标准和调整剂量的危急病患者中的β-乳酸抗生素度:一项前性观察性研究
Ilja Areskog Lejbman1, Gustav Torisson2, Fredrik Resman2
1Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, Sweden.
在重症患者中,抗生素度目标经常被错过. 虽然剂量调整可以有帮助,但需要个性化剂量和治疗药物监测,以优化重症监护室 (ICU) 中的抗生素有效性.
科学领域:
- 药理学 药理学是指药理学的学科.
- 关键护理医学 关键护理医学
- 传染性疾病 传染性疾病
背景情况:
- 在重症患者中,抗生素度目标的达到往往不够理想.
- 建议对药物动力学变化,肥胖或细菌感染敏感度较低的患者进行剂量调整.
- 了解抗生素度变化对于重症监护室 (ICU) 的有效治疗至关重要.
研究的目的:
- 在接受标准或调整剂量方案的重症患者中研究抗生素度变化.
- 评估在ICU环境中实现beta-lactam抗生素的药理学目标.
主要方法:
- 在102名病情危急的患者中测量了塞福他西姆,皮佩拉西林/塔扎巴克坦和美罗的度.
- 在单次剂量间隔期间收集的中剂量和低谷值.
- 评估的药理动力学终点:100%的自由抗生素度超过最小抑制度 (MIC) 和MIC的四倍 (100% ƒT>MIC和100% ƒT>4MIC).
主要成果:
- 总体而言,76%的患者实现了主要终点 (100% ƒT>MIC),抗生素之间存在差异 (74%-88%).
- 只有39%的患者达到二次终点 (100% ƒT>4MIC).
- 标准剂量在71%的患者中实现了100%的 ƒT > MIC,而增加剂量只显示了边际改善 (79%),而减少剂量在所有患者中实现了100%.
结论:
- 标准的β-lactam抗生素剂量不足以达到重症患者中很大一部分的目标.
- 剂量减少成功地达到度目标,而剂量增加并没有持续改善结果.
- 需要个性化剂量策略,可能由治疗药物监测指导,以提高ICU中的抗生素疗效.
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