蒙特卡洛模拟评价头孢哌酮舒巴坦钠延长输注治疗 鲍曼不动杆菌血流感染给药方案. (Chinese)

Objective To evaluate the dosage regimen of prolonged infusion of cefoperazone sulbactam sodi, um for the treatment of Acinetobacter baumannii bloodstream infections by using Monte Carlo simulation. Methods According to the surveillance reports on the resistance of Acinetobacter baumannii bloodstream infections to cefopera, zone sulbactam sodium collected from Zhongshan City People's Hospital in 2022, the dosage regimens and infusion times of cefoperazone sulbactam sodium were determined, the probability of target attainment (PTA) and cumulative fraction of response (CFR) of each dosage regimen under different infusion time were calculated by Monte Carlo simulation, and the suitability of prolonged infusion regimen was evaluated. Results With the infusion prolonged, the PTA of cefoperazone sulbactam sodium also increased, but each dosage regimen had a MIC critical value. When the MIC was less than the critical value, PTA > 90% could be achieved by prolonging infusion time. When the MIC was greater than the critical value, PTA quickly turnd to < 90%. When MIC=16 µg / ml, there were appropriate treatment regimens and infusion time meeting PTA > 90%. However, when MIC=32 µg / ml, PTA was < 90% regardless of dosage regimen and infusion time. In the empirical treatment, the CFR of all dosage regimens and infusion time was < 90%. The sensitive correlation of MIC values ranged from - 71, 1% to - 68, 8%, and that of the infusion time ranged from 17, 3% to 22, 0%. Conclusion The main factor affecting the PK/PD effect of cefoperazone sulbactam sodium in the treatment of Acinetobacter baumannii bloodstream infection is MIC value, followed by infusion time. The isolated strains with sensitive high and critical high MIC values are more suitable for prolonged infusion. Empirical treatment with prolonged infusion can not achieve satisfactory anti, infective effect, while empirical therapy with combined administration is more meaningful. [ABSTRACT FROM AUTHOR]

目的利用蒙特卡洛模拟评价头孢哌酮舒巴坦钠延长输注治疗鲍曼不动杆菌血流感染给药方 案. 方法根据中山市人民医院2022年鲍曼不动杆菌血液感染标本对头孢哌酮舒巴坦钠耐药性监测报告, 确定 头孢哌酮舒巴坦钠给药方案和输注时间, 运用蒙特卡洛模拟计算各给药方案在不同输注时间下的达标概率 (Probability of target attainment, PTA) 和累积反应分数 (Cumulative fraction of response, CFR), 评价延长输注给药 方案的适宜性. 结果随着输注时间的延长, 头孢哌酮舒巴坦钠 PTA 亦增加, 但每种给药方案均存在-个最低 抑菌浓度 (Minimum inhibitory concentration, MIC) 临界值. 当MIC小于该临界值时, 可通过延长输注时间满足 PTA >90%;而当MIC大于该临界值时, PTA迅速向<90%发生转折. 当MIC≤16 µg/ml时, 均有合适的治疗方 案和输注时间, 满足PTA>90%;而当MIC≥32 µg/ml时, 不管何种给药方案和输注时间, PTA均<90%. 经验 性治疗时, 所有给药方案和输注时间CFR均<90%. MIC值的敏感相关性范围为-71.1% 68.8%, 输注时 间敏感相关性范围为17.3%-22.0%. 结论影响头孢哌酮舒巴坦钠治疗鲍曼不动杆菌血流感染 PK/PD 效应 的主要因素是 MIC 值, 其次是输注时间, MIC值处于敏感高值和临界高值的分离菌株更适合延长输注给药, 延长 输注经验性治疗并不能达到满意的抗感染效果, 联合用药经验性治疗更有意义. [ABSTRACT FROM AUTHOR]

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