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[由于最低抑菌浓度(MIC)测量浓度范围差异导致的%T>MIC达标概率的影响——铜绿假单胞菌美罗培南分析——]

[Influences of %T>MIC achievement probability due to the difference of the MIC measurement concentration range-analysis of meropenem for Pseudomonas aeruginosa-].

作者信息

Nagasawa Zenzo, Nakashima Yukari, Fukutomi Yumiko, Uki Nozomi, Kusaba Koji, Nagumo Fumio, Ohta Shoichiro, Sueoka Eizaburo, Miyamoto Hiroshi

机构信息

Department of Clinical Laboratory, Saga University Hospital, Saga-shi, Saga, Japan.

出版信息

Rinsho Biseibutshu Jinsoku Shindan Kenkyukai Shi. 2011;22(1-2):11-22.

Abstract

We attempted to analyze any influences to %T>MIC achievement probability due to the difference of the MIC measurement concentration range of MEPM for 613 strains of Pseudomonas aeruginosa by the Monte Carlo simulation method. As for the analysis, we calculated the achievement probability of 30% and 50% for MEPM %T>MIC by the administration volume of MEPM: 250 mg, 500 mg, and 1,000 mg, the administration time: 0.5 h, and 3 h, the administration frequency: 2 times, and 3 times, and the renal excretion capability: Normal, Slight, Moderate, and High abnormal with the 3 types of MIC concentration measurement level 1) <=0.06>=256 µg/ml: 13 levels, 2) <=0.5>=32 µg/ml: 7 levels, and 3) <=1~>=16 µg/ml: 5 levels. As the result, we found the following findings; 1. In terms of the administration of normal renal excretion capability, 250 mg, in comparison with 500 mg and 1,000 mg, indicated the differential due to the difference of MIC measurement concentration range. 2. The administration volume of MEPM 500 mg which has been recommended shown the less differential of the achievement probability due to the difference of MIC measurement concentration range. As the renal excretion was shifted through Normal to Slight to Moderate to High abnormal, the differential of the achievement probability due to the difference of MIC measurement concentration range was gradually decreased. With these results, PK/PD analysis is possible for the 5 levels measurement concentration. It is significant that the facility using the automated microbiology analyzer can provide not only the MIC report, but also the information on the appropriate administration method for antibacterial drug by PK/PD analysis.

摘要

我们试图通过蒙特卡罗模拟方法分析613株铜绿假单胞菌美洛培南(MEPM)最低抑菌浓度(MIC)测量浓度范围的差异对%T>MIC达标概率的影响。对于该分析,我们通过美洛培南的给药剂量(250mg、500mg和1000mg)、给药时间(0.5小时和3小时)、给药频率(2次和3次)以及肾脏排泄能力(正常、轻度、中度和高度异常),计算了美洛培南%T>MIC达到30%和50%的达标概率,采用3种MIC浓度测量水平:1)≤0.06~≥256μg/ml:13个水平;2)≤0.5~≥32μg/ml:7个水平;3)≤1~≥16μg/ml:5个水平。结果发现以下情况:1. 就肾脏排泄能力正常的给药情况而言,250mg与500mg和1000mg相比,显示出因MIC测量浓度范围差异导致的差异。2. 已推荐的美洛培南500mg给药剂量显示,因MIC测量浓度范围差异导致的达标概率差异较小。随着肾脏排泄从正常转变为轻度、中度和高度异常,因MIC测量浓度范围差异导致的达标概率差异逐渐减小。基于这些结果,对于5个水平的测量浓度可以进行药代动力学/药效学(PK/PD)分析。使用自动化微生物分析仪的机构不仅能够提供MIC报告,还能通过PK/PD分析提供抗菌药物合适给药方法的信息,这具有重要意义。

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