Abdul-Aziz Mohd H, Lipman Jeffrey, Roberts Jason A
aBurns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia bSchool of Pharmacy, International Islamic University of Malaysia, Kuantan, Pahang, Malaysia cDepartment of Intensive Care Medicine dPharmacy Department, Royal Brisbane and Women's Hospital eCentre for Translational Antiinfective Pharmacodynamics, The University of Queensland, Brisbane, Australia.
Curr Opin Infect Dis. 2017 Apr;30(2):231-239. doi: 10.1097/QCO.0000000000000348.
Nosocomial pneumonia caused by multidrug-resistant pathogens is increasing in the ICU, and these infections are negatively associated with patient outcomes. Optimization of antibiotic dosing has been suggested as a key intervention to improve clinical outcomes in patients with nosocomial pneumonia. This review describes the recent pharmacokinetic/pharmacodynamic data relevant to antibiotic dosing for nosocomial pneumonia caused by multidrug-resistant pathogens.
Optimal antibiotic treatment is challenging in critically ill patients with nosocomial pneumonia; most dosing guidelines do not consider the altered physiology and illness severity associated with severe lung infections. Antibiotic dosing can be guided by plasma drug concentrations, which do not reflect the concentrations at the site of infection. The application of aggressive dosing regimens, in accordance to the antibiotic's pharmacokinetic/pharmacodynamic characteristics, may be required to ensure rapid and effective drug exposure in infected lung tissues.
Conventional antibiotic dosing increases the likelihood of therapeutic failure in critically ill patients with nosocomial pneumonia. Alternative dosing strategies, which exploit the pharmacokinetic/pharmacodynamic properties of an antibiotic, should be strongly considered to ensure optimal antibiotic exposure and better therapeutic outcomes in these patients.
重症监护病房（ICU）中由多重耐药病原体引起的医院获得性肺炎正在增加，并且这些感染与患者预后呈负相关。优化抗生素给药方案已被认为是改善医院获得性肺炎患者临床结局的关键干预措施。本综述描述了与多重耐药病原体引起的医院获得性肺炎抗生素给药相关的近期药代动力学/药效学数据。
对于患有医院获得性肺炎的重症患者，优化抗生素治疗具有挑战性；大多数给药指南未考虑与严重肺部感染相关的生理改变和疾病严重程度。抗生素给药可由血浆药物浓度指导，但血浆药物浓度不能反映感染部位的浓度。根据抗生素的药代动力学/药效学特性应用积极的给药方案，可能需要确保感染肺组织中快速有效的药物暴露。
传统的抗生素给药增加了患有医院获得性肺炎的重症患者治疗失败的可能性。应强烈考虑采用利用抗生素药代动力学/药效学特性的替代给药策略，以确保这些患者获得最佳的抗生素暴露和更好的治疗效果。
