万古霉素在儿童社区获得性耐甲氧西林金黄色葡萄球菌肺炎的个体化抗感染治疗策略

Individualized anti-infectious therapeutic strategies of vancomycin in children with community-acquired methicillin-resistant Staphylococcus aureus pneumonia

社区获得性耐甲氧西林金黄色葡萄球菌(CAMRSA)肺炎患病率报道增多。CA-MRSA菌株基因突变、MIC漂移、抗菌药物耐药性增加等因素使儿科医师在经验性治疗CA-MRSA肺炎时面临重大挑战。万古霉素是抗MRSA感染的一线抗菌药物,具有治疗窗窄及肾脏毒性等特点。患儿在不同病理生理状态下,以药代动力学与药效学(PK/PD)原理及治疗药物浓度监测(TDM)为指导,进行万古霉素个体化治疗,可提高CA-MRSA肺炎患儿使用万古霉素的安全性和有效性,并减少耐药菌株产生。

Reports have shown that there has been increased prevalence of community-acquired methicillin-resistant Staphylococcus aureus( CA-MRSA) pneumonia. The factors such as CA-MRSA strain gene mutation,MIC drift,and antimicrobial resistance have increased the challenge for pediatricians in empirical treatment of CA-MRSA infections. Vancomycin is the first-line antibiotic for MRSA infection,which has the characteristics of narrow therapeutic window and nephrotoxicity.Based on individualized pharmacokinetics and pharmacodynamics( PK/PD) and therapeutic drug concentration monitoring( TDM),and under different pathophysiological state of the children,individualized treatment with vancomycin for the patients with CA-MRSA pneumonia can increase the safety and effectiveness,and reduce the prodution of drug-resistant bacteria.