics/pharmacodynamics( PK/PD) characteristics of antibacterial drugs and the adjustment of drug dose were analyzed. Results The patient was a 71 years old male. He was in critical condition upon admission with increased infection indicators,procalcitonin > 100 μg/L,and renal insufficiency. This patient was given anti-infective therapy with meropenem;the antimicrobial dose was adjusted to 1. 0 g intravenous drip of meropenem based on creatinine clearance,once per 12 hours. The original calcitonin was 81. 390 μg/L on November 27,2017. Both blood and urine cultures were Extended-spectrum β-lactamase-producing Escherichia coli. Meropenem was selected for treatment based on the drug sensitivity results and the PK/PD characteristics of antibacterial drugs. Meropenem was given in two steps,with a 0. 5 h intravenous drip for the first 0. 5 g and a 2. 5 h intravenous drip for the last 0. 5 g;the antimicrobial drug was adjusted. The procalcitonin was 0. 200 μg/L on December 15,2017. He was followed up for 3 months without recurrence. Conclusion For patients with severe infection,the anti-infective strategy was formulated and adjusted under the guidance of procalcitonin;the PK/PD characteristics of antibacterial drugs can be used to optimize antibiotic treatment.