| 张弘 张春玲 徐德祥 孙荣丽 陈霞.肺炎克雷伯杆菌对抗菌药物耐药性变化的影响[J].,2015,15(2):328-331 |
| 肺炎克雷伯杆菌对抗菌药物耐药性变化的影响 |
| A Study on the Antimicrobial Resistance Change of Klebsiella Pneumoniae |
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| DOI： |
| 中文关键词: 蒙特卡罗模拟 肺炎克雷伯杆菌 抗菌药物 耐药性 |
| 英文关键词: Monte Carlo simulation Klebsiella pneumoiae Antimicrobial drug Drug resistance |
| 基金项目:青岛市公共领域科技支撑项目（2012-1-3-4-（3）-
nsh） |
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| 中文摘要: |
| 目的：监测几种临床常用抗菌药物对肺炎克雷伯杆菌最低抑菌浓度（MIC）变化情况，在临床工作中帮助选择合理的初始化
抗菌治疗方案。方法：本研究选择哌拉西林他唑巴坦、头孢哌酮舒巴坦、拉氧头孢钠、左氧氟沙星及头孢他啶5 种常用的抗革兰
氏阴性杆菌感染的治疗药物作为初始经验性治疗方案，使用随机法将5 种抗菌方案分配到5 个观察组，5 个观察组于
2011.07-2012.07 间各自采集HAP 患者痰标本，筛选出其中ESBLs（-）肺炎克雷伯杆菌资料，并于2012.08-2013.08 间分别使用1
种拟定的抗菌治疗方案进行HAP的初始化治疗。使用Crystal Ball 软件进行蒙特卡罗模拟计算上述5 种药物常用方案的两个阶
段的累计反应分数（CFR），比较其效果。结果：（1）在按规定方案治疗1 年后，头孢哌酮钠舒巴坦、哌拉西林他唑巴坦、拉氧头孢
钠、左氧氟沙星组有效率改变均无统计学意义，头孢他啶组固定初始化治疗1 年后有效率下降，有统计学意义（P=0.037）；（2 ）对各
科室初始化方案再次进行了蒙特卡罗模拟，对比后发现头孢他啶方案CFR 较前下降明显，其余方案CFR 差异小。结论：蒙特卡
罗模拟法可计算出用药方案达到药效学指标的概率，以CFR 为标准可以更为直观的选择经验性治疗方案，并有效的监测细菌耐
药性的变化。 |
| 英文摘要: |
| Objective:Monitoring Minimum inhibitory concentration （MIC）changes of Klebsiella pneumoniae of several
antimicrobial agents which commonly used in clinical, to help making a reasonable choice of initializing antimicrobial treatment
programs in clinical work.Methods:In this study, piperacillin-tazobactam, cefoperazone sulbactam, Latamoxef sodium, levofloxacin and
ceftazidime five kinds of commonly used anti-Gram-negative bacilli infections drugs as initial empiric therapy, were assigned to five
observation groups by random method.Collected sputum samples of patients with HAP in each observation group at 2011.07-2012.07,
then screened out of which ESBLs (-) Klebsiella pneumoniae data and used one intended antimicrobial initialization treatment of HAP
Respectively at 2012.08-2013.08. Using Crystal Ball software for Monte Carlo calculation of two-stage CFR of the above five kinds of
drugs commonly used programs, and their results were compared.Results:(1) One year later, treatment efficiency in cefoperazone
sulbactam group, piperacillin-tazobactam group, Latamoxef sodium group and levofloxacin group was not statistically significantly
changed, while its decrease was statistically significant in ceftazidime group (P = 0.037). (2) Compared the CFR of two stages and found
that of ceftazidime significantly decreased compared with the previous CFR, and others had small differences.Conclusion:Monte Carlo
simulation calculates the probability of drug regimens to achieve pharmacodynamic targets. With the CFR as a standard , empiric
treatment programs can be selected more visually, and change of bacterial resistance can be monitored effectively. |
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