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目的:优化抗菌药物治疗重症监护病房(ICU)中铜绿假单胞菌感染患者的初始给药方案。方法:基于收集到的国内外抗菌药物药动学和药效学参数,结合卫生部全国细菌耐药监测网(Mohnarin)和中国CHINET与耐药监测网关于医院ICU铜绿假单胞菌耐药监测报告及美国临床实验室标准化协会(CLSI)2013版标准,对铜绿假单胞菌的最低抑菌浓度设置为离散均匀分布,拟订出6种抗菌药物的24种给药方案,运用药效/药动学(PK/PD)模型和蒙特卡洛模拟10 000例“真实患者”的达标概率和累积反应分数,优化出最佳初始给药方案。结果:对铜绿假单胞菌感染可选择的初始给药方案分别是哌拉西林/他唑巴坦4.5 g,q6 h;头孢吡肟2.0 g,q12 h;美罗培南1.0 g,q6 h;阿米卡星17.5 mg/(kg·d);环丙沙星0.4 g,q8 h;多黏菌素150 mg,q12 h。结论:作为优化的初始给药方案,ICU中的非多重耐药铜绿假单胞菌感染建议选用头孢吡肟;多重耐药铜绿假单胞菌感染建议选用头孢吡肟+环丙沙星;全耐药铜绿假单胞菌感染则建议选用头孢吡肟+环丙沙星+多黏菌素。
OBJECTIVE: To optimize the initial dosing regimen of antimicrobial agents for the treatment of Pseudomonas aeruginosa infections in Intensive Care Unit (ICU). Methods: Based on the collected pharmacokinetic and pharmacodynamic parameters of antimicrobial drugs at home and abroad, combined with Mohnarin and Chinese CHINET and Drug Resistant Surveillance Network Report and American Society of Clinical Laboratory Standards (CLSI 2013 version of the standard, the minimum inhibitory concentration of Pseudomonas aeruginosa set to discrete uniform distribution, drafted 24 kinds of antibacterial drugs dosing program 24, the use of drug / drug Kinetic (PK / PD) model and Monte Carlo simulation of 10,000 patients “real patients ” the probability of compliance and cumulative reaction score, to optimize the optimal initial dosing regimen. Results: The initial dosing regimens for Pseudomonas aeruginosa infection were 4.5 g, q6 h of piperacillin / tazobactam, 2.0 g, q12 h of cefepime and 1.0 g, q6 h of meropenem. Mika star 17.5 mg / (kg · d); Ciprofloxacin 0.4 g, q8 h; Polymyxin 150 mg, q12 h. Conclusion: As the optimal initial drug regimen, cefepime is recommended for non-multidrug-resistant Pseudomonas aeruginosa infection in ICU; cefepime + ciprofloxacin is recommended for multi-resistant Pseudomonas aeruginosa infection; Resistant P. aeruginosa infection is recommended to use cefepime + ciprofloxacin + polymyxin.