感染病患者多重耐药菌感染风险的分层课件.ppt

IDSA has updated its guidelines for empiric therapy of community-acquired pneumonia.1 An important consideration is appropriate use of antipseudomonal agents in this setting. For patients admitted to the hospital ICU with community-acquired pneumonia for whom pseudomonal infection is not an issue, ertapenem is a preferred treatment option.1 Patients who have community-acquired pneumonia and risk factors for pseudomonal infection—including severe structural lung disease such as bronchiectasis, or recent antibiotic therapy or recent prior hospitalization, especially in the ICU—require different therapy. For these patients, antipseudomonal coverage with imipenem, meropenem, cefepime, piperacillin, or piperacillin/tazobactam combined with ciprofloxacin has been recommended.1 Reference Mandell LA, Bartlett JG, Dowell SF, et al. Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults. Clin Infect Dis. 2003;37:1405–1433. Source: IVZ 2005-W-26381-SS (Slide 72) As is the case with other β-lactam antibiotics, an important pharmacodynamic parameter that correlates well with clinical efficacy for carbapenems is the fraction of the dosing interval during which the drug concentration exceeds the MIC for a given pathogen. For bacteriostasis to occur, carbapenem concentrations must exceed the MIC for approximately 30% of the dosing interval (ie, approximately 8 hours for ertapenem).1 A pharmacokinetic study in 68 healthy adult subjects measured plasma concentrations of total and free (unbound) ertapenem following a single 1 g intravenous dose infused over 30 minutes.2 As shown on the slide, the MIC90 of Enterobacteriaceae was below the mean concentration of total ertapenem (red squares) for 24 hours postdose, and below the mean concentration of free ertapenem (gold squares) for at least 16 hours postdose. In addition, the MIC90 of P aeruginosa was below the mean concentration of total ertapenem (red squares) for at least 8 hou