持続的血液濾過透析施行時における抗 MRSA薬の投与設計
外科・救急領域では，sepsis，septic shock，急性腎障害などの患者に対して持続的腎代替療法 （以下，CRRT）が導入されることがある。急性腎障害を伴った敗血症患者における主な薬物動態の変化として，抗菌薬クリアランスや分布容積があげられる。CRRT時の体外におけるクリアランスは抗菌薬の特性に加えて，CRRT側の因子としては，血液浄化量がもっとも影響が大きい。CRRTの方法は国での差も大きく，日本では欧米と比較して，血液浄化量は少ない条件下で施行されるため，欧米での CRRT時の抗菌薬推奨用量を用いると日本では過量投与の危険性がある。本トピックスでは日本における血液浄化量が少ない条件...
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| Published in | 日本外科感染症学会雑誌 Vol. 15; no. 3; pp. 228 - 237 |
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| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本外科感染症学会
30.06.2018
Japan Society for Surgical Infection |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1349-5755 2434-0103 |
| DOI | 10.24679/gekakansen.15.3_228 |
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| Abstract | 外科・救急領域では，sepsis，septic shock，急性腎障害などの患者に対して持続的腎代替療法 （以下，CRRT）が導入されることがある。急性腎障害を伴った敗血症患者における主な薬物動態の変化として，抗菌薬クリアランスや分布容積があげられる。CRRT時の体外におけるクリアランスは抗菌薬の特性に加えて，CRRT側の因子としては，血液浄化量がもっとも影響が大きい。CRRTの方法は国での差も大きく，日本では欧米と比較して，血液浄化量は少ない条件下で施行されるため，欧米での CRRT時の抗菌薬推奨用量を用いると日本では過量投与の危険性がある。本トピックスでは日本における血液浄化量が少ない条件下で施行される持続的血液濾過透析時での抗 MRSA薬の投与設計について，われわれのバンコマイシン，テイコプラニン，ダプトマイシンおよびリネゾリドでの成績も含め考察する。 |
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| AbstractList | Continuous renal replacement therapy (CRRT) is now commonly used as a mean of support for critically ill patients with renal failure. In Japan, CRRT is also performed to remove several inflammatory mediators that have detrimental effects in septic shock. Key aspects of PK like antibiotic clearance (CL) and volume of distribution are altered in critically ill patients with acute kidney injury. Extracorporeal CL during CRRT is mainly influenced by the properties of the antibiotics and the dose of dialysate and filtrate (CRRT dose). Continuous renal replacement procedures vary depending on the country. In general, the CRRT dose in Japan is lower than the setting in USA, UK, and Australia. Using post hoc analysis of our data in vancomycin, teicoplanin, daptomycin and linezolid, this topic aims to describe the current clinical scenario for design of antimicrobial agents with anti-methicillin-resistant Staphylococcus aureus(MRSA) activity dosing in critically ill patients with sepsis/septic shock undergoing continuous veno-venous hemodiafiltration under low-dose setting which is adopted in Japan.
外科・救急領域では，sepsis，septic shock，急性腎障害などの患者に対して持続的腎代替療法 （以下，CRRT）が導入されることがある。急性腎障害を伴った敗血症患者における主な薬物動態の変化として，抗菌薬クリアランスや分布容積があげられる。CRRT時の体外におけるクリアランスは抗菌薬の特性に加えて，CRRT側の因子としては，血液浄化量がもっとも影響が大きい。CRRTの方法は国での差も大きく，日本では欧米と比較して，血液浄化量は少ない条件下で施行されるため，欧米での CRRT時の抗菌薬推奨用量を用いると日本では過量投与の危険性がある。本トピックスでは日本における血液浄化量が少ない条件下で施行される持続的血液濾過透析時での抗 MRSA薬の投与設計について，われわれのバンコマイシン，テイコプラニン，ダプトマイシンおよびリネゾリドでの成績も含め考察する。 外科・救急領域では，sepsis，septic shock，急性腎障害などの患者に対して持続的腎代替療法 （以下，CRRT）が導入されることがある。急性腎障害を伴った敗血症患者における主な薬物動態の変化として，抗菌薬クリアランスや分布容積があげられる。CRRT時の体外におけるクリアランスは抗菌薬の特性に加えて，CRRT側の因子としては，血液浄化量がもっとも影響が大きい。CRRTの方法は国での差も大きく，日本では欧米と比較して，血液浄化量は少ない条件下で施行されるため，欧米での CRRT時の抗菌薬推奨用量を用いると日本では過量投与の危険性がある。本トピックスでは日本における血液浄化量が少ない条件下で施行される持続的血液濾過透析時での抗 MRSA薬の投与設計について，われわれのバンコマイシン，テイコプラニン，ダプトマイシンおよびリネゾリドでの成績も含め考察する。 |
| Author | 中嶋, 一彦 竹田, 健太 植田, 貴史 森川, 則文 竹末, 芳生 小濱, 華子 猪川, 和朗 |
| Author_FL | Nakajima Kazuhiko Ikawa Kazuro Ueda Takashi Takeda Kenta Kohama Hanako Morikawa Norifumi Takesue Yoshio |
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| Copyright | 2018, 一般社団法人 日本外科感染症学会 |
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| References_xml | – reference: 35) EUCAST Technical Note on daptomycin. Clin Mi-crobiol Infect 2006; 12: 599-601 – reference: 43) Swoboda S, Ober MC, Lichtenstern C, et al: Pharmacokinetics of linezolid in septic patients with and without extended dialysis. Eur J Clin Pharma-col 2010; 66: 291-298 – reference: 7) Ueda T Takesue Y, Nakajima K, et al: Dosing Regimen for Vancomycin in Patients Receiving Continuous Venovenous Hemodiafiltration under Low-flow Setting.（Poster Session）57th ICAAC 2017.6 New Orleans [abstract] – reference: 26) Bellmann R, Falkensammer G, Seger C, et al: Teicoplanin pharmacokinetics in critically ill patients on continuous veno-venous hemofiltration. Int J Clin Pharmacol Ther 2010; 48: 243-249 – reference: 28) Wolter K, Claus M, Wagner K, et al: Teicoplanin pharmacokinetics and dosage recommendations in chronic hemodialysis patients and in patients undergoing continuous veno-venous hemodialysis. Clin Nephrol 1994; 42: 389-397 – reference: 3) Li AM, Gomersall CD, Choi G, et al: A systematic review of antibiotic dosing regimens for septic patients receiving continuous renal replacement therapy: do current studies supply sufficient data? J Antimicrob Chemother 2009; 64: 929-937 – reference: 34) Safdar N, Andes D, Craig WA: In vivo pharmaco-dynamic activity of daptomycin. Antimicrob Agents Chemother 2004; 48: 63-68 – reference: 4) Kawarazaki H, Uchino S: Validity of low-efficacy continuous renal replacement therapy in critically ill patients. Anaesthesiol Intensive Ther 2016; 48: 191-196 – reference: 5) Vincent JL, Rello J, Marshall J, et al: International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009; 302: 2323-2329 – reference: 16) Palevsky PM: Intensity of continuous renal replacement therapy in acute kidney injury. Semin Dial 2009; 22: 151-154 – reference: 32) Takesue Y, Mikamo H, Kusachi S, et al: Correlation between pharmacokinetic/pharmacodynamic indices and clinical outcomes in Japanese patients with skin and soft tissue infections treated with daptomycin: analysis of a phase Ⅲ study. Diagn Microbiol Infect Dis 2015; 83: 77-81 – reference: 41) Slatter JG, Stalker DJ, Feenstra KL, et al: Pharmacokinetics, metabolism, and excretion of linezolidfollowing an oral dose of [（14）C] linezolid to healthy human subjects. Drug Metab Dispos 2001; 29: 1136-1145 – reference: 8) 植田貴史，竹末芳生，中嶋一彦，ほか：持続的血液濾過透析例に対するテイコプラニンの初期投与設計の検討．日外感染症会誌 2016；13：629-635 – reference: 30) Kim A, Suecof LA, Sutherland CA, et al: In vivo microdialysis study of the penetration of daptomycin into soft tissues in diabetic versus healthy volunteers. Antimicrob Agents Chemother 2008; 52: 3941-3946 – reference: 10) Ide T, Takesue Y, Ikawa K, et al: Population pharmacokinetics/pharmacodynamics of linezolid in sepsis patients with and without continuous renal replacement therapy. Int J Antimicrob Agents 2018; 51: 745-751 – reference: 25) Steer JA, Papini RP, Wilson AP, et al: Pharmaco-kinetics of a single dose of teicoplanin in burn patients. J Antimicrob Chemother 1996; 37: 545-553 – reference: 14) Jamal JA, Udy AA, Wallis SC, et al: Can we use an ex vivo continuous hemofiltration model to describe the adsorption and elimination of meropenem and piperacillin? Int J Artif Organs 2015; 38: 419–424 – reference: 45) Rayner CR, Forrest A, Meagher AK, et al: Clinical pharmacodynamics of linezolid in seriously ill patients treated in a compassionate use pro-gramme. 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| Snippet | 外科・救急領域では，sepsis，septic shock，急性腎障害などの患者に対して持続的腎代替療法... Continuous renal replacement therapy (CRRT) is now commonly used as a mean of support for critically ill patients with renal failure. In Japan, CRRT is also... |
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| StartPage | 228 |
| SubjectTerms | CRRT MRSA治療薬 持続的腎代替療法（CRRT） 薬物動態 |
| Title | 持続的血液濾過透析施行時における抗 MRSA薬の投与設計 |
| URI | https://www.jstage.jst.go.jp/article/gekakansen/15/3/15_228/_article/-char/ja https://cir.nii.ac.jp/crid/1390001288070034304 |
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| ispartofPNX | 日本外科感染症学会雑誌, 2018/06/30, Vol.15(3), pp.228-237 |
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