Nakashima Hajime, Miyazaki Motoyasu, Kuwamura Tsuneo, Oda Kazutaka, Haga Yumi, Imakyure Osamu
Department of Pharmacy, Japan Community Health Care Organization Kyushu Hospital, Fukuoka 806-0034, Japan.
Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka 818-8502, Japan.
Antibiotics (Basel). 2024 Feb 27;13(3):219. doi: 10.3390/antibiotics13030219.
bacteremia is associated with a high mortality rate, and meropenem (MEPM) is commonly used to treat it. However, the relationship between the time above the minimum inhibitory concentration (T) of MEPM and its therapeutic efficacy in bacteremia has not been explored. This study aimed to investigate this relationship by defining the target % T of MEPM as 75%. The retrospective study spanned 14 years and included hospitalized patients treated with MEPM for bacteremia. Monte Carlo simulation was used to calculate the probability of target attainment (PTA) for each patient, and the threshold for a PTA of 75% T associated with in-hospital survival was determined using receiver operating characteristic (ROC) curves. The ROC curve-derived PTA associated with improved in-hospital survival was 65.0%, a significant finding in multivariate logistic regression analysis adjusted for patient background factors (odds ratio: 20.49, 95% confidence interval: 3.02-245.23, = 0.005). This result suggests a dosing regimen that achieves a PTA of at least 65% when the target T of MEPM for treating bacteremia is defined as 75%.
菌血症与高死亡率相关，美罗培南（MEPM）常用于治疗菌血症。然而，MEPM高于最低抑菌浓度的时间（T）与其在菌血症治疗中的疗效之间的关系尚未得到探讨。本研究旨在通过将MEPM的目标T%定义为75%来研究这种关系。这项回顾性研究历时14年，纳入了因菌血症接受MEPM治疗的住院患者。采用蒙特卡洛模拟计算每位患者达到目标的概率（PTA），并使用受试者工作特征（ROC）曲线确定与院内生存相关的75%T的PTA阈值。ROC曲线得出的与改善院内生存相关的PTA为65.0%，在针对患者背景因素进行调整的多因素逻辑回归分析中这是一个显著发现（优势比：20.49，95%置信区间：3.02 - 245.23，P = 0.005）。该结果表明，当将治疗菌血症的MEPM目标T定义为75%时，一种能实现至少65%PTA的给药方案。
