美罗培南治疗肺部感染患者的血清杀菌活性监测
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摘要
目的:研究美罗培南治疗肺部感染患者血清杀菌活测定(SBA)的经验参考值,为临床个体化给药提供参考。方法:筛选2014年1月-2015年12月期间某院美罗培南进行抗感染治疗且痰培养阳性的肺部感染患者96例(肾功能减退患者51例,肾功能正常患者45例),用患者自身致病菌进行SBA峰值、谷值测定,观察美罗培南的临床疗效、用药前后患者肾功能变化情况、不良反应等。结果:肾功能减退患者及肾功能正常患者,2组患者使用美罗培南治疗肺部感染的峰时、谷时血清杀菌活性效价均高于SBA经验效价值,有显著性差异(P<0.05)。有效及显效的患者SBA峰值、谷值与无效的患者SBA峰值、谷值均存在显著性差异(P<0.05)。治疗期间未见明显肾功能损害。结论:据临床疗效及SBA实测数值,美罗培南治疗肺部感染患者自身血清杀菌活性测定的经验参考值可初步调整为峰值1∶32,谷值1∶8。
OBJECTIVE To research the reference values of serum bactericidal activity(SBA)related to the pulmonary infection patients treated with meropenem,and provide a reference for clinical individualized medicine.METHODS Totally 96 pulmonary infection and phlegm positive patients treated with meropenem were enrolled,including 45 with normal renal function and 51 with decreased renal function.Patients were observed for the clinical efficacy of meropenem,the changes of renal function before and after medication,adverse reactions,and the determined SBA peaks and trough values.RESULTS Both groups showed SBA peak and trough values significantly higher than SBA empirical value(P<0.05).SBA peak and trough values had significant difference between meropenem effective and ineffective patients(P<0.05).No serious renal impairment was observed for all patients during the treatment.CONCLUSION The peak value and trough values for meropenem in the treatment of pulmonary infection can be initially adjusted to 1∶32 and 1∶8,respectively.
OBJECTIVE To research the reference values of serum bactericidal activity(SBA)related to the pulmonary infection patients treated with meropenem,and provide a reference for clinical individualized medicine.METHODS Totally 96 pulmonary infection and phlegm positive patients treated with meropenem were enrolled,including 45 with normal renal function and 51 with decreased renal function.Patients were observed for the clinical efficacy of meropenem,the changes of renal function before and after medication,adverse reactions,and the determined SBA peaks and trough values.RESULTS Both groups showed SBA peak and trough values significantly higher than SBA empirical value(P<0.05).SBA peak and trough values had significant difference between meropenem effective and ineffective patients(P<0.05).No serious renal impairment was observed for all patients during the treatment.CONCLUSION The peak value and trough values for meropenem in the treatment of pulmonary infection can be initially adjusted to 1∶32 and 1∶8,respectively.
引文
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[6]Nie WM,Wang R,Fang Y,et al.The serum bactericidal activity of gatifloxacin[J].Chin J Nosocomiol(中华医院感染学杂志),2002,12(7):510-512.
[7]Wiseman LR,Wagstaff AJ,Brogden RN,et al.Meropenem.A review of its antibacterial activity,pharmacokinetic properties and clinical efficacy[J].Drugs,1995,50(1):73-101.
[8]Dong CL,Xu L,Shao Y,et al.Monitoring serum bactericidal activity determination in patients with renal insufficiency undergoing antibacterials[J].Laboratory Medicine(检验医学),2014,29(11):1132-1135.
[9]ThamLikitkul V,Tiengrim S,Chalermsri C,et al.Microbiological equivalence of serum bacteriostatic and bactericidal activities of the sera from healthy volunteers receiving original meropenem(Mero)and genetic meropenem(Mero)[J].J Med Assoc Thai,2010,(Suppl.1):S110-S116.
[10]Mouton JW,van den Anker JN.Meropenem clinical pharmacokinetics[J].Clin Pharmacokinet.1995,28(4):275-286.
[11]Tomaselli F,Maier A,Matzi V,et al.Penetration of meropenem into pneumonic human lung tissue as measured by in vivo microdialysis[J].Antimicrob Agents Chemother,2004,48(6):2228-2232.
[12]Diekema DJ,Pfaller MA.Trends in antimicrobial susceptibility of bacterial pathogens isolated from patients with blood stream in the USA,Canada and Latin America[J].Int J Antimicrob Agents,2000,13(4):257-271.
[13]Prober CG,Yeager AS.Use of the serum bactericidal titer to assess the adequacy of oral antibiotic therapy in the treatment of acute hematogenous osteomyelitis[J].J Pediatr,1979,95:131-135.
[2]John W,Morton NS.Serum Bactericidal Activity as a Monitor of Antibiotic Therapy[J].New Engl J Med,1985,312(15):968-973.
[3]Klastersky J,Daneau D,Swings G,et al.Antibacterial activity in serum and urine as a therapeutic guide in bacterial infections[J].Infect Dis,1974,129(2):187-193.
[4]Weinstein MP,Stratton CW,Ackley A,et al.Multicenter collaborative evaluation of a standardized serum bactericidal test as a prognostic indicator in infective endocarditis[J].Am J Med,1985,78:262-269.
[5]Zhou JJ,Dong YY,Liang BB,et al.Clinical significance of study on the serum bactericidal activity of antibacterial drugs[J].Chin J Clin Pharmacol(中国临床药理学杂志),2010,26(11):877-880.
[6]Nie WM,Wang R,Fang Y,et al.The serum bactericidal activity of gatifloxacin[J].Chin J Nosocomiol(中华医院感染学杂志),2002,12(7):510-512.
[7]Wiseman LR,Wagstaff AJ,Brogden RN,et al.Meropenem.A review of its antibacterial activity,pharmacokinetic properties and clinical efficacy[J].Drugs,1995,50(1):73-101.
[8]Dong CL,Xu L,Shao Y,et al.Monitoring serum bactericidal activity determination in patients with renal insufficiency undergoing antibacterials[J].Laboratory Medicine(检验医学),2014,29(11):1132-1135.
[9]ThamLikitkul V,Tiengrim S,Chalermsri C,et al.Microbiological equivalence of serum bacteriostatic and bactericidal activities of the sera from healthy volunteers receiving original meropenem(Mero)and genetic meropenem(Mero)[J].J Med Assoc Thai,2010,(Suppl.1):S110-S116.
[10]Mouton JW,van den Anker JN.Meropenem clinical pharmacokinetics[J].Clin Pharmacokinet.1995,28(4):275-286.
[11]Tomaselli F,Maier A,Matzi V,et al.Penetration of meropenem into pneumonic human lung tissue as measured by in vivo microdialysis[J].Antimicrob Agents Chemother,2004,48(6):2228-2232.
[12]Diekema DJ,Pfaller MA.Trends in antimicrobial susceptibility of bacterial pathogens isolated from patients with blood stream in the USA,Canada and Latin America[J].Int J Antimicrob Agents,2000,13(4):257-271.
[13]Prober CG,Yeager AS.Use of the serum bactericidal titer to assess the adequacy of oral antibiotic therapy in the treatment of acute hematogenous osteomyelitis[J].J Pediatr,1979,95:131-135.