ICU危重感染抗菌药应用.pptVIP

Dose Optimization of Antimicrobial Agents in Patients with Severe Infection;Therapeutic Strategy of Antibiotic to Severe Infection;Therapeutic Strategy of Antibiotic to Patients with Severe Infection;Appropriate treatment: Bacterial sensitivity to antibiotics matchs selected antimicrobial agents ;Therapeutic Strategy of Antibiotic to Patients with Severe Infection;Inadequate antimicrobial treatment was correlated with high mortality in severe infection;Inadequate antimicrobial treatment significantly affects the survival rate of patients with severe infection;上述决定因素取决于： 体外效力（微生物特性） 药物暴露（药物代谢动力学特性） 体内效力（药效学特性）;Adequate antibiotic therapy should regard patients as a “core”:Considering the relationship among the "patients- drugs - bacteria" comprehensively;Alteration of Pharmacokinetics in Severe Infection;Severe infection = Sepsis + acute organs dysfunction;Characteristics of Severe Infection; ;;Effect of severe infective patient to PK ;Enhancement of distribution volume (Vd) of antimicrobial drugs in severe patient;Increased volume of distribution (Vd) in critical patient——Drug concentration reduced in blood and tissue;Volume of distribution of Amikacin in 100 ICU adults and children Result Vd was increased in accordance with the severity of disease Vd was increased in all water-soluble antibiotics in ICU, the initial dose should be higher than the standard one!; ;;PK / PD is changed by sepsis;Optimization of antibiotic dosage in severe infection ;;Evaluation parameters of PK / PD for antimicrobial agents;Pharmacodynamics (PD) Index of antibiotics;;14例入组ICU的VAP（临床肺部感染评分【CPIS】 ≥6 ）患者 左氧氟沙星： 第1天2×500mg；随后连续7天1×500mg 通过中心静脉管静脉输注，60分钟内输完 左氧氟沙星PK/PD指数： f Cmax,ss/MIC; f AUC/MIC;氟喹诺酮类：格兰阴性菌：f Cmax,ss/MIC = 10; f AUC/MIC ≥ 100–125 格兰阳性菌：f Cmax,ss/MIC = 10; f AUC/MIC≥ 30 ;;Cases;Case (Meropenem 1g q8h 30 min Infusion);The PD of Tigecycline and dose optimization;61例院内获得性肺炎患者使用替加环素 静脉输注100 mg负荷剂量 之前输注剂量为50 mg q1