| Objective:To systematically evaluate the pharmacokinetic study of antibacterial drugs in patients with CRRT.Methods:We searched databases including PubMed,The Cochrane Library?Issue3,2017?,Embase,CNKI,VIP,and Wan Fang Data to collect studies about four antimicrobials in patients with CRRT from inception to Mar.2017.According to the inclusion and exclusion criteria,Two reviewers independently screened the literatures,extracted data.And assessed the risk of bias.Finally,the RevMan5.3 software was used for statistical analysis.Results:26 papers were included in the study,included 359 patients.Patients with CRRT who were treated with piperacillin/tazobactam,the result of a single rate Meta analysis showed that:When the MIC value was 64ug/ml and the dosage regimen was4.5g/q8h,the target rate of f%T>MIC>50%was 0.45[95%CI?0.17,0.76?,P<0.00001].The results of descriptive analysis shows that:when the MIC value was 16ug/ml,and the dosage regimen was 4.5 g/q12h,the target rate were 0.753 and 1.The rest of target rate was 1.When the MIC value was 32ug/ml,and the dosage regimen was4.5g/q24h,4.5g/q12h,4.5g/q8h,the target rate were 0,0.75 and 1,0.857 and 1.The rest of target rate was 1.When the MIC value was 64ug/ml,and the dosage regimen was 4.5g/q24h,4.5g/q12h,2.25g/q8h,the target rate was 0,0.25,0.5.Patients with CRRT who were treated with meropenem,the results of descriptive analysis shows that:when the MIC value was 4ug/ml,and the dosage regimen was 0.5g/q12h,the target rate of f%T>MIC>40%were 0.875 and 1.The rest of target rate was 1.When the MIC value was8ug/ml,and the dosage regimen was 0.5g/q12h,the target rate of were 0.625 and 1.The rest of target rate was 1.When the MIC value was 16ug/ml,and the dosage regimen was1g/q12h,1g/q8h,the target rate was 1,0.9.Patients with CRRT who were treated with imipenem,the results of descriptive analysis shows that:when the MIC value was4ug/ml,and the dosage regimens were 0.5g/q12h,0.5g/q8h,0.5g/q6h,1g/q8h,1g/q6h,the target rate were 0.429,0.6 and 1,0.833 and 1,1,0.778.When the MIC value was8ug/ml,and the dosage regimens were 0.5g/q6h,1g/q8h,1g/q6h,the target rate was 0.50,1and 0.556.And the rest of target rate was 0.When the MIC value was 16ug/ml,and the dosage regimen was 1g/q6h,the target rate of f%T>MIC>40%was 0.333.And the rest of target rate was 0.Patients with CRRT who were treated with vancomycin,the result of a single rate Meta analysis showed that:When the dosage regimen was 1g/d,the target rate of PK/PD was 0.37[95%CI?0.15,0.66?,P=0.17].When the dosage regimen was loading dose of 1.5g and maintenance dose of 1g/qd,the target rate of PK/PD was 0.51[95%CI?0.38,0.63?,P=0.10].The results of descriptive analysis shows that:when the dosage regimen was loading dose of 1g and maintenance dose of 1g/q12h,loading dose of15mg/kg·d and maintenance dose of 15mg/kg·d,13±3mg/kg·d,2g/d,the target rate of PK/PD were 0.59,0.48,0.52,0.50.Conclusion:The PK/PD parameters of piperacillin/tazobactam,imipenem and vancomycin were significantly affected by CRRT.As the MIC value increased,more single dose and more dosing frequency could obtain higher PK/PD target rate for piperacillin/tazobactam,meropenem,imipenem and vancomycin.More loading dose and more daily dose for vancomycin,higher PK/PD target rates for CRRT patients could be obtained.Due to limited quality and quantity of the included studies,more high quality and large samples original research are needed to verify the above conclusion. |
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