在临床实践中何时以及如何使用最低抑菌浓度(MIC)?
When and How to Use MIC in Clinical Practice?
作者信息
Magréault Sophie, Jauréguy Françoise, Carbonnelle Etienne, Zahar Jean-Ralph
机构信息
Department of Pharmacology, AP-HP, Groupe Hospitalier Paris Seine Saint-Denis, F-93140 Bondy, France.
Université Sorbonne Paris Nord and Université Paris Cité, Inserm, IAME, F-93000 Bobigny, France.
出版信息
Antibiotics (Basel). 2022 Dec 3;11(12):1748. doi: 10.3390/antibiotics11121748.
Bacterial resistance to antibiotics continues to be a global public health problem. The choice of the most effective antibiotic and the use of an adapted dose in the initial phase of the infection are essential to limit the emergence of resistance. This will depend on (i) the isolated bacteria and its resistance profile, (ii) the pharmacodynamic (PD) profile of the antibiotic used and its level of toxicity, (iii) the site of infection, and (iv) the pharmacokinetic (PK) profile of the patient. In order to take account of both parameters to optimize the administered treatment, a minimal inhibitory concentration (MIC) determination associated with therapeutic drug monitoring (TDM) and their combined interpretation are required. The objective of this narrative review is thus to suggest microbiological, pharmacological, and/or clinical situations for which this approach could be useful. Regarding the microbiological aspect, such as the detection of antibiotic resistance and its level, the preservation of broad-spectrum β-lactams is particularly discussed. PK-PD profiles are relevant for difficult-to-reach infections and specific populations such as intensive care patients, cystic fibrosis patients, obese, or elderly patients. Finally, MIC and TDM are tools available to clinicians, who should not hesitate to use them to manage their patients.
细菌对抗生素的耐药性仍然是一个全球公共卫生问题。在感染初期选择最有效的抗生素并使用合适的剂量对于限制耐药性的出现至关重要。这将取决于:(i)分离出的细菌及其耐药谱;(ii)所用抗生素的药效学(PD)特征及其毒性水平;(iii)感染部位;以及(iv)患者的药代动力学(PK)特征。为了兼顾这两个参数以优化给药治疗,需要进行与治疗药物监测(TDM)相关的最低抑菌浓度(MIC)测定及其综合解读。因此,本叙述性综述的目的是提出这种方法可能有用的微生物学、药理学和/或临床情况。关于微生物学方面,如抗生素耐药性及其水平的检测,特别讨论了广谱β-内酰胺类药物的保留问题。PK-PD特征与难以到达的感染以及特定人群(如重症监护患者、囊性纤维化患者、肥胖或老年患者)相关。最后,MIC和TDM是临床医生可用的工具,他们应毫不犹豫地使用这些工具来管理患者。
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