多黏菌素临床应用中国专家共识-2019

·1194·中华危重病总救医学2019年10月第31卷第10期Chin Crit Care Med..0 ctober2019.Vol.31,No.10·专家共识·多黏菌素临床应用中国专家共识中国研究型医院学会危重医学专业委员会中国研究型医院学会感染性疾病循证与转化专业委员会【摘要】多黏菌素是从多黏芽孢杆菌培养液中获得的多肽类抗生素，于20世纪50年代上市并应用于临床，由于其肾毒性大被其他更安全的抗菌药物取代。近年来，随着多重耐药和广泛耐药革兰阴性杆菌感染发生率的不断上升，多黏菌素重新应用于临床，是治疗多重耐药和广泛耐药革兰阴性杆菌感染的有效药物。为规范多黏菌素的临床应用，我们组织相关领域专家，对多黏菌素的药代动力学与药效动力学特性、剂量和用法、禁忌证和相对禁忌证、临床应用及不良反应5个方面制定共识，供同道借鉴。【关键词】多黏菌素B；多黏菌素E；专家共识基金项目：中原科技创新领军人才项目(194200510017)：河南省医学科技攻关计划省部共建项目(SBGJ2018020):河南省自然科学基金(182300410369)：河南省卫生计生科技创新型人才“51282”工程(2016-32)：河南省郑州市科技惠民计划项目(2019KHM0001):国家科技重大专项项目(2018ZX10101004)临床试验注册：国际实践指南注册平台，PGRP-2019CN065D0I:10.3760/cma.j.issm.2095-4352.2019.10.003Chinese expert consensus on polymyxins in the clinical practiceChinese Research Hospital Association of Critical Care Medicine,Chinese Research Hospital Association of Evidence baseand Translational Infectious Diseases[Abstract]Polymyxin,a polypeptide antibiotic,derived from the culture of bacillus polymucilis,was introducedin the 1950s and used in clinical practice,but was replaced by safer antimicrobials due to its renal toxicity.In the recentyears,with the increasing incidence of multidrug-resistant (MDR)and extensively drug-resistant(XDR)bacilli infections,polymyxin is reintroduced into the clinic because it is assumed an important role in the treatment of MDR infections andXDR infections.In order to regulate the clinical applications of polymyxin,we organized experts in relevant fields todevelop expert consensus on polymyxin for reference,including parameters like pharmacokinetics and pharmacodynamics,dosage and usage,contraindications and relative contraindications,clinical applications and adverse reactions.[Key words]Polymyxin B:Polymyxin E:ConsensusFund program:Scientific and Technological Innovation leaders in Central Plains (194200510017):ProvincialMinistry Co-construction Project from Medical Scientific and Technological Research Program of Henan Province of China(SBGJ2018020):Natural Science Foundation of Henan Province of China(182300410369):the "51282"Project Leaders ofScientific and Technological Innovative Talents from Health and Family Planning Commission in Henan Province of China(2016-32);Zhengzhou City Science and Technology People-Benefit Project of Henan Province of China(2019KJHM0001):Subjects of Major National Science and Technology Subjects (2018ZX 10101004)Trial Registration:Interational Practice Guideline Registry Platform,IPGRP-2019CN065D0L:10.3760/cma.j.issn.2095-4352.2019.10.003多黏菌素是多肽类抗生素，由于其肾毒性大被其他更安全的抗菌药物取代：但近年来随着对碳青NH霉烯类耐药的鲍曼不动杆菌、铜绿假单胞菌、肠杆菌CHL-Dab-R:-L-Leu等细菌耐药形势日益严峻3]，可选择药物有限，临Et-CH-(CHa)4CO-L-Dab-L-Thr-L-Dab-L-DabL-Thr-L-Dab-L-Dab床重新启用多黏菌素。我国常用的有多黏菌素B和NHNH多黏菌素E,但尚无多黏菌素的临床应用规范和指NhNH南，故组织全国相关领域专家对多黏菌素的临床应R用问题进行探讨，制定了《多黏菌素临床应用中国专注：多黏菌素B:R,=H.R2=D-Phe:多黏菌素E:R,=H.B2=D-Leu:黏菌素甲磺酸盐：R,=-CHz-SO,H,B2=D-Leu家共识》。图1多酷菌家的化学结构试1多黏菌素的药代动力学与药效动力学特性多黏菌素是一组碱性多肽类抗生素的总称，主药代动力学：多黏菌素B主要通过非肾途径要有A、B、C、D和E5种。多黏菌素B与多黏菌素清除（图24），尿中的原型药物<1%【2]肾功能不会E仅有一个氨基酸的差异（图1）【41。多黏菌素B常影响多黏菌素B血浆浓度[s)。CMS主要通过肾脏用剂型为硫酸多黏菌素B:多黏菌素E常用剂型是清除