Abstract:

Objective To evaluate the optimal treatment plan of cefoperazone-sulbactam combined with imipenem,meropenem or biapenem by Monte Carlo simulation（MCS） in the treatment of multidrug-resistant Acinetobacter baumannii（MRAB）. Methods The minimum inhibitory concentrations（MIC） of imipenem,meropenem,biapenem and cefoperazone-sulbactam alone and in combination against 36 isolates of MRAB were determined,and the fractional inhibitory concentration（FIC） was identified. The probability of achieving target and cumulative response score（CFR） of different anti-infective regimens were calculated by MCS to evaluate the optimal treatment plan. Results MIC₉₀ and MIC₅₀ were both decreased in the evaluation of combined medication. Totally,3 kinds of carbapenems combined with cefoperazone-sulbactam mainly showed that the synergistic effect accounted for >50%,the additive effect accounted for ≥25%,and the irrelevant effect and antagonism accounted for <12%. Conclusions MCS can guide MRAB anti-infective drug treatment. The CFR values of imipenem,meropenem,biapenem and cefoperazone-sulbactam alone are all less than the effective target value,and the effective target value could be obtained by increasing the dose or prolonging the infusion time of combined medication.

Key words: Fractional inhibitory concentration, Multidrug-resistant Acinetobacter baumannii, Cefoperazone-sulbactam, Combined medication, Monte Carlo simulation