急性肾损伤患者抗生素剂量的调整

急性肾损伤非透析患者抗生素剂量的调整,朱婷2014年8月19日,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,AKI对抗生素剂量的影响,肌酐清除率CLcr抗生素 PK参数,AKI患者肌酐清除率CLcr,MDRD 方程 eGFR a (ml/min/1.73 m2) = 186 Pcr - 1. 154 年龄 (岁 ) - 0. 203 女性 0. 742 CockcroftGaultCCr（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)=980.8(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）,AKI患者肌酐清除率CLcr,抗生素PK/PD分类,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.,S. Blot et al. / Diagnostic Microbiology and Infectious Disease 79 (2014) 7784,抗生素PK/PD调整,氨基糖苷类庆大霉素,D. Xuan et al. International Journal of Antimicrobial Agents 23 (2004) 291295,庆大霉素：45-80ml/min 7mg/kg q48h 10-30ml/min 4-7mg/kg q36h-q48h氨基糖苷： 10-30ml/min，15-30mg/kg q36h-q48h。,氨基糖苷类庆大霉素,喹诺酮类环丙沙星,Journal of Antimicrobial Chemotherapy(2006) 58, 380386,喹诺酮类环丙沙星,环丙沙星，无需调整剂量。,青霉素类-哌拉西林/他唑巴坦,Gonalves-Pereira and PvoaCritical Care2011,15:R206,Beta-lactams can develop a significantly altered Vd and clearance in septic patients leading to large heterogeneity of possible concentrations,青霉素类-哌拉西林/他唑巴坦,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。,头孢菌素类头孢他啶，头孢吡肟,ANTIMICROBIALAGENTS ANDCHEMOTHERAPY, June 2003, p. 18531861,头孢菌素类头孢他啶，头孢吡肟,头孢他啶、头孢吡肟推荐剂量为：50-80mL/min 2.0 q12h 10-50mL/min 1.0 q12h MIC against susceptible organisms withMIC1 mg/L.,碳青霉烯类美罗培南,inadequate antimicrobial concentrations were found in 17% of patients with AKI, which was again defined as CLcr50 mL/min.,碳青霉烯类美罗培南,Using standard non-AKIdoses in the first 24 hours of therapy. After that time, dose decreasesto appropriate renally adjusted doses should occur.,替加环素,Korth Bradley et al.J Clin Pharmacol 2012;52:1379-1387,替加环素,tigecycline clearance was reduced by about 20% resulting in an increase/optimization in AUC0-24of nearly 30%. from a pharmacokinetic point of view, no dosage adjustment based on renal function is warranted.,No dose adjustments seem necessary in case of impaired renal function.,替加环素,万古霉素,International Journal of Antimicrobial Agents 41 (2013) 434 438,AKI患者，给予标准负荷剂量，维持剂量无需