Basic Treatment of Hospital-acquired Escherichia Coli Urinary Tract Infection Based on PK/PD Model and Monte Carlo Simulation

OBJECTIVE To optimize the initial treatment plan for hospital-acquired Escherichia coli urinary tract infection by using pharmacokinetic/pharmacodynamic(PK/PD) model and Monte Carlo simulation. METHODS Screening patients with urinary tract infection of hospital-acquired Escherichia coli in hospital in 2017 and 2018 were selected as the 2017 group (42 cases) and 2018 group (40 cases), and six antibiotics including levofloxacin, cefazolin, amikacin, ceftazidime, ciprofloxacin, piperacillin/tazobactam were selected for PK/PD model and Monte Carlo simulation. The cumulative fraction of response (CFR) for two years were calculated and compared to optimize the optimal initial treatment regimen. RESULTS In the 2017 group, the CFR of ceftazidime (2 000 mg, bid), cefazolin (1 000 mg, tid), piperacillin/tazobactam (4 500 mg qid, PI), amikacin (400 mg, qd) was 100.0%, 94.27%, 88.02%, and 90.89%, respectively. In the 2018 group, the CFR of the above 4 antibiotic drugs were 81.52%, 92.88%, 82.58%, and 88.69%, respectively, which was 18.48%, 1.39%, 5.44%, and 2.20% lower than that in 2017, respectively. And cefazolin(1 000 mg, tid) had the lowest CFR reduction. CONCLUSION Cefazolin (1 000 mg, tid) can be used as the best initial treatment for the optimization of urinary tract infection in hospital-acquired Escherichia coli. amikacin (400 mg, qd), piperacillin/tazobactam (4 500 mg, qid) and ceftazidime (2 000 mg twice daily) are acceptable and can be used as a preparation choose a dosing regimen.