ICU 抗菌藥物用藥劑量不足風(fēng)險探討(新)

目前一頁\總數(shù)四十二頁\編于十三點VPA1.2g/d，3d后，VPA39.91更改至1.6g/d，7d后，VPA19.32

（VAP達標(biāo)濃度50-100）VAN1.0g，q12h，2d后，VAN2.37更改至1.0g，q8h，8d后，VAN8.8-11.52

（VAN達標(biāo)濃度＞10，甚至更高）目前二頁\總數(shù)四十二頁\編于十三點目前三頁\總數(shù)四十二頁\編于十三點目前四頁\總數(shù)四十二頁\編于十三點臨床常用的給藥劑量哌拉西林他唑巴坦（4.5g/支）目前五頁\總數(shù)四十二頁\編于十三點臨床常用的給藥劑量美羅培南（0.5g/支）目前六頁\總數(shù)四十二頁\編于十三點目前七頁\總數(shù)四十二頁\編于十三點目前八頁\總數(shù)四十二頁\編于十三點However,whenasubjectisexposedtoastandarddoseofanantibacterialindailypractice,thepK/pDratioachievedmaybelowerthanexpectedasaconsequenceofthepatient’sclinicalconditionandthecharacteristicsoftheinvolvedpathogenThismaybeconsideredas‘underdosing’,theresultofwhichwillbeatherapeuticfailure.目前九頁\總數(shù)四十二頁\編于十三點Incriticallyillpatients,thereareanumberofreasonsforaninadequatepK/pDratioofantimicrobialsatthesiteofinfectionandthatshouldbeconsideredincaseofpoorclinicaloutcomeortherapeuticfailure(tableIII).目前十頁\總數(shù)四十二頁\編于十三點目前十一頁\總數(shù)四十二頁\編于十三點1.給藥劑量不足按照實際體重計算用藥劑量（actualbodyweight）☆氨基糖苷類、糖肽類、兩性霉素B、達托霉素按照標(biāo)準(zhǔn)體重估算給藥劑量（standardizedbodyweight）☆內(nèi)酰胺類、替加環(huán)素、棘白菌素、大環(huán)內(nèi)脂、喹諾酮類目前十二頁\總數(shù)四十二頁\編于十三點宜進行劑量調(diào)整人群包括1.Overweight2.親脂性藥物actualbodyweight3.親水性藥物idealbodyweight目前十三頁\總數(shù)四十二頁\編于十三點目前十四頁\總數(shù)四十二頁\編于十三點2.感染局部濃度不足原因分析1.血供減少2.細(xì)胞膜通過/進入障礙3.分布容積增加/膠體滲透壓減低4.蛋白結(jié)合率高的藥物分布障礙5.屏障作用（CNS）目前十五頁\總數(shù)四十二頁\編于十三點3.清除率增加目前十六頁\總數(shù)四十二頁\編于十三點目前十七頁\總數(shù)四十二頁\編于十三點目前十八頁\總數(shù)四十二頁\編于十三點目前十九頁\總數(shù)四十二頁\編于十三點目前二十頁\總數(shù)四十二頁\編于十三點目前二十一頁\總數(shù)四十二頁\編于十三點美羅培南比阿培南目前二十二頁\總數(shù)四十二頁\編于十三點美羅培南比阿培南目前二十三頁\總數(shù)四十二頁\編于十三點目前二十四頁\總數(shù)四十二頁\編于十三點目前二十五頁\總數(shù)四十二頁\編于十三點目前二十六頁\總數(shù)四十二頁\編于十三點目前二十七頁\總數(shù)四十二頁\編于十三點目前二十八頁\總數(shù)四十二頁\編于十三點Withdialysis,withoutpreviouslivertransplantation/resection,withdialysis,withpreviouslivertransplantation/resectionwithoutdialysis,withoutpreviouslivertransplantation/resectionwithoutdialysis,withpreviouslivertransplantation/resection目前二十九頁\總數(shù)四十二頁\編于十三點ConclusionDialysis

increasedtheCIoflinezolidby3.5L/h,correspondingtoameanincreaseof23%.Inpatientsafterlivertransplantation/resection,linezolidCIwasreducedby60%relativetopatientswithoutpriorlivertransplantation/resection.目前三十頁\總數(shù)四十二頁\編于十三點目前三十一頁\總數(shù)四十二頁\編于十三點目前三十二頁\總數(shù)四十二頁\編于十三點目前三十三頁\總數(shù)四十二頁\編于十三點目前三十四頁\總數(shù)四十二頁\編于十三點目前三十五頁\總數(shù)四十二頁\編于十三點目前三十六頁\總數(shù)四十二頁\編于十三點目前三十七頁\總數(shù)四十二頁\編于十三點目前三十八頁\總數(shù)四十二頁\編于十三點目前三十九頁\總數(shù)四十二頁\編于十三點Nocorrelationcouldbeestablishedbetweenanidulafunginexposureanddiseaseseverityorplasmaproteinconcentrationsinthisgroupofcriticallyillpatients.Inthispopulation,weobservedaloweranidulafunginexposurethaninthegeneralpatientpopulation.InpatientsinfectedwithasusceptibleCandidaalbicansorglabratastrainwithaMICwellbelowthebreakpoint,noproblemsaretobeexpectedinthecaseofalowerexposure.However,inpatientswithless-susceptibleCandidaalbicansorglabratastrains,alowerexposurecanbeaproblem.IftheMICishighorunknown,wer