中国实用儿科杂志

中国实用儿科杂志 ›› 2022, Vol. 37 ›› Issue (2): 99-103.DOI: 10.19538/j.ek2022020605

• 专题笔谈 • 上一篇    下一篇

万古霉素在儿童社区获得性耐甲氧西林金黄色葡萄球菌肺炎的个体化抗感染治疗策略

  

  1. 重庆医科大学附属儿童医院呼吸科、药学部  国家儿童健康与疾病临床医学研究中心  儿童发育疾病研究教育部重点实验室  儿科学重庆市重点实验室，重庆  400014 
  • 出版日期:2022-02-06 发布日期:2022-02-20
  • 通讯作者: 罗征秀，电子信箱：luozhengxiu816@163.com

Individualized antiinfectious therapeutic strategies of vancomycin in children with community-acquired methicillin-resistant Staphylococcus aureus pneumonia

  1. Department of Respiratory/Pharmacy，Children’s Hospital of Chongqing Medical University；National Clinical Research Center for Child Health and Disorders；Ministry of Education Key Laboratory of Child Development and Disorders；Chongqing Key Laboratory of Pediatrics，Chongqing  400014，China
  • Online:2022-02-06 Published:2022-02-20

摘要： 社区获得性耐甲氧西林金黄色葡萄球菌（CA-MRSA）肺炎患病率报道增多。CA-MRSA菌株基因突变、MIC漂移、抗菌药物耐药性增加等因素使儿科医师在经验性治疗CA-MRSA肺炎时面临重大挑战。万古霉素是抗MRSA感染的一线抗菌药物，具有治疗窗窄及肾脏毒性等特点。患儿在不同病理生理状态下，以药代动力学与药效学（PK/PD）原理及治疗药物浓度监测（TDM）为指导，进行万古霉素个体化治疗，可提高CA-MRSA肺炎患儿使用万古霉素的安全性和有效性，并减少耐药菌株产生。

关键词: 儿童, 社区获得性耐甲氧西林金黄色葡萄球菌, 肺炎, 万古霉素

Abstract: Reports have shown that there has been increased prevalence of community-acquired methicillin-resistant Staphylococcus aureus（CA-MRSA） pneumonia. The factors such as CA-MRSA strain gene mutation，MIC drift，and antimicrobial resistance have increased the challenge for pediatricians in empirical treatment of CA-MRSA infections.Vancomycin is the first-line antibiotic for MRSA infection，which has the characteristics of narrow therapeutic window and nephrotoxicity.Based on individualized pharmacokinetics and pharmacodynamics （PK/PD） and therapeutic drug concentration monitoring （TDM），and under different pathophysiological state of the children，individualized treatment with vancomycin for the patients with CA-MRSA pneumonia can increase the safety and effectiveness，and reduce the prodution of drug-resistant bacteria.

Key words: child, community-acquired methicillin-resistant Staphylococcus aureus, pneumonia, vancomycin