Objective To evaluate the therapeutic effects of delayed infusion and normal infusion in patients with complicated intra-abdominal infections and to promote rational and effective use of drugs. Methods A total of 52 patients with severe abdominal infection in the First People's Hospital of Changzhou from 2011 to 2015 were divided into delayed infusion group (treatment group, 0.3 g biapenem, ivgtt,q6h/q8h, for 3 h) and normal infusion group (control group, 0.3 g biapenem, ivgtt, q6h/q8h, for 0.5 h) according to administration route. The currative effect was compared between two groups. Results The fever clearance time of treatment group and control group was (13.5±8.3) and (16.7±14.9) d; the length of hospital stay was (38.9±16.9) and (45.8±13.6) d; and the decrease rate of procalcitonin was (7.284±10.126) and (5.234±8.004) μg·L-1,repectively.The curative effect of treatment group was better than control group. Conclusion For patients with complicated intra-abdominal infections, prolonged infusion is better than normal infusion of biapenem.
正腹腔内感染(intra-abdominal infection,IAI)是一类危害严重的常见感染性疾病。流行病学资料显示约1/4的严重脓毒症或感染性休克由IAI引起,IAI是继肺部感染后,感染性休克的第二大病因[1]。2010年,美国感染病学会(Infectious Diseases Society of America,IDSA)和外科感染学会(Surgical Infection Society of America,SISA)更新发布了复杂腹腔内感染(complicated intra-abdominal infection,c IAI)诊治指南(以下简称IDSA指南)[2],基于循证医学证据,对c IAI的临床诊治提出了指导性意见。自其发布以来,该指南的影响力迅速超越了北美地区范
SOLOMKIN JS,MAZUSKI JE,BRADLEY JS,et al.Dia-gnosis and management of complicated intra-abdominal infection in adults and children:guidelines by the surgical infection society and the infectious diseases society of America[J].Surg Infect(Larchmt),2010,11(1):79-109.
STURKENBOOM MC,GOETTSCH WG,PICELLIG,et al.Inappropriate initial treatment of secondary intra-abdominal infections leads to increased risk of clinical failure and costs[J].J Clin Pharmacol,2005,60(4):438-443.
AIMS: The objective of this population-based, retrospective cohort study was to investigate the incidence and initial antibiotic treatment of secondary intra-abdominal infections (sIAI) and to assess whether inappropriate initial antibiotic therapy affects patient outcomes.METHODS: All patients hospitalized for sIAI (1995-1998) were identified in the PHARMO Record Linkage System, a patient-centric database including pharmacy dispensing records from community pharmacies linked to hospitalization records in the Netherlands. Complementary in-hospital antibiotic drug use was obtained from the computerized inpatient pharmacy files. The patient outcomes considered were switch to second-line antibiotic treatment, re-operation, and death. In addition, a composite variable clinical failure was constructed based on the above-mentioned outcomes. Furthermore, the effect of clinical failure on length of hospital stay and costs of hospitalization was assessed. Associations between appropriateness of initial antibiotic treatment and outcomes were estimated using multivariate logistic and linear regression models.RESULTS: In the source population of 228,000 persons, 175 cases were classified as sIAI (mean age 49.3 +/- 24.5, 50.9% male) resulting in an incidence of 2.3/10,000 person-years [95% confidence interval (CI) 2.0, 2.7]. Initial antibiotic treatment was appropriate for 84% of the cases. The risk of clinical failure was 17.1%. Inappropriate initial antibiotic treatment increased the risk of clinical failure 3.4-fold (95% CI 1.3, 9.1). Length of hospital stay and costs of hospitalization were significantly increased for patients with clinical failure.CONCLUSIONS: Inappropriate choice of initial antibiotic therapy in sIAI patients leads to more clinical failure resulting in a longer hospital stay and higher costs of hospitalization compared with appropriate initial antibiotic therapy.
FALAGAS ME,TANSARLI GS,IKAWAK,et al.Clinical outcomes with extended or continuous versus short-term intravenous infusion of carbapenems and piperacillin /tazobactam:a systematic review and meta-analysis[J].Clin Infect Dis,2013, 56( 2):272-282.
We sought to study whether the better pharmacokinetic and pharmacodynamic (PK/PD) properties of carbapenems and piperacillin/tazobactam, when the duration of infusion is longer, were associated with lower mortality. PubMed and Scopus were searched for studies reporting on patients treated with extended (>= 3 hours) or continuous (24 hours) versus short-term duration (20-60 minutes) infusions of carbapenems or piperacillin/tazobactam. Fourteen studies were included (1229 patients). Mortality was lower among patients receiving extended or continuous infusion of carbapenems or piperacillin/tazobactam compared to those receiving short-term (risk ratio [RR], 0.59; 95% confidence interval [CI], .41-.83). Patients with pneumonia who received extended or continuous infusion had lower mortality than those receiving short-term infusion (RR, 0.50; 95% CI, 0.26-0.96). Data for other specific infections were not available. The available evidence from mainly nonrandomized studies suggests that extended or continuous infusion of carbapenems or piperacillin/tazobactam was associated with lower mortality. Well-designed randomized controlled trials are warranted to confirm these findings before such approaches become widely used.
YUSUFE,SPAPENH,PIERARDD.Prolonged vs intermi-ttent infusion of piperacillin /tazobactam in crtically ill patients:a narrative and systematic review[J].J Crrit Care,2014,29( 6):1089-1095.
The purpose of this study is to review the rationale of prolonged (ie, extended or continuous) infusion of piperacillin/tazobactam (PIP/TAZ) in critically ill patients and to perform a systematic review that compare the effectiveness of prolonged infusion with intermittent bolus of PIP/TAZ. A search of Medline, Web of Science, Embase, and Cochrane databases was conducted up to April 2014. For systematic review, studies comparing the effectiveness of prolonged and bolus administration of PIP/TAZ were included. The level of evidence is determined using best-evidence synthesis, which consisted of 5 possible levels of evidence: strong, moderate, limited, conflicting, or no evidence. The pharmacokinetic/pharmacodynamic studies that account for an eventual benefit of prolonged PIP/TAZ infusion were reviewed. In the systematic review, 1 randomized controlled trial was identified that showed higher ure in the prolonged than in the intermittent infusion group, yet the chosen clinical outcome in this study, decline in mean Acute Physiology and Chronic Health Evaluation II score is controversial. Of 6 retrospective cohort studies, 4 showed either less mortality, a higher clinical cure rate, or shorter length of hospital stay with prolonged PIP/TAZ treatment. The level of evidence supporting a better clinical outcome with prolonged infusion of PIP/TAZ is moderate. Pharmacokinetic/pharmacodynamic studies provide a robust rationale to prefer prolonged above intermittent infusion of PIP/TAZ. However, although some studies suggest a better outcome in critically ill patients receiving prolonged infusion, the level of evidence is moderate.
EIKIK,JUNKOK,YASUYUKIN,et al.Comparison of the pharmacodynamics of biapenem in Bronchial epithelial lining fluid in healthy volunteers given half-hour and three-hour intravenous infusions[J].Antimicrob Agents Chemother,2009,53(7):2799-2803.
ASSICOTM,GENDRELD,CARSINH,et al.High serum procalcitonin concentrations in patients with sepsis and infection[J].Lancet,1993,341(8844):515-518.
High concentrations of calcitonin-like immunoreactivity have been found in the blood of patients with various extrathyroid diseases. By means of a monoclonal immunoradiometric assay for calcitonin precursors, we have measured serum concentrations of procalcitonin in patients with various bacterial and viral infections. 79 children (newborn to age 12 years) in hospital with suspected infections were investigated prospectively. 19 patients with severe bacterial infections had very high serum concentrations of procalcitonin at diagnosis (range 6-53 ng/mL) in comparison with 21 children found to have no signs of infection (baseline concentrations <0 1 ng/mL). Serum procalcitonin values decreased rapidly during antibiotic therapy. 11 patients with peripheral bacterial colonisation or local infections without invasive sepsis and 18 (86%) of 21 patients with viral infections had concentrations within or slightly above the normal range (0 1-1 5 ng/mL). Among 9 severely burned patients studied in an intensive care unit, the post-traumatic course of procalcitonin concentrations (range 0 1-120 ng/mL) was closely related to infectious complications and acute septic episodes. Concentrations of mature calcitonin were normal in all subjects, whatever procalcitonin concentrations were found. Concentrations of a substance immunologically identical to procalcitonin are raised during septic conditions. Serum concentrations seem to be correlated with the severity of microbial invasion.
SCHUETZP,CHIAPPAV,BRIELM,et al.Procalcitonina-lgorithms for antibiotic therapy decisions:a systematic review of randomized controlled trials and recommendations for clinical algorithms[J].Arch Intern Med,2011,171(15):1322-1331.
Dia-gnosis and management of complicated intra-abdominal infection in adults and children:guidelines by the surgical infection society and the infectious diseases society of America
Clinical outcomes with extended or continuous versus short-term intravenous infusion of carbapenems and piperacillin /tazobactam:a systematic review and meta-analysis
Comparison of the pharmacodynamics of biapenem in Bronchial epithelial lining fluid in healthy volunteers given half-hour and three-hour intravenous infusions
Procalcitonina-lgorithms for antibiotic therapy decisions:a systematic review of randomized controlled trials and recommendations for clinical algorithms
, 钱春艳
