摘要
随着抗菌药物的广泛应用,细菌耐药问题严重威胁人类健康,新型复方β内酰胺抗生素/β-内酰胺酶抑制剂是临床治疗多种耐药菌感染的重要选择。重症感染合并急性肾损伤的患者通常依赖连续性肾脏替代治疗(CRRT)提供肾功能支持。头孢他啶-阿维巴坦、头孢洛扎-他唑巴坦、亚胺培南-西司他丁-瑞来巴坦以及美罗培南-韦博巴坦这四种新型抗菌药物,因其低分子量、有限的分布容积和蛋白结合率,以及主要通过肾脏清除的特点,在CRRT过程中容易被清除。在CRRT治疗期间,这些药物的药代动力学和药效学可能会受到影响,给药方案不当可能导致治疗失败或病原体耐药。本文回顾并总结了这些新型抗菌药物在CRRT患者中的药代动力学研究,旨在为优化临床给药方案提供参考。
With the widespread use of antibiotics,bacterial resistance has emerged as a significant threat to human health.The combination of novelβ-lactam antibiotics andβ-lactamase inhibitors represents an important strategy for treating multidrug-resistant bacterial infections in clinical settings.Patients with severe infections and acute kidney injury often depend on continuous renal replacement therapy(CRRT)to provide extracorporeal renal support.Four recently introduced antibiotics—ceftazidime-avibactam,ceftolozane-tazobactam,imipenem-cilastatin-relebactam,and meropenem-vaborbactam—are readily cleared during CRRT due to their low molecular weight,limited volume of distribution,low protein binding,and predominantly renal clearance.During CRRT,the pharmacokinetics and pharmacodynamics of these drugs may be altered,and inappropriate dosing regimens could result in treatment failure or the emergence of pathogen resistance.This article reviews and synthesizes the available pharmacokinetic data for these novel antibiotics in CRRT patients,aiming to inform the optimization of clinical dosing strategies.
作者
李辰阳(综述)
葛永纯(审校)
LI Chenyang;GE Yongchun(National Clinical Research Center for Kidney Diseases,Jinling Hospital,Nanjing University of Chinese Medicine,Nanjing 210016,China)
出处
《肾脏病与透析肾移植杂志》
2025年第4期381-385,共5页
Chinese Journal of Nephrology,Dialysis & Transplantation
基金
江苏省卫健委医学创新中心项目(CXZX202202)。
关键词
急性肾损伤
连续性肾脏替代治疗
抗生素
药代动力学
药物剂量调整
acute kidney injury
continuous renal replacement therapy
antibiotics
pharmacokinetic
drug dosage adjustment
