Appropriateness of Amikacin Dose Prescription, Monitoring and Safety during Hospitalization as an Impact of Clinical Pharmacologist Intervention, in the Israeli Regional Hospital

Background: Use of inappropriate amikacin dose is one of the most important factors in inducing toxicity, prolonged hospitalization as well as in increasing patient’s mortality. Objective: The aims of this study are the analysis of amikacin dose, serum level and the examination of the effectiveness of the clinical pharmacologist (CP) therapeutic drug monitoring (TDM) intervention to guarantee the safety of amikacin use. Methods: This is a one-year retrospective observational chart review study, which evaluates amikacin dose, serum drug level, development of adverse effects in patients on amikacin with or without CP TDM consultation. Results: Amikacin was prescribed for 393 complex patients, with median age 83. Amikacin group (AG) included 140 (32%) courses with CP consultation (AG1) and 292 (68%) courses without CP consultation (AG2). The distribution of most study characteristics in both groups was similar including amikacin dose (9-10 mg/kg/day), renal failure (14%) and mortality (12%). Acceptance for CP consultation was in 46% of amikacin courses and dose changes were done in 63% after CP intervention. Prolonged antibiotic course (4.6 ± 1.5 vs 3.8 ± 1.6 days, p < 0.0001) and the patient’s hemodynamic instability (15% vs 7%, p = 0.01) were more frequent in the AG1 compared to the AG2. There was a strong association between CP consultation and prolonged hospitalization (p = 0.005), while no association between it and amikacin adverse effects, renal failure or mortality. Conclusions: There was no trend to reducing amikacin toxicity, days of hospitaliza tion or mortality in patients with CP consultation. CP TDM intervention was more in the management of complicated clinical situations. However, it is necessary to optimize it.

Treatment of chronic bacterial prostatitis with amikacin through anal submucosal injection

Aim: To assess the efficacy and safety of anal submucosal injection (ASI) of amikacin in chronic bacterial prostatitis (CBP). Methods: Fifty male outpatients with CBP were randomly divided into two groups. Thirty cases of ASI group were given amikacin 400 mg daily by ASI for ten times and the other twenty cases of intramuscular injection (IM) group were given the same drug dally by IM. All patients were evaluated with NIH-Chronic prostatitis symptom index (NIH-CPSI), the bacteria culture of the expressed prostate secretion (EPS), proctoscopic examination, rectal biopsy and the clinical manifestation were checked at pretreatment and on day 7 and 90 after cessation of therapy. Results: The cure rate, apparent effective rate and effective rate of ASI group and IM group were 33.3% vs 5% (P<0.05), 43.3% vs 10% (P<0.05) and 16.7% vs 20% (P>0.05), respectively. The score of NIH-CPSI in both of ASI group and IM group decreased significantly 7 days after cessation of therapy, both ASI and IM of amikacin could relieve symptoms within a short time. However, 3 months after cessation of therapy the score of NIH-CPSI in ASI group continued down in spite of no significant differences compared with 7 days after cessation of therapy, but the score of IM group was rebound nearly closed to level of pretreatment at 23.8±8.5 and significantly higher than that of ASI group. The amount of white blood cell (WBC) of EPS in ASI group increased slightly at 7 days after cessation of therapy without significant difference with pretreatment (P>0.05), but it significantly decreased at 3 months after cessation of therapy, the amount of WBC of EPS in ASI group was lower than that of IM group at 3 months after cessation of therapy (P<0.05). Proctoscopic examination of anal canal were normal after ASI therapy and the rectum biopsy showed no obvious histopathologic abnormality at the site of injection except mild focal submucosal infiltration of lymphocytes and plasma cells at 7 days after cessation of therapy which disappeared on 3 months after cessation of therapy. All patients had no evident complications. Conclusion: ASI could be recommended as a new safe, effective, painless method of antibiotics administration in the treatment of CBP.

Single daily amikacin versus cefotaxime in the short-course treatment of spontaneous bacterial peritonitis in cirrhotics

AIM: To compare the efficacy and safety of single daily amikacin vs. cefotaxime in the 5-d treatment of spontaneous bacterial peritonitis (SBP).METHODS: Thirty-seven cirrhotic patients with SBP,19 in group A and 18 in group B, were studied. Group A received 1 g of cefotaxime every 6 h, and group B received 500 mg of amikacin qd. Both antibiotics were administered up to 5 d and the responses were compared.RESULTS: Infection was cured in 15 of 19 patients (78.9%) treated with cefotaxime and in 11 of 18 (61.1%)treated with amikacin. Four patients of the Cefotaxime group (21.1%) and five patients of the Amikacin group (27.8%) died. Two in each group (10.5% vs 11.1%)had renal impairment during study period. One in each group (5.3% vs 5.6%) may be considered to suffer from nephrotoxicity due to increased urinary β2-microglobulin concentration.CONCLUSION: In this study, single daily doses of amikacin in the treatment of SBP in cirrhotics were not associated with an increased incidence of renal impairment or nephrotoxicity. However, a 5-d regimen of amikacin is less effective than a 5-d regimen of cefotaxime in the SBP treatment.

Reagent-free determination of amikacin content in amikacin sulfate injections by FTIR derivative spectroscopy in a continuous flow system

The quantitative estimation of amikacin （AMK） in AMK sulfate injection samples is reported using FTIR-derivative spectrometric method in a continuous flow system. Fourier transform of mid-IR spectra were recorded without any sample pretreatment. A good linear calibration （r40.999, %RSDo 2.0） in the range of 7.7-77.0 mg/mL was found. The results showed a good correlation with the manufacturer＇s and overall they all fell within acceptable limits of most pharmacopoeial monographs on AMK sulfate.

Resonance Light Scattering Method for Determination of Amikacin with Potassium Ferrioxalate as a Probe

In a weak acid medium, potassium ferrioxalate（PF） can react with some aminoglycoside（AGs） antibiotics, such as amikacin（AMK）, kanamycin（KANA）, tobramycin（TOB） and gentamicin（GEN）, to form ion-association complexes. It results in the enhancement of resonance light scattering（RLS） in different degrees. The maximum scattering peaks are all located at 345 nm. Among them, the relative scattering intensity（AIRLs） of AMK system is much higher than that of KANA, TOB or GEN. Therefore the method is more propitious to the determination of trace amounts of AMK. The optimum reaction conditions, influencing factors, and the relationship between scattering intensity and concentration of antibiotics were investigated by means of the proposed method. The enhancement of RLS signals is directly proportional to the concentration of antibiotics in a certain range of concentration. A new resonance light scattering method for the determination of AMK and other aminoglycoside antibiotics with [Fe（C2O4）3]^3- as a probe is thus established based on it. The method exhibits high sensitivity and good selectivity. The detection limit（3σ） for AMK is 1.8 ng/mL. The method can be applied to the determination of AMK in clinical serum samples. The reaction mechanism and the reasons for RLS enhancement are discussed in this paper.

Voltammetric studies on the interaction of amikacin with methyl blue and its analytical application

A new method to determine the concentration of amikacin （AMK） using methyl blue （MB） as electrochemical probe was developed in this paper. In pH 4.5 Britton-Robinson （B-R） buffer solution, the MB reacted with AMK to form ion association complexes, which led to the reductive peak current of MB at -0.275 V （versus SCE） to decrease, and the decreases were linear with the concentration of AMK in the range of 1.0-60.0 mg/L, the regression of equation is AIp （hA） = -8.48 ＋ 102.36c （rag/L）, correlation coefficient yis 0.997. The conditions for determining the concentration of AMK using linear sweep voltammetry （SLV） were optimized. The method was used to determine the content of amikacin commercially available with satisfactory results.

A novel luminol-based chemiluminescence method for the determination of amikacin sulfate in serum by using trivalent copper-periodate complex

A novel chemiluminescence （CL） reaction was based on the oxidizing reaction of luminol by the trivalent copper-periodate complex （Ks[Cu（HIO6）2], DPC） in alkaline medium. The CL intensity could be enhanced in the presence of amikacin sulfate （AKS）. A new CL method was developed for the determination of AKS by coupling with flow injection （FI） technology. Because of the distinctive oxidative effect of DPC, the luminol-based CL reaction could occur at a low concentration of 10-7 M. The relative CL intensity was proportional to the concentration of AKS in the range of 4.0 x 10-9-4.0 x 10-6 g/mL with the detection limit of 1.2 x 10-9 g/mL. The relative standard deviation was 2.1% for 8.0xl0-9g/mL AKS （n=9）. The proposed method was successfully applied to the direct determination of AKS at the level of ng/mL in serum samples. The recovery varied from 97.0% to 106.3%. A possible mechanism of the CL reaction was discussed in detail by relating to the CL kinetic characteristics and electrochemical activities of the oxidant DPC.

Serum and Blister Fluid Pharmacokinetics of Amikacin in Severe Burn Patients

Objective: To characterize amikacin pharmacokinetics in serum and in blister fluid of severe burn patients to guide optimal treatment timing. Methods: Patients (N = 32) were divided into four groups based on amikacin administration timing and groups received drug minutes to hours after injury. In Groups A, B, C, and D, amikacin (400 mg, IV) was administered 3 - 4, 10, 20 and 30 h post burn injury, respectively (N = 8 for all groups). Next blister fluid and venous blood samples from 9 patients were obtained at 0, 0.25, 0.5, 1, 2, 3, 4, 5, 6, and 7 h after drug infusion. Amikacin concentrations were measured with a fluorescent polarization immunoassay and pharmacokinetics was deduced using DAS3.2.5. Statistical analyses performed with SPSS13.0. Results: Compared with normal values, t1/2z of amikacin from burn patients was shortened in serum but amikacin half-lives in blister fluid was significantly greater than serum half-life values (p < 0.05). Groups A and B had greater pharmacokinetic values at each time point, and Group D did not achieve antibacterial concentrations of amikacin. Conclusion: Early amikacin administration in severe burn patients offers greater concentrations of drug in serum and blister fluids.

(-)-Epigallocatechin-3-gallate protects spiral ganglion neurons against amikacin-induced apoptosis

Morphology of spiral ganglion neurons （SGNs） in Sprague-Dawley rats before and after amikacin treatment was observed by transmission electron microscopy. Amikacin induced cochlear SGN apoptosis. Immunohistochemical staining and RT-PCR revealed a decrease in Bcl-2 protein ex-pression, and an increase in Bax protein, caspase-3 protein and caspase-6 mRNA expression fol-lowing amikacin treatment. （-）-Epigallocatechin-（3）-gallate （EGCG） inhibited SGN Bax protein, caspase-3 protein and caspase-6 mRNA expression, and enhanced Bcl-2 protein expression, thereby decreasing SGN apoptosis. Results demonstrated that EGCG can protect SGNs against amikacin-induced injury.

Silver nitrate restores susceptibility of clinical multidrug resistant gram-negative and gram-positive bacteria to amikacin in vitro

Silver nitrate could inhibit the clinical multidrug resistant isolates at high concentrations（with minimal inhibitory concentrations（MICs） from 32 μM to 64 μM）. The activities of amikacin in the presence of sub-lethal silver nitrate（15 μM） were tested for the combinational effects against multidrug resistant clinical isolates in vitro. Silver nitrate restored the susceptibility of drug-resistant Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus to amikacin. It lowered the MICs of amikacin from 〉128 μg/mL to（2–16） μg/mL and 32 μg/mL, respectively, and lowered the MICs of amikacin on extended spectrum β-lactamase-producing Pseudomonas aeruginosa and Escherichia coli from（16–32） μg/mL and 16 μg/mL to（〈1–4） μg/mL and 〈1 μg/mL, respectively.

阿米卡星诱导对大肠埃希氏菌耐药性及生物被膜和外排泵活性的影响

为研究亚抑菌浓度阿米卡星诱导对大肠埃希氏菌敏感菌株耐药性、生物被膜形成能力及外排泵活性的影响,采用微量肉汤稀释法测定阿米卡星对6株菌株的最小抑菌浓度(MIC),并以0.5 MIC作为初始诱导浓度进行诱导,每隔5 d重新测定阿米卡星MIC,并调整诱导浓度,共计30 d,最后将诱导第30天菌株进行无药物压力稳定培养5 d,保存各诱导菌株及无药传代菌株共计210株,测定各诱导菌株药物敏感性、生物被膜形成能力及部分菌株外排泵活性变化。结果发现,随着诱导天数的增加,阿米卡星对6株分离菌株MIC逐渐升高,诱导菌株耐药性不断增强,其对诱导第30天菌株的MIC值为诱导前的8~32倍;经过5 d无药培养后,MIC测定结果与第30天基本保持一致;诱导后的菌株中,强成膜能力菌株占总数的5%,中成膜能力菌株为56.7%;以每5 d的生物被膜形成量平均值与原菌相比,结果发现,所有诱导菌株生物被膜形成量均显著增加(P<0.01),表明亚抑菌浓度阿米卡星诱导可促进大肠埃希氏菌生物被膜的形成;无药稳定培养5 d的菌株与诱导第30天菌株相比,生物被膜形成能力基本保持不变。荧光探针测定外排泵结果显示,诱导菌株外排泵活性显著受到抑制。以上研究结果表明,阿米卡星诱导促进菌株生物被膜的形成,抑制外排泵活性,使菌株的耐药性增强,研究结果可为氨基糖苷类药物用药提供理论依据。

Aerosolized Amikacin as Adjunctive Therapy of Ventilator-associated Pneumonia Caused by Multidrug-resistant Gram-negative Bacteria： A Single-center Randomized Controlled Trial

Background： Aerosolized amikacin （AA） is a current option for the management of ventilator-associated pneumonia （VAP） caused by multidrug-resistant Gram-negative bacteria （MDR-GNB）, as it is reported that AA could increase the alveolar level of the drug without increasing systemic toxicity. This study aimed to evaluate the efficacy and safety of AA as an adjunctive therapy for VAP caused by MDR-GNB. Methods： In this single-center, double-blind study conducted in a 36-bed general Intensive Care Unit （ICU） in a tertiary hospital from June 2014 to June 2016, 52 ICU patients with confirmed MDR-GNB VAP were randomized to two groups （AA group, n - 27 and placebo group, n = 25）. Amikacin （400 rag, q8h） or saline placebo （4 ml, q8h） was aerosolized for 7 days. The attending physician determined the administration of systemic antibiotics for VAP. Patients were tbllowed up for 28 days. Bacteriological eradication, clinical pulmonary infection score （CP1S）, and serum creatinine were assessed on day 7 of therapy. New resistance to amikacin, cure rate of VAP, weaning rate, and mortality were assessed on day 28. Results： The baseline characteristics of patients in both groups were similar. At the end of the treatment, 13 of the 32 initially detected bacterial isolates were eradicated in AA group, compared to 4 of 28 in placebo group （41% vs. 14%, P - 0.024）. As for patients, 11 of 27 patients treated with AA and 4 of 25 patients treated with placebo have eradication （41% vs. 16%, P = 0.049）. The adjunction of AA reduced CPIS （4.2 ± 1.6 vs. 5.8 ± 2.1, P = 0.007）. New drug resistance to amikacin and the change in serum creatinine were not detected in AA group. No significant differences in the clinical cure rate in survivors （48% vs. 35%, P = 0.444）, weaning rate （48% vs. 32%, P = 0.236）, and mortality （22% vs. 32%, P = 0.427） were detected between the two groups on day 28. Conclusions： As an adjunctive therapy of MDR-GNB VAP, AA successfully eradicated existing MDR organisms without inducing new resistance to amikacin or change in serum creatinine. However, the improvement of mortality was not found.

阿米卡星联合哌拉西林钠/他唑巴坦钠治疗重症肺炎的疗效及对血清HMGB1、sTREM-1、miR-233的影响

目的研究阿米卡星联合治疗哌拉西林钠/他唑巴坦钠治疗重症肺炎的疗效及对血清高迁移率族蛋白B1(HMGB1)、可溶性髓系细胞触发受体-1(sTREM-1)、微RNA(miR)-233的影响。方法前瞻性选择2018年1月至2022年12月黄石市中心医院收治的重症肺炎患者100例,依据随机数字表法分为阿米卡星组与对照组,各50例。两组均行祛痰、补液、扩张支气管及营养支持等常规治疗。在常规治疗基础上,对照组行哌拉西林钠/他唑巴坦钠治疗,阿米卡星组在对照组基础上行阿米卡星治疗。治疗14 d后,观察两组临床疗效、临床症状指标(发热时间、痰液颜色改变时间、肺部炎症吸收时间、机械通气时间及细菌清除率),观察两组治疗前及治疗14 d后血清指标[HMGB1、sTREM-1、miR-233水平、血清肿瘤坏死因子-ɑ(TNF-ɑ)、白细胞介素(IL)-6、L-10]、肺功能指标[用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、功能残气量(FRC)、深吸气量(IC)]和不良反应情况。结果治疗14 d后,阿米卡星组总有效率为94.00%,高于对照组(76.00%),差异有统计学意义(P<0.05)。治疗14 d后,阿米卡星组发热时间、痰液颜色改变时间、肺部炎症吸收时间、机械通气时间为(3.26±0.35)、(4.19±0.44)、(8.24±0.85)、(8.64±0.89)d,均短于对照组[(6.31±0.66)、(7.08±0.73)、(9.31±0.95)、(10.78±1.30)d],细菌清除率为(92.75±9.54)%,高于对照组[(76.29±7.93)%],差异均有统计学意义(P<0.05)。治疗14 d后,阿米卡星组血清HMGB1、sTREM-1、miR-233水平为(112.08±13.96)μg/L、(42.84±4.50)ng/L、1.19±0.13,均低于对照组[(140.17±17.64)μg/L、(51.07±6.38)ng/L、(1.51±0.17)],差异均有统计学意义(P<0.05)。治疗14 d后,阿米卡星组的血清TNF-ɑ、IL-6水平为(1.01±0.12)ng/mL、(22.65±2.49)pg/mL,均低于对照组[(1.32±0.16)ng/mL、(26.83±2.94)pg/mL],阿米卡星组的IL-10水平为(15.98±1.82)pg/mL,均高于对照组[(12.74±1.53)pg/mL],差异均有统计学意义(P<0.05)。治疗14 d后,阿米卡星组FVC、FEV1、IC为(3.22±0.35)、(2.14±0.23)、(2.56±0.28)L,均大于对照组[(2.94±0.32)、(1.93±0.21)、(2.27±0.25)L],FRC为(2.02±0.22)L,小于对照组[(2.35±0.26)L],差异均有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(16.00%vs.8.00%)(P>0.05)。结论阿米卡星联合治疗哌拉西林钠/他唑巴坦钠治疗重症肺炎可有效清除致病菌,抑制炎症反应,缩短临床恢复时间,改善肺功能,降低血清HMGB1、sTREM-1、miR-233水平,疗效显著,安全性好。

阿米卡星与哌拉西林钠他唑巴坦钠联合治疗老年重症肺炎的效果分析

目的分析阿米卡星与哌拉西林钠他唑巴坦钠联合治疗老年重症肺炎的效果。方法98例老年重症肺炎患者,使用随机数字表法分为对照组(49例)与研究组(49例)。两组患者均采取常规对症治疗,在此基础上,对照组应用哌拉西林钠他唑巴坦钠治疗,研究组应用哌拉西林钠他唑巴坦钠联合阿米卡星治疗。比较两组患者的临床疗效、炎症因子[C反应蛋白(CRP)与降钙素原(PCT)]水平、不良反应发生情况。结果研究组的治疗总有效率91.84%高于对照组的75.51%(P<0.05)。治疗前,两组CRP、PCT水平比较,结果无差异性(P>0.05);治疗10 d后,研究组CRP(20.65±4.89)mg/L、PCT(2.50±1.02)μg/L低于对照组的(35.40±5.00)mg/L、(6.00±1.25)μg/L(P<0.05)。两组不良反应发生率未见差异性(P>0.05)。结论阿米卡星与哌拉西林钠他唑巴坦钠联合治疗老年重症肺炎的效果确切,可以有效抑制机体炎症反应,安全性较为理想,适于临床推广。

Study on the resonance Rayleigh scattering spectra and resonance non-linear spectra of congo red-amikacin system and its analytical application

The interaction between congo red (CR) and amikacin (AMK) was studied by resonance Rayleigh scattering (RRS), frequency doubling scattering (FDS) and second-order scattering (SOS) combining with absorption spectrum. In a weak acidic medium, CR combined with AMK to form an ion association complex with the composition ratio of 1∶1 by electrostatic interaction, hydrophobicity and charge transferring effect. As a result, the new spectra of RRS, FDS, and SOS appeared and their intensities were enhanced greatly. The maximum wavelengths of RRS, FDS and SOS were located at 563 nm, 475 nm and 940 nm, and the scattering intensities were proportional to the concentration of AMK. These three methods have very high sensitivities, and the detection limits were 4.0 ng·mL?1 for RRS, 3.6 ng·mL?1 for FDS and 1.9 ng·mL?1 for SOS, respectively. At the same time, the methods have better selectivity. A new method for the determination of trace amounts of AMK with congo red by resonance scattering technique has been developed. The recovery for the determination of AMK in blood serum and urine sample was between 95.5% and 105.5%. In this study, the properties, such as enthalpy of formation, charge distribution and mean polarizability, were calculated by AM1 quantum chemistry method. In addition, the reaction mechanism and the reasons for the enhancement of scattering spectra were discussed.

雾化阿米卡星辅助治疗多重耐药革兰阴性菌肺炎疗效与安全性的Meta分析

目的系统评价雾化阿米卡星(amikacin nebulization,AN)辅助治疗多重耐药革兰阴性菌肺炎(multi-drug resistant gram-negativebacteriapneumonia,MDR-GNBP)的疗效与安全性。方法计算机检索数据库,按照纳入与排除标准纳入关于AN辅助治疗MDR-GNBP的随机对照试验(randomized controlled trials,RCT),并采用Review Manager 5.4和Stata SE 12.0软件进行Meta分析。结果纳入9篇(10RCT研究)关于AN辅助治疗MDR-GNBP的文献,包含1302例患者。Meta分析的结果显示:在有效性方面,AN可提高MDR-GNBP患者的临床治愈率[RR=1.27(95%CI=1.03~1.58),P=0.03],尤其是呼吸机相关性肺炎患者的临床治愈率[RR=1.75(95%CI=1.21~2.53),P=0.003]。另外,AN可提高MDR-GNBP患者的微生物清除率[RR=1.34(95%CI=1.09~1.66),P=0.005],缩短ICU停留时间[WMD=-2.23(95%CI=-3.79~-0.66),P=0.005],但不能降低全因死亡率[RR=1.01(95%CI=0.78~1.31),P=0.96]和肺炎相关死亡率[RR=1.09(95%CI=0.77~1.53),P=0.64]。在安全性方面,AN不增加MDR-GNBP患者的不良反应发生率[RR=1.01(95%CI=0.95~1.09),P=0.68]、肾损伤发生率[RR=0.74(95%CI=0.52~1.05),P=0.09],但会增加呼吸道痉挛的发生率[RR=2.50(95%CI=1.12~5.56),P=0.02]。结论AN辅助治疗MDR-GNBP有一定优势,可作为一种新的治疗选择,但仍需大规模、多中心的RCT来验证。

金水宝对使用含阿米卡星抗结核治疗的肺结核患者肝肾功能的影响

目的探索金水宝在阿米卡星抗结核治疗过程中对患者的肝肾功能的影响。方法回顾性分析102例2022年4月至2023年11月在本院使用含阿米卡星药物方案进行治疗的肺结核复治患者,根据是否合并使用金水宝分为金水宝组(51例)和对照组(51例),采用t检验,卡方检验及非参数检验比较两组患者基线资料的差异。在药物治疗前及治疗一段时间(7-14天)后检测患者的血清肌酐、ALT、AST等指标,比较两组间的差异水平。结果对照组和金水宝组患者的年龄、性别、肝肾功能等资料均无统计学差异。在阿米卡星对照组中,药物治疗前后患者肾小球滤过率估计值(eGFR)显著降低(P<0.001);然而在金水宝组中,药物治疗前后eGFR无统计学差异。治疗前后肾小球变化率ΔeGFR(治疗后-治疗前)在对照组和金水宝组有统计学差异[(-8.99±14.23)mL/min vs(0.91±17.20)mL/min,P=0.002]。此外,金水宝组患者治疗前后ALT的变化值中位数为负数,低于对照组,差异具有统计学意义[0(-4,8)U/L vs-5(-9,2)U/L,P=0.006];而AST的变化在两组间无统计学差异。结论短疗程金水宝治疗可以改善阿米卡星抗结核药物导致的肾小球滤过率的下降,并对患者肝功能具有改善作用,然而,金水宝在抗结核治疗中的价值仍需要进一步明确。

应用蒙特卡罗模拟评估及优化脓毒症患者临床阿米卡星的给药剂量

目的采用蒙特卡罗模拟的方法,以抗菌药物PK/PD理论为基础,评价与优化脓毒症患者阿米卡星的给药剂量。方法收集国内外已发表的阿米卡星的药代动力学资料和提取我院阿米卡星对革兰阴性杆菌的MIC分布数据;利用Cristal Ball软件模拟出10000例患者的目标获得概率(PTA)和累计反应分数(CRF)。结果对于脓毒症患者阿米卡星说明书推荐的给药剂量未能达到满意抗菌活性。结论蒙特卡罗模拟法把药代动力学参数和药效学数据结合起来,既考虑了不同个体对药物处置的差异性,又考虑了病原菌耐药性的差异,推荐的给药方案更能实现个体化给药目标,提高临床治疗效果,减少细菌耐药。

探针熔解曲线在耐药结核病快速筛查中的临床应用研究

目的研究探针熔解曲线在耐药结核病快速筛查中的临床应用价值。方法选取2020年1月—2021年3月镇江市第三人民医院收治的378例肺结核患者为研究对象,依次完成传统罗氏固体药物敏感性检测(比例法)、探针熔解曲线技术检测常用的6种药物耐药结果,包含利福平、异烟肼、乙胺丁醇、链霉素、氧氟沙星、阿米卡星,和比例法进行对比,计算探针熔解曲线技术检测6种药物的敏感度、特异度、阳性预测值、阴性预测值、符合率与约登指数。结果与比例法作比较,熔解曲线技术检测利福平耐药性的敏感度、特异度、阳性预测值、阴性预测值、符合率、约登指数分别为91.70%、98.10%、61.10%、99.70%、97.90%、0.898;异烟肼是87.90%、94.20%、59.20%、98.80%、93.65%、0.821;乙胺丁醇是87.50%、97.03%、38.89%、99.72%、96.83%、0.845;链霉素是91.30%、98.19%、87.50%、98.79%、97.35%、0.895;氧氟沙星是94.74%、98.89%、81.82%、99.72%、98.68%、0.936;阿米卡星是80.00%、99.46%、66.67%、99.73%、99.21%、0.795。结论探针熔解曲线在耐药结核病快速筛查中应用,具有较高敏感度及特异度,有利于临床早期识别耐药现象。

阿米卡星肺泡灌洗联合纤维支气管镜技术在重症肺部感染患者治疗中的应用

目的观察重症肺部感染患者行阿米卡星肺泡灌洗联合纤维支气管镜技术时患者的整体获益水平。方法采取随机数表法将南阳市第二人民医院2023年1月-2023年12月收治的100例重症肺部感染患者分为对照组(50例,常规治疗+阿米卡星注射液静滴)与研究组(50例,阿米卡星肺泡灌洗联合纤维支气管镜技术),对比治疗2周后的治疗效果、血气指标[动脉二氧化碳分压(PaCO_(2))、血氧饱和度(SaO_(2))、动脉氧分压(PaO_(2))]、肺功能[最大通气量(MMV)、最大呼气中期流量(MMEF)功能残气量(FRC)]、炎症指标[超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、SP蛋白(SP-D)、降钙素原(PCT)]、肺部感染评分及不良反应。结果与对照组相比,研究组治疗总有效率明显更高(χ2=8.036,P<0.05);治疗结束时,两组PaCO_(2)下降,PaO_(2)、SaO_(2)升高,研究组PaCO_(2)较低,PaO_(2)、SaO_(2)较高(P<0.05);两组FRC、MMV、MMEF均升高,且研究组FRC、MMV、MMEF明显高于对照组(P<0.05);两组PCT、hs-CRP、TNF-α、SP-D表达均下降,且研究组PCT、hs-CRP、TNF-α、SP-D明显更低(P<0.05);治疗结束时两组肺部感染评分均下降,且研究组低于对照组(P<0.05)。结论重症肺部感染患者应用阿米卡星肺泡灌洗联合纤维支气管镜技术,治疗效果显著,利于改善患者血气及肺功能,缓解炎症状态与肺部感染程度,且安全性理想,可在临床重症肺部感染患者治疗中应用。