Optimization of initial antibacterial drug regimens for treating common staphylococcal infection in ICU / 重庆医学

ABSTRACT

Objective To optimize the antibacterial drug regimen in ICU common staphylococcal infection.Methods The pharmacokinetic and pharmacodynamic parameters of antibacterial drugs were collected in combination with the hospital ICU anti-microbial drug resistance monitoring reports from the national antimicrobial resistance investigation net (Mohnarin)of the Ministry of Health and the performance standards for antimicrobial susceptibility testing (2013)issued by the clinical and laboratory stand-ards institute (CLSI),the minimum inhibitory concentration (MIC)of staphylococci was set by using the discrete uniform distribu-tion method and 16 kinds of administration regimens with 6 antimicrobial agents were worked out.The best initially antimicrobial regimen was optimized by using the pharmacokinetic and pharmacodynamic models and Monte Carlo simulations of cumulative frac-tion of response (CFR)from 5 000 patients.Results The alternative initially drug regimens to the infectious bacteria were:linezolid 0.40 g twice daily and vancomycin 0.75 g twice daily for staphylococcus aureus;amikacin 0.60 g once daily and linezolid 0.40 g twice daily,and vancomycin 0.75 g twice daily for hemolytic staphylococci and staphylococcus epidermidis;linezolid 0.40 g twice daily and vancomycin 0.75 g twice daily for methicillin-resistant Staphylococcus aureus;ampicillin/sulbactam 1.50 g 4 times daily, cefuroxime 0.75 g 4 times daily,amikacin 0.60 g once daily,moxifloxacin 0.40 g once daily for methicillin-sensitive staphylococcus aureus.Conclusion In the Staphylococcus aureus infection occurred in ICU,if which being methicillin-sensitive could be deter-mined,ampicillin/sulbactam,cefuroxime,amikacin and moxifloxacin could be selected for treatment,and linezolid or vancomycin could be selected for treating possible methicillin-resistant Staphylococcus aureus infection or undetermined whether being methicil-lin-resistant Staphylococcus aureus infection.