Risk factors of substandard drug blood concentration of meropenem in patients with hospital-acquired pneumonia

SHI Lu; CHEN Fang; LU Guangxian; DUAN Lufen; LU Jian; ZHUANG Zhiwei; XU Jinhui; XU Hongtao; WU Chao; ZHOU Qin; TANG Lian

doi:10.6039/j.issn.1001-0408.2022.19.17

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Risk factors of substandard drug blood concentration of meropenem in patients with hospital-acquired pneumonia

更新时间：2025-12-03

- Risk factors of substandard drug blood concentration of meropenem in patients with hospital-acquired pneumonia
- ZHONGGUO YAOFANG Vol. 33, Issue 19, Pages: 2388-2392(2022)
- 作者机构：
  
  1.南京医科大学附属苏州医院药剂科，江苏苏州　215002
  2.南京医科大学附属苏州医院重症医学科，江苏苏州　215002
  3.南京医科大学附属苏州医院急诊监护室，江苏苏州　215002
  4.杭州佰辰医学检验所有限公司，杭州　310012
- 作者简介：
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2022.19.17
  CLC： R974;R969.1
- Received：14 February 2022，
  
  Revised：2022-07-26，
  
  Published：15 October 2022
- 稿件说明：
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石璐,陈芳,鲁广先等.医院获得性肺炎患者美罗培南血药浓度不达标的危险因素分析 ^Δ[J].中国药房,2022,33(19):2388-2392.

SHI Lu,CHEN Fang,LU Guangxian,et al.Risk factors of substandard drug blood concentration of meropenem in patients with hospital-acquired pneumonia[J].ZHONGGUO YAOFANG,2022,33(19):2388-2392.
石璐,陈芳,鲁广先等.医院获得性肺炎患者美罗培南血药浓度不达标的危险因素分析 ^Δ[J].中国药房,2022,33(19):2388-2392. DOI： 10.6039/j.issn.1001-0408.2022.19.17.

SHI Lu,CHEN Fang,LU Guangxian,et al.Risk factors of substandard drug blood concentration of meropenem in patients with hospital-acquired pneumonia[J].ZHONGGUO YAOFANG,2022,33(19):2388-2392. DOI： 10.6039/j.issn.1001-0408.2022.19.17.

摘要

目的

分析医院获得性肺炎（HAP）患者美罗培南血药浓度不达标的危险因素。

方法

选择南京医科大学附属苏州医院2020年1月至2021年6月入住重症监护室且行美罗培南稳态血药谷浓度检测的130例HAP患者为研究对象。记录患者的年龄、性别、体质量等病史资料。测定美罗培南稳态血药谷浓度，并确定其靶标。采用单因素和多因素Logistic回归分析法筛选美罗培南稳态血药谷浓度不达标的危险因素，绘制受试者工作特征（ROC）曲线筛选危险因素的警戒值并评估危险因素的预测价值。

结果

美罗培南稳态血药谷浓度≥2 mg/L的有85例，稳态血药谷浓度＜2 mg/L的有45例。多因素Logistic回归分析显示，年龄、负平衡量、颅脑损伤为美罗培南稳态血药谷浓度不达标的独立危险因素（

＜0.05）。ROC曲线显示，患者年龄为58岁时，ROC曲线下面积最大（0.744），灵敏度为0.882，特异度为0.556，约登指数为0.438；负平衡量为520.5 mL/24 h时，ROC曲线下面积达到最大（0.827），灵敏度为0.722，特异度为0.905，约登指数为0.628。颅脑损伤组患者的肌酐清除率显著高于非颅脑损伤组患者、美罗培南稳态血药谷浓度显著低于非颅脑损伤组患者（

＜0.001）。

结论

HAP患者年龄＜58岁、存在颅脑损伤及负平衡量＞520.5 mL/24 h时，美罗培南稳态血药谷浓度不达标的风险会增加。

Abstract

OBJECTIVE

To analyze the risk factors of substandard drug blood concentration of meropenem in patients with hospital acquired pneumonia （HAP）.

METHODS

Totally 130 HAP patients who were admitted to the intensive care unit of Suzhou Hospital Affiliated to Nanjing Medical University from January 2020 to June 2021 and received steady-state blood concentration test of meropenem were selected as the study subjects. The patient’s age， sex， body mass and other medical history were recorded. The steady-state blood trough concentration of meropenem was determined and its target was determined. Univariate and multivariate Logistic regression analysis were used to screen the risk factors for the substandard steady-state blood trough concentration of meropenem. The receiver operating characteristic （ROC） curve was drawn to screen the warning value of the risk factors and evaluate the predictive value of the risk factors.

RESULTS

The steady-state blood trough concentrations of 85 cases were ≥2 mg/L， and those of 45 cases were

＜2 mg/L. Multivariate Logistic regression analysis showed that age， negative balance and brain injury were independent risk factors for the substandard steady-state blood trough concentration of meropenem （

＜0.05）.ROC curve showed that when the patient was 58 years old， the area under the ROC curve was the largest （0.744）， the sensitivity was 0.882， the specificity was 0.556， and the Youden index was 0.438；when the negative balance was 520.5 mL/24 h， the area under the ROC curve reached the maximum （0.827）， the sensitivity was 0.722， the specificity was 0.905， and the Youden index was 0.628. The creatinine clearance rate in the brain injury group was significantly higher than that in the non-brain injury group， and the steady-state blood trough concentration of meropenem in the brain injury group was significantly lower than that in the non-brain injury group （

＜0.001）.

CONCLUSIONS

When the HAP patient’s age is less than 58 years old， the brain injury and the negative balance is more than 520.5 mL/24 h， the risk of substandard steady-state blood trough concentration of meropenem will increase.

关键词

Keywords

references

中华医学会呼吸病学分会感染学组 . 中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南：2018年版 [J ] . 中华结核和呼吸杂志， 2018 ， 41 （ 4 ）： 255 - 280 .

中国医药教育协会感染疾病专业委员会 . 抗菌药物药代动力学/药效学理论临床应用专家共识 [J ] . 中华结核和呼吸杂志， 2018 ， 41 （ 6 ）： 409 - 446 .

ABDUL-AZIZ M H ， ALFFENAAR J W C ， BASSETTI M ， et al . Antimicrobial therapeutic drug monitoring in critically ill adult patients：a position paper [J ] . Intensive Care Med ， 2020 ， 46 （ 6 ）： 1127 - 1153 .

GUILHAUMOU R ， BENABOUD S ， BENNIS Y ， et al . Optimization of the treatment with beta-lactam antibiotics in critically ill patients-guidelines from the French Society of Pharmacology and Therapeutics （Société Française de Pharmacologie et Thérapeutique-SFPT） and the French Society of Anaesthesia and Intensive Care Medicine （Société Française d'Anesthésie et Réanimation-SFAR） [J ] . Crit Care ， 2019 ， 23 （ 1 ）： 104 .

AL-SHAER M H ， RUBIDO E ， CHERABUDDI K ， et al . Early therapeutic monitoring of β-lactams and associated therapy outcomes in critically ill patients [J ] . J Antimicrob Chemother ， 2020 ， 75 （ 12 ）： 3644 - 3651 .

BENÍTEZ-CANO A ， LUQUE S ， SORLÍ L ， et al . Intrapulmonary concentrations of meropenem administered by continuous infusion in critically ill patients with nosocomial pneumonia：a randomized pharmacokinetic trial [J ] . Crit Care ， 2020 ， 24 （ 1 ）： 55 .

巴特利特 . ABX指南：感染性疾病的诊断与治疗 [M ] . 北京：科技文献出版社， 2012 ： 113 - 119 .

戴维·N·吉尔伯特 . 热病：桑福德抗微生物治疗指南 [M ] . 50版 . 北京：中国协和医科大学出版社， 2020 ： 1 - 668 .

国家药典委员会 . 中华人民共和国药典：二部 [S ] .2020年版. 北京：中国医药科技出版社， 2020 ： 1088 .

Clinical and Laboratory Standards Institute . Performance standards for antimicrobial susceptibility testing [S ] . 32nd edition . Wayne，PA，USA ： CLSI ， 2022 .

Centers for Disease Control and Prevention . Facility gui- dance for control of carbapenem-resistant Enterobacteriaceae（CRE）：November 2015 update CRE toolkit [S/OL ] . （ 2020-02-08 ）[ 2022-05-15 ] . https：//www.cdc.gov/hai/organisms/cre/cre-toolkit/index.html https://www.cdc.gov/hai/organisms/cre/cre-toolkit/index.html .

《抗菌药物临床试验技术指导原则》写作组 . 抗菌药物临床试验技术指导原则附件：抗菌药物立题原则建议 [J ] . 中国临床药理学杂志， 2014 ， 30 （ 9 ）： 857 - 858 .

OLIVEIRA M S ， MACHADO A S ， MENDES E T ， et al . Pharmacokinetic and pharmacodynamic characteristics of vancomycin and meropenem in critically ill patients receiving sustained low-efficiency dialysis [J ] . Clin Ther ， 2020 ， 42 （ 4 ）： 625 - 633 .

WU C C ， TAI C H ， LIAO W Y ， et al . Augmented renal clearance is associated with inadequate antibiotic pharmacokinetic/pharmacodynamic target in Asian ICU population：a prospective observational study [J ] . Infect Drug Resist ， 2019 ， 12 ： 2531 - 2541 .

ABDULLA A ， DIJKSTRA A ， HUNFELD N G M ， et al . Failure of target attainment of beta-lactam antibiotics in critically ill patients and associated risk factors：a two-center prospective study （EXPAT） [J ] . Crit Care ， 2020 ， 24 （ 1 ）： 558 .

OSWALT A ， JOSEPH A C ， SIMA A ， et al . Evaluation of intravenous vancomycin pharmacokinetic parameters in patients with acute brain injury [J ] . J Pharm Pract ， 2019 ， 32 （ 2 ）： 132 - 138 .

NELSON N R ， MORBITZER K A ， JORDAN J D ， et al . The impact of capping creatinine clearance on achieving therapeutic vancomycin concentrations in neurocritically ill patients with traumatic brain injury [J ] . Neurocrit Care ， 2019 ， 30 （ 1 ）： 126 - 131 .

ROBERTS J A ， PAUL S K ， AKOVA M ， et al . DALI：defining antibiotic levels in intensive care unit patients：are current β-lactam antibiotic doses sufficient for critically ill patients? [J ] . Clin Infect Dis ， 2014 ， 58 （ 8 ）： 1072 - 1083 .

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