亚胺培南和美罗培南对柠檬酸杆菌属引起的血流感染的最佳治疗
Optimal treatment of Imipenem and meropenem against bloodstream infections caused by the Citrobacter spp.
作者信息
Jiang Lushun, Fang Jiaheng, Zhang Jiajie, Zhang Kanghui, Yue Junpeng, Dong Kaixuan, Shen Jiaying, Qiu Yunqing, Yu Wei
机构信息
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, National Clinical Research Center for Infectious Diseases, Zhejiang University School of Medicine, Hangzhou, China.
Department of gastroenterology, Hangzhou Normal University Affiliated Hospital, Hangzhou, China.
出版信息
BMC Infect Dis. 2025 Mar 17;25(1):366. doi: 10.1186/s12879-025-10760-6.
OBJECTIVES
This work was to investigate the optimal treatments of imipenem (IPM) and meropenem (MEM) against bloodstream infections (BSIs) caused by Citrobacter spp.
METHODS
A total of 230 nonduplicate BSIs Citrobacter spp. were collected from 2014 to 2020 in three hospitals in Zhejiang Province in China. The minimum inhibitory concentrations (MICs) of 17 antibiotics were determined. Monte Carlo simulation (MCS) was used to investigate the cumulative fraction of response (CFR) of 8 regimens of IPM and 10 regimens of MEM.
RESULTS
C. freundii (Cfr) was the predominant epidemic isolate (83.9%, 193/230). The resistance rates to IPM and MEM showed an increasing trend from 2015 to 2019. Fosfomycin showed excellent activity from 2014 to 2020. The probability of target attainment of IPM and MEM by prolonged 3 h infusion therapy (PIT) was higher than that by traditional 0.5 h (h) infusion therapy (TIT) during the same administration dosage. The CFR of all IPM regimes was above 90%, while MEM with 500 mg q8h was lower than 90%, especially for Cfr.
CONCLUSIONS
Cfr is the most common BSIs. Citrobacter spp. PIT is more adequate to provide activity against BSIs Citrobacter spp., especially for IPM.
目的
本研究旨在探讨亚胺培南（IPM）和美罗培南（MEM）对柠檬酸杆菌属所致血流感染（BSIs）的最佳治疗方案。
方法
2014年至2020年期间，在中国浙江省的三家医院共收集了230株非重复的柠檬酸杆菌属BSIs菌株。测定了17种抗生素的最低抑菌浓度（MICs）。采用蒙特卡洛模拟（MCS）研究了8种IPM方案和10种MEM方案的累积反应分数（CFR）。
结果
弗氏柠檬酸杆菌（Cfr）是主要的流行菌株（83.9%，193/230）。2015年至2019年期间，对IPM和MEM的耐药率呈上升趋势。2014年至2020年期间，磷霉素表现出优异的活性。在相同给药剂量下，延长3小时输注疗法（PIT）的IPM和MEM达到目标的概率高于传统的0.5小时（h）输注疗法（TIT）。所有IPM方案的CFR均高于90%，而每8小时500mg的MEM方案低于90%，尤其是对Cfr。
结论
Cfr是最常见的BSIs。柠檬酸杆菌属PIT更适合用于对抗柠檬酸杆菌属BSIs，尤其是IPM。
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