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目的探讨蒙特卡洛模拟评价革兰阴性菌感染的3种β-内酰胺给药方案。方法使用药物动力学蒙特卡洛模拟,得出累积效应分数(CFR),根据CFR评价和分析哪种给药方案对抗耐药菌株为最佳。结果使用亚胺培南对抗超广谱β-内酰胺酶(ESBLs)菌和易产头孢菌素酶(AmpC)菌株的CFR和灵敏性均为100%,对抗铜绿假单胞菌次之,CFR和灵敏性为75.30%和79.28%;哌拉西林钠对鲍曼不动杆菌的CFR和敏感率均为53.78%;较大剂量的头孢吡肟对抗产气肠杆菌、枸橼酸杆菌属的CFR和敏感度分别为94.26%和68.33%。结论亚胺培南类药物临床更适用于对抗β-内酰胺酶(ESBLs)菌和易产头孢菌素酶(AmpC)菌;对抗鲍曼不动杆菌单独应用哌拉西林钠效果不佳,与头孢吡肟联合应用药效好;对抗产气肠杆菌、枸橼酸杆菌属首选头孢吡肟。
Objective To investigate the three kinds of β-lactam dosing schemes of Monte Carlo simulation to evaluate Gram-negative bacteria infection. Methods The pharmacokinetic Monte Carlo simulation was used to calculate the cumulative effect score (CFR). According to the CFR evaluation and analysis, which dosing regimen was the best against the resistant strains. Results The imipenem-resistant strains of ESBLs and susceptible cephalosporins (AmpC) had 100% CFR and sensitivity against P. aeruginosa followed by CFR And the sensitivity was 75.30% and 79.28%, respectively. The CFR and sensitivity of piperacillin to Acinetobacter baumannii were both 53.78%. The higher dose of cefepime against CFG of Enterobacter aerogenes and Citrobacter And the sensitivity were 94.26% and 68.33% respectively. CONCLUSION Imipenem is more suitable for the treatment of ESBLs and AmpC-producing bacteria. Piperacillin alone is not effective against Acinetobacter baumannii, Cefepime combined with good efficacy; against Enterobacter aerogenes, citrobacter is the preferred cefepime.