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目的探讨利用抗菌药物的PK/PD特点及药物浓度监测结果指导多药耐药菌感染的重症患者的个体化抗感染治疗策略及连续性肾脏替代治疗(CRRT)治疗时药物剂量的调整,提高重症感染患者救治成功率。方法对2013年西安交通大学第一附属医院重症医学科收治的1例多药耐药菌感染的重症患者的临床、影像学及病原学资料,抗菌药物的PK/PD特点及药物浓度监测结果,以及CRRT治疗时的药物剂量调整进行分析总结。结果患者病情危重,治疗过程中痰培养为泛耐药鲍氏不动杆菌,血培养曾出现多药耐药的肺炎克雷伯菌肺炎亚种及近平滑假丝酵母菌、尿培养曾出现多药耐药的肺炎克雷伯菌肺炎亚种及多药耐药的屎肠球菌。治疗中我们根据药敏结果结合患者脏器功能选择抗菌药物,使用美罗培南对耐药菌进行治疗时,采用两步法给药,根据抗菌药物的PK/PD特点优化抗菌药物使用,分析CRRT治疗对药物浓度的影响,对治疗药物进行浓度监测,根据监测结果对抗菌药物进行个体化调整,以发挥抗菌药物的最大疗效,最终患者好转出院。结论对于多药耐药菌混合感染的重症患者,利用抗菌药物的PK/PD特点优化抗菌药物治疗。根据治疗中药物浓度监测结果调整抗菌药物剂量,实现精准化、个体化治疗,提高重症患者的救治成功率。
Objective To explore the individualized anti-infective treatment strategies and the dose adjustment of continuous renal replacement therapy (CRRT) in patients with severe multidrug-resistant bacterial infection by using the characteristics of PK / PD of antibacterial drugs and drug concentration monitoring results, Infection patients treatment success rate. Methods The clinical, imaging and etiological data of 1 severe multidrug-resistant bacterial infection admitted to the Department of Critical Care Medicine of the First Affiliated Hospital of Xi’an Jiaotong University in 2013, PK / PD characteristics and drug concentration monitoring results of antimicrobial agents, As well as CRRT treatment of drug dose adjustment analysis and summary. Results The patient was critically ill. During the course of treatment, the sputum was cultivated as pan-resistant Acinetobacter baumannii. Multi-drug resistant Klebsiella pneumoniae pneumonia and Candida parapsilosis appeared in blood culture. Drug-resistant Klebsiella pneumoniae pneumonia and multi-drug resistant Enterococcus faecium. In the course of treatment, we selected antimicrobial agents based on the results of drug sensitivity and organ function of the patients. When using meropenem to treat drug-resistant bacteria, we administered it in a two-step method. The use of antimicrobial agents was optimized according to the PK / PD characteristics of antimicrobial agents. CRRT treatment The impact of drug concentration, the concentration of the therapeutic drug monitoring, monitoring results based on individual antibacterial drugs to adjust to play the maximum effect of antimicrobial drugs, the final patient was discharged. Conclusions For patients with severe multidrug-resistant mixed infections, the use of antimicrobial PK / PD features optimized antimicrobial therapy. Adjust the dosage of antibacterials according to the monitoring result of the drug concentration in the treatment so as to realize the accurate and individualized treatment and improve the successful treatment rate of the critically ill patients.