The Monte Carlo Simulation of Three Antimicrobials for Empiric Treatment of Adult Bloodstream Infections With Carbapenem-Resistant Enterobacterales in China
Introduction: The aim of this study was to predict and evaluate three antimicrobials for treatment of adult bloodstream infections (BSI) with carbapenem-resistant Enterobacterales (CRE) in China, so as to optimize the clinical dosing regimen further.Methods: Antimicrobial susceptibility data of bloo...
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2021
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oai:doaj.org-article:3e5e48789c7b433b965874567a09eacb2021-12-01T02:16:59ZThe Monte Carlo Simulation of Three Antimicrobials for Empiric Treatment of Adult Bloodstream Infections With Carbapenem-Resistant Enterobacterales in China1664-302X10.3389/fmicb.2021.738812https://doaj.org/article/3e5e48789c7b433b965874567a09eacb2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fmicb.2021.738812/fullhttps://doaj.org/toc/1664-302XIntroduction: The aim of this study was to predict and evaluate three antimicrobials for treatment of adult bloodstream infections (BSI) with carbapenem-resistant Enterobacterales (CRE) in China, so as to optimize the clinical dosing regimen further.Methods: Antimicrobial susceptibility data of blood isolates were obtained from the Blood Bacterial Resistance Investigation Collaborative Systems in China. Monte Carlo simulation was conducted to estimate the probability target attainment (PTA) and cumulative fraction of response (CFR) of tigecycline, polymyxin B, and ceftazidime/avibactam against CRE.Results: For the results of PTAs, tigecycline following administration of 50 mg every 12 h, 75 mg every 12 h, and 100 mg every 12 h achieved > 90% PTAs when minimum inhibitory concentration (MIC) was 0.25, 0.5, and 0.5 μg/mL, respectively; polymyxin B following administration of all tested regimens achieved > 90% PTAs when MIC was 1 μg/mL with CRE; ceftazidime/avibactam following administration of 1.25 g every 8 h, 2.5 g every 8 h achieved > 90% PTAs when MIC was 4 μg/mL, 8 μg/mL with CRE, respectively. As for CFR values of three antimicrobials, ceftazidime/avibactam achieved the lowest CFR values. The highest CFR value of ceftazidime/avibactam was 77.42%. For tigecycline and ceftazidime/avibactam, with simulated regimens daily dosing increase, the CFR values were both increased; the highest CFR of tigecycline values was 91.88%. For polymyxin B, the most aggressive dosage of 1.5 mg/kg every 12 h could provide the highest CFR values (82.69%) against CRE.Conclusion: This study suggested that measurement of MICs and individualized therapy should be considered together to achieve the optimal drug exposure. In particular, pharmacokinetic and pharmacodynamic modeling based on local antimicrobial resistance data can provide valuable guidance for clinicians for the administration of empirical antibiotic treatments for BSIs.Dongna ZouGuangyue YaoChengwu ShenJinru JiJinru JiJinru JiChaoqun YingChaoqun YingChaoqun YingPeipei WangPeipei WangPeipei WangZhiying LiuZhiying LiuZhiying LiuJun WangYan JinYonghong XiaoYonghong XiaoYonghong XiaoFrontiers Media S.A.articlebloodstream infectionscarbapenem-resistant Enterobacteriaceaepolymyxin Bceftazidime/avibactamtigecyclineMonte Carlo simulationMicrobiologyQR1-502ENFrontiers in Microbiology, Vol 12 (2021) |
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bloodstream infections carbapenem-resistant Enterobacteriaceae polymyxin B ceftazidime/avibactam tigecycline Monte Carlo simulation Microbiology QR1-502 |
| spellingShingle |
bloodstream infections carbapenem-resistant Enterobacteriaceae polymyxin B ceftazidime/avibactam tigecycline Monte Carlo simulation Microbiology QR1-502 Dongna Zou Guangyue Yao Chengwu Shen Jinru Ji Jinru Ji Jinru Ji Chaoqun Ying Chaoqun Ying Chaoqun Ying Peipei Wang Peipei Wang Peipei Wang Zhiying Liu Zhiying Liu Zhiying Liu Jun Wang Yan Jin Yonghong Xiao Yonghong Xiao Yonghong Xiao The Monte Carlo Simulation of Three Antimicrobials for Empiric Treatment of Adult Bloodstream Infections With Carbapenem-Resistant Enterobacterales in China |
| description |
Introduction: The aim of this study was to predict and evaluate three antimicrobials for treatment of adult bloodstream infections (BSI) with carbapenem-resistant Enterobacterales (CRE) in China, so as to optimize the clinical dosing regimen further.Methods: Antimicrobial susceptibility data of blood isolates were obtained from the Blood Bacterial Resistance Investigation Collaborative Systems in China. Monte Carlo simulation was conducted to estimate the probability target attainment (PTA) and cumulative fraction of response (CFR) of tigecycline, polymyxin B, and ceftazidime/avibactam against CRE.Results: For the results of PTAs, tigecycline following administration of 50 mg every 12 h, 75 mg every 12 h, and 100 mg every 12 h achieved > 90% PTAs when minimum inhibitory concentration (MIC) was 0.25, 0.5, and 0.5 μg/mL, respectively; polymyxin B following administration of all tested regimens achieved > 90% PTAs when MIC was 1 μg/mL with CRE; ceftazidime/avibactam following administration of 1.25 g every 8 h, 2.5 g every 8 h achieved > 90% PTAs when MIC was 4 μg/mL, 8 μg/mL with CRE, respectively. As for CFR values of three antimicrobials, ceftazidime/avibactam achieved the lowest CFR values. The highest CFR value of ceftazidime/avibactam was 77.42%. For tigecycline and ceftazidime/avibactam, with simulated regimens daily dosing increase, the CFR values were both increased; the highest CFR of tigecycline values was 91.88%. For polymyxin B, the most aggressive dosage of 1.5 mg/kg every 12 h could provide the highest CFR values (82.69%) against CRE.Conclusion: This study suggested that measurement of MICs and individualized therapy should be considered together to achieve the optimal drug exposure. In particular, pharmacokinetic and pharmacodynamic modeling based on local antimicrobial resistance data can provide valuable guidance for clinicians for the administration of empirical antibiotic treatments for BSIs. |
| format |
article |
| author |
Dongna Zou Guangyue Yao Chengwu Shen Jinru Ji Jinru Ji Jinru Ji Chaoqun Ying Chaoqun Ying Chaoqun Ying Peipei Wang Peipei Wang Peipei Wang Zhiying Liu Zhiying Liu Zhiying Liu Jun Wang Yan Jin Yonghong Xiao Yonghong Xiao Yonghong Xiao |
| author_facet |
Dongna Zou Guangyue Yao Chengwu Shen Jinru Ji Jinru Ji Jinru Ji Chaoqun Ying Chaoqun Ying Chaoqun Ying Peipei Wang Peipei Wang Peipei Wang Zhiying Liu Zhiying Liu Zhiying Liu Jun Wang Yan Jin Yonghong Xiao Yonghong Xiao Yonghong Xiao |
| author_sort |
Dongna Zou |
| title |
The Monte Carlo Simulation of Three Antimicrobials for Empiric Treatment of Adult Bloodstream Infections With Carbapenem-Resistant Enterobacterales in China |
| title_short |
The Monte Carlo Simulation of Three Antimicrobials for Empiric Treatment of Adult Bloodstream Infections With Carbapenem-Resistant Enterobacterales in China |
| title_full |
The Monte Carlo Simulation of Three Antimicrobials for Empiric Treatment of Adult Bloodstream Infections With Carbapenem-Resistant Enterobacterales in China |
| title_fullStr |
The Monte Carlo Simulation of Three Antimicrobials for Empiric Treatment of Adult Bloodstream Infections With Carbapenem-Resistant Enterobacterales in China |
| title_full_unstemmed |
The Monte Carlo Simulation of Three Antimicrobials for Empiric Treatment of Adult Bloodstream Infections With Carbapenem-Resistant Enterobacterales in China |
| title_sort |
monte carlo simulation of three antimicrobials for empiric treatment of adult bloodstream infections with carbapenem-resistant enterobacterales in china |
| publisher |
Frontiers Media S.A. |
| publishDate |
2021 |
| url |
https://doaj.org/article/3e5e48789c7b433b965874567a09eacb |
| work_keys_str_mv |
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