中枢性神经系统感染患者美罗培南血药浓度达标情况及影响因素分析

Analysis of clinical characteristics and influencing factors of meropenem concentration in patients with CNS infection

目的:分析中枢性神经系统(CNS)感染患者美罗培南血药浓度达标情况及可能的影响因素,为优化中枢性神经系统感染患者美罗培南的给药方案提供依据。方法:采用回顾性研究方法,以南宁市第一人民医院2021年1月至2022年12月使用美罗培南治疗并监测稳态血药谷浓度(Cmin)的CNS感染患者为研究对象,记录患者的基本临床资料,统计美罗培南血药谷浓度的达标情况,采用单因素及二元Logistic回归法分析美罗培南血药谷浓度不达标的影响因素,绘制ROC曲线预测临床发生特征。结果:入选有效病例45例,美罗培南血药浓度中位数为4.14(0.82,16.29)mg/L,以Cmin大于4 mg/L为目标,血药浓度达标率51.11%;二元Logistic回归分析结果显示,患者血清肌酐值以及合并使用甘露醇是中枢性神经系统感染患者美罗培南稳态Cmin不达标的影响因素(P<0.05);绘制ROC曲线,当血清肌酐值小于84μmol/L时,曲线下面积最大(0.916),灵敏度为0.783,特异度为0.955,约登指数为0.738。结论:中枢性神经系统感染患者美罗培南稳态血药谷浓度的达标率较低,特别是存在肾功能亢进以及合并使用甘露醇的患者,建议通过血药浓度监测制定个体化给药方案。

AIM:To analyze the compliance rate and possible influencing factors for blood concentration of meropenem in patients with central nervous system(CNS)infections,and to provide basis for optimizing the administration of meropenem in the patients.METHODS:A retrospective analysis was performed in patients who were treated with meropenem and monitored the concentration(Cmin)from January 2021 to December 2022.The basic clinical data of the patients were recorded,and the achievement of meropenem blood concentration was counted.Univariate and binary logistic regression analysis were used to analyze the influencing factors for the e substandard steady-state blood trough concentration of meropenem.The ROC curve was drawn to predict the clinical characteristics.RESULTS:Forty-five cases were included.The median Cmin of meropenem was 4.14(0.82,16.29)mg/L,and 51.11%reached the target range with 4 mg/L.Binary logistic regression analysis showed that serum creatinine value and using mannitol were risk factors for the substandard steady-state blood trough concentration of meropenem(P<0.05).When serum creatinine value was less than 84μmol/L,the area under the ROC curve was the largest(0.916),the sensitivity was 0.783,the specificity was 0.955,and the Youden index was 0.738.CONCLUSION:The Cmin compliance rate of meropenem blood concentration in patients with CNS infection is low,especially in patients with hyperfunction of kidney and those who using mannitol.It is necessary to conduct drug concentration monitoring to optimize the administration of meropenem in patients with CNS infection.