Department of Medicine, University of Udine.
Institute of Clinical Pharmacology, Santa Maria della Misericordia University Hospital of Udine, ASUFC.
Ther Drug Monit. 2020 Jun;42(3):349-352. doi: 10.1097/FTD.0000000000000740.
The authors present the case of a critically ill morbidly obese patient (body mass index, 51.2 kg/m) who suffered from methicillin-resistant Staphylococcus epidermidis, and Candida albicans bloodstream infections. Initial treatment with caspofungin and daptomycin was deemed inappropriate, because blood cultures remained positive for both isolates after 14 days. The clinical pharmacological consultant suggested adding fluconazole and ceftobiprole to the ongoing antimicrobial therapy, and starting a real-time therapeutic drug monitoring program of daptomycin, ceftobiprole, and fluconazole, aimed at optimizing plasma exposures. Punctual minimum inhibitory concentration knowledge on the clinical isolates allowed attainment of the desired pharmacodynamic efficacy targets. Within few days, the patient greatly improved, as blood cultures became negative, and the inflammatory markers decreased to near normal values. This is a proof-of-concept of the importance of a therapeutic drug monitoring-based multidisciplinary approach in the proper management of complex antimicrobial therapy in special populations.
作者报告了一例患有肥胖症危重症患者（体重指数，51.2kg/m），该患者患有耐甲氧西林表皮葡萄球菌和白色念珠菌血流感染。最初使用卡泊芬净和达托霉素治疗被认为是不恰当的，因为在 14 天后，两种分离株的血培养仍为阳性。临床药理学顾问建议在正在进行的抗菌治疗中添加氟康唑和头孢他啶，同时启动达托霉素、头孢他啶和氟康唑的实时治疗药物监测计划，以优化血浆暴露。及时了解临床分离株的最低抑菌浓度有助于达到预期的药效学目标。在几天内，患者的病情得到了极大改善，血培养转为阴性，炎症标志物降至接近正常水平。这证明了基于治疗药物监测的多学科方法在特殊人群中对复杂抗菌治疗的正确管理中的重要性。
