急性肾损伤患者抗生素剂量的调整简介数据历程荣誉对于非透析的AKI患者是否需要调整抗生素剂量?怎样调整剂量?—根据抗生素PK/PD参数进行调整简介数据历程荣誉AKI对抗生素剂量的影响肌酐清除率CLcr抗生素PK参数简介数据历程荣誉AKI患者肌酐清除率CLcrMDRD方程eGFRa(ml/min/1.73m2)=186×[Pcr]-1.154×[年龄(岁)]-0.203×[女性×0.742]Cockcroft–GaultCCr(ml/min)=(男性)(140-年龄)×体重(kg)/72×血肌酐(mg/dL)(女性)(140-年龄)×体重(kg)/85×血肌酐(mg/dL)Jelliffe方程Ccr(ml/min)={98-0.8×(年龄-20)×(0.09女性)}/Scr尿量(仅适用于有尿患者)新的生物标志物(需要更多证据支持)胱抑素C(CysC),尿中性粒细胞明胶酶相关载脂蛋白(NGAL)简介数据历程荣誉AKI患者肌酐清除率CLcr简介数据历程荣誉抗生素PK/PD分类时间依赖性且短PAE时间依赖性且长PAE浓度依赖性T>MICAUC/MICCmax/MIC在有效剂量内减少单次服用剂量,增加服用次数在安全剂量内提高单次服用剂量,适当减少服用次数青霉素类β-内酰胺类大环内酯类林可霉素类氨曲南达托霉素替加环素利奈唑胺糖肽类阿奇霉素氨基糖苷类氟喹诺酮类甲硝唑等吴伟东.从PK/PD角度优化抗生素治疗[A].浙江省医学会重症医学分会.重症医学十年回顾与展望——2012年浙江省重症医学学术年会论文汇编[C].浙江省医学会重症医学分会:,2012:4.简介数据历程荣誉S.Blotetal./DiagnosticMicrobiologyandInfectiousDisease79(2014)77–84抗生素PK/PD调整简介数据历程荣誉氨基糖苷类—庆大霉素D.Xuanetal.InternationalJournalofAntimicrobialAgents23(2004)291–295简介数据历程荣誉庆大霉素:45-80ml/min7mg/kgq48h10-30ml/min4-7mg/kgq36h-q48h氨基糖苷:10-30ml/min,15-30mg/kgq36h-q48h。氨基糖苷类—庆大霉素简介数据历程荣誉喹诺酮类—环丙沙星JournalofAntimicrobialChemotherapy(2006)58,380–386简介数据历程荣誉喹诺酮类—环丙沙星环丙沙星,无需调整剂量。简介数据历程荣誉青霉素类-哌拉西林/他唑巴坦Gonçalves-PereiraandPóvoaCriticalCare2011,15:R206Beta-lactamscandevelopasignificantlyalteredVdandclearanceinsepticpatientsleadingtolargeheterogeneityofpossibleconcentrations简介数据历程荣誉青霉素类-哌拉西林/他唑巴坦简介数据历程荣誉青霉素类-哌拉西林/他唑巴坦治疗初始24小时内,按照标准剂量给药。然后再根据肾功能调整剂量。简介数据历程荣誉头孢菌素类—头孢他啶,头孢吡肟ANTIMICROBIALAGENTSANDCHEMOTHERAPY,June2003,p.1853–1861简介数据历程荣誉头孢菌素类—头孢他啶,头孢吡肟简介数据历程荣誉头孢他啶、头孢吡肟推荐剂量为:50-80mL/min2.0q12h10-50mL/min1.0q12h<10mL/min0.5qd但达不到最佳治疗效果。probabilityoftargetattainmentwillbeevenmorereducedduetoincreasedVd,atleastinthefirstfewdaysoftherapy头孢菌素类—头孢他啶,头孢吡肟简介数据历程荣誉碳青霉烯类—美罗培南R.Kitzes-Cohenetal./InternationalJournalofAntimicrobialAgents19(2002)105–110theauthorsfoundthatpatientswithAKIwhoreceivedareduceddose(1gbidversus1gtidinpatientswithoutAKI)stillachieved100%fT>MICagainstsusceptibleorganismswithMIC<1mg/L.简介数据历程荣誉碳青霉烯类—美罗培南inadequateantimicrobialconcentrationswerefoundin17%ofpatientswithAKI,whichwasagaindefinedasCLcr<50mL/min.简介数据历程荣誉碳青霉烯类—美罗培南Usingstandardnon-AKIdosesinthefirst24hoursoftherapy.Afterthattime,dosedecreasestoappropriaterenallyadjusteddosesshouldoccur.简介数据历程荣誉替加环素KorthBradleyetal.JClinPharmacol2012;52:1379-1387简介数据历程荣誉替加环素tigecyclineclearancewasreducedbyabout20%resultinginanincrease/optimizationinAUC0-24ofnearly30%.fromapharmacokineticpointofview,nodosageadjustmentbasedonrenalfunctioniswarranted.简介数据历程荣誉Nodoseadjustmentsseemnecessaryincaseofimpairedrenalfunction.替加环素简介数据历程荣誉万古霉素InternationalJournalofAntimicrobialAgents41(2013)434–438简介数据历程荣誉AKI患者,给予标准负荷剂量,维持剂量无需调整,TDM万古霉素简介数据历程荣誉小结治疗初始24~48h,大多数抗生素剂量无需调整,如哌拉西林/他唑巴坦、美罗培南等。头孢他啶和头孢吡肟按照肾功能调整给药剂量可能达不到疗效。环丙沙星、万古霉素、替加环素无需调整剂量。简介数据历程荣誉谢谢!