探索美罗培南在不同病原菌下给药方案的临床疗效

Explore Clinical Effectiveness of Meropenem Adosage Regimen with Different Pathogens

目的基于已报道的蒙特卡洛模拟(MCS)优化美罗培南治疗不同病原菌下患者的给药方案,探索上述方案在真实世界中有效性,获得临床应用的参考数据。方法以2016年01月01日~2020年12月31日就诊于贵航贵阳医院使用美罗培南的患者为研究对象,筛选、统计并分析不同病原菌下给药方案的有效性。结果本研究共纳入1261份病例,其中致病菌最多为多重耐药鲍曼不动杆菌。对于未达到多重耐药的病原菌,美罗培南1 g q8h输注30 min以上对肺炎克雷伯菌与大肠埃希菌治疗有效,美罗培南1 g q8h输注1 h以上对铜绿假单胞菌治疗有效。当病原菌为多重耐药时,美罗培南1 g q8h输注2 h以上对铜绿假单胞菌、大肠埃希菌和鲍曼不动杆菌治疗有效,美罗培南1 g q6h输注3 h对肺炎克雷伯菌治疗有效。结论除多重耐药鲍曼不动杆菌及多重耐药肺炎克雷伯菌外,余病原菌均与已报导的基于MCS推测治疗效果一致。当病原菌为多重耐药菌或MIC值较高时,需增加输注时间或(和)给药频次才能达到有效治疗目的。

OBJECTIVE Explore effectiveness of the reported meropenem adosage regimen which based on Monte Carlo simulation(MCS)with different pathogens in a real world,and obtain the reference data of clinical application.METHODS In this study,we screened,counted and analyzed the efficacy of meropenem adosage regimen with different pathogens in our hospital during 2016.01.01~2020.12.31.RESULTS This study included 1261 cases,the maximum pathogenic bacteria was multidrug-resistant Acinetobacter baumannii.When the pathogens were not multidrug-resistant bacterias,the study showed that meropenem(more than 30-min infusion,1 g,every 8 hours)were effective for people who were infected by Klebsiella pneumoniae or Escherichia coli.Meropenem(more than 1-hour infusion,1 g,every 8 hours)were effective for people who were infected by Pseudomonas aeruginosa.When the pathogens were multidrug-resistant bacterias,Meropenem(more than 2-hour infusion,1 g,every 8 hours)were effective for people which were infected by Pseudomonas aeruginosa,Escherichia coli or Acinetobacter baumannii.Meropenem(more than 3-hour infusion,1 g,every 8 hours)were effective for people who were infected by Klebsiella pneumoniae.CONCLUSION Except Acinetobacter baumannii and Klebsiella pneumoniae which were multidrug-resistant bacterias,the remaining pathogens are consistent with the reported adosage regimens which based on MCS.When the pathogens were multidrug-resistant bacterias or MIC value is high,it is necessary to increase the infusion time or(and)frequency to achieve the effective treatment purpose.