碳青霉烯在MDR菌感染的应用.pptVIP

* The FDA发现the use of tigecycline 与an increased mortality risk有关(91a)，(267),所以单用此药效果不佳。 使用Tigecycline的 standard dosing regimen of the drug (50 mg twice daily) range from 0.6 to 0.9 μg/ml, while those attained in the urine and in the epithelial lining fluid are several fold lower (2,36, 88, 210). 无法达到 drug’s MIC profile for current CPE isolates,因此Tigecycline治疗CPE infections效果不佳。 因此要combination with another active agent，并考虑concentration at the anatomic site of infection and of the MIC for the infecting organism. a lower total daily dosage of intravenous colistin was associated with increased mortality (90). the delay in attaining an efficacious drug concentration with the standard treatment regimen of colistin. This could be overcome by administering a loading dose of the drug (211) 抗菌药物超MIC时间(TMIC) (或TimeMIC ):是指药物浓度高于MIC的时间. MIC:最小抑制浓度，表示抗生素的抗菌活性,指可以抑制菌生长的最低的抗菌的浓度。 MIC越低说明该药物对相应的病原菌的作用越强。 通俗点说就是：能抑制培养基内细菌生长的最低浓度。 * 如果MIC为1mg/L或2mg/L,无论0.5g 0.5h输注、0.5g 2h输注还是1g 2h输注，T〉4倍MIC时间均〉40% 但如果MIC为4mg/L，只有1g 2h输注时，才能让T〉4倍MIC时间均 〉40% 。 提示：对于不敏感病原菌感染，特别是MIC为4mg/L以上时，一定要剂量达到1g，且两小时输注才可达到最佳杀菌活性。 此篇研究中作者还是认为自己入组病人较少， * * The “12 Steps to Prevent Antimicrobial Resistance: Hospitalized Adults” intervention program is the first “12 Steps” to be launched because hospital patients are at especially high risk for serious antimicrobial-resistant infections. Each year nearly 2 million patients in the United States get an infection in a hospital. Of those patients, about 90,000 die as a result of their infection. More than 70% of the bacteria that cause hospital-acquired infections are resistant to at least one of the drugs most commonly used to treat them. Persons infected with antimicrobial-resistant organisms are more likely to have longer hospital stays and require treatment with second-or third-choice drugs that may be less effective, more toxic, and/or more expensive. * 杀菌的目标达成率比较 有学者认为，对于时间依赖性抗菌药物，当治疗重症感染患者时，40% TMIC 是不够的，应达到60%-70% TMIC 研究显示，亚胺培南治疗血流感染， 获得70% T MIC的目标达成率高达9