ICU抗菌藥物用藥劑量不足風(fēng)險(xiǎn)探討(新)

當(dāng)前1頁，總共45頁。VPA1.2g/d，3d后，VPA39.91更改至1.6g/d，7d后，VPA19.32

（VAP達(dá)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(dá)標(biāo)濃度＞10，甚至更高）當(dāng)前2頁，總共45頁。當(dāng)前3頁，總共45頁。當(dāng)前4頁，總共45頁。臨床常用的給藥劑量哌拉西林他唑巴坦（4.5g/支）當(dāng)前5頁，總共45頁。臨床常用的給藥劑量美羅培南（0.5g/支）當(dāng)前6頁，總共45頁。當(dāng)前7頁，總共45頁。當(dāng)前8頁，總共45頁。However,whenasubjectisexposedtoastandarddoseofanantibacterialindailypractice,thepK/pDratioachievedmaybelowerthanexpectedasaconsequenceofthepatient’sclinicalconditionandthecharacteristicsoftheinvolvedpathogenThismaybeconsideredas‘underdosing’,theresultofwhichwillbeatherapeuticfailure.當(dāng)前9頁，總共45頁。Incriticallyillpatients,thereareanumberofreasonsforaninadequatepK/pDratioofantimicrobialsatthesiteofinfectionandthatshouldbeconsideredincaseofpoorclinicaloutcomeortherapeuticfailure(tableIII).當(dāng)前10頁，總共45頁。當(dāng)前11頁，總共45頁。1.給藥劑量不足按照實(shí)際體重計(jì)算用藥劑量（actualbodyweight）☆氨基糖苷類、糖肽類、兩性霉素B、達(dá)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、喹諾酮類當(dāng)前12頁，總共45頁。宜進(jìn)行劑量調(diào)整人群包括1.Overweight2.親脂性藥物actualbodyweight3.親水性藥物idealbodyweight當(dāng)前13頁，總共45頁。當(dāng)前14頁，總共45頁。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(jìn)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）當(dāng)前15頁，總共45頁。3.清除率增加當(dāng)前16頁，總共45頁。當(dāng)前17頁，總共45頁。當(dāng)前18頁，總共45頁。當(dāng)前19頁，總共45頁。當(dāng)前20頁，總共45頁。當(dāng)前21頁，總共45頁。美羅培南比阿培南當(dāng)前22頁，總共45頁。美羅培南比阿培南當(dāng)前23頁，總共45頁。當(dāng)前24頁，總共45頁。當(dāng)前25頁，總共45頁。當(dāng)前26頁，總共45頁。當(dāng)前27頁，總共45頁。當(dāng)前28頁，總共45頁。Withdialysis,withoutpreviouslivertransplantation/resection,withdialysis,withpreviouslivertransplantation/resectionwithoutdialysis,withoutpreviouslivertransplantation/resectionwithoutdialysis,withpreviouslivertransplantation/resection當(dāng)前29頁，總共45頁。ConclusionDialysis

increasedtheCIoflinezolidby3.5L/h,correspondingtoameanincreaseof23%.Inpatientsafterlivertransplantation/resection,linezolidCIwasreducedby60%relativetopatientswithoutpriorlivertransplantation/resection.當(dāng)前30頁，總共45頁。當(dāng)前31頁，總共45頁。當(dāng)前32頁，總共45頁。當(dāng)前33頁，總共45頁。當(dāng)前34頁，總共45頁。當(dāng)前35頁，總共45頁。當(dāng)前36頁，總共45頁。當(dāng)前37頁，總共45頁。當(dāng)前38頁，總共45頁。當(dāng)前39頁，總共45頁。Nocorrelationcouldbeestablishedbetweenanidulafunginexposureanddiseaseseverityorplasmaproteinconcentrationsinthisgroupofcriticallyillpatients.Inthispopulation,weobservedaloweranidulafunginexposurethaninthegeneralpatientpopulation.InpatientsinfectedwithasusceptibleCandidaalbicansorglabratastrainwithaMICwellbelowthebreakpoint,noproblemsaretobeexpectedinthecaseofalowerexposure.However,inpatientswithless-susceptibleCandidaalbicansorglabratastrains,alowerexposurecanbeaproblem.IftheMICishighorunknown,werecommendconsideringdetermini