关键词: 真菌性尿路感染, 蒙特卡洛模拟, 给药方案, 念珠菌属

Abstract: Objective To provide reference for clinical individual medication of fluconazole by combining PK/PD and Monte Carlo simulation. Methods Candida albicans and Candida glabrata strains isolated from urine samples of patients with urinary tract infection in our hospital from January 2020 to December 2021 were collected. The distributions of MICs(minimum inhibitory concentrations,MICs) of fluconazole to Candida albicans and Candida glabrata were summarized as well as the pharmacokinetic parameters of fluconazole. Using probability of target attainment (probability of target attainment,PTA) and cumulative fraction of response(cumulative fraction of response,CFR)as indexes,crystal ball software 11.1.2.4 was used for Monte Carlo simulation of different dosage regimens. Results A total of 73 strains of Candida albicans and 108 strains of Candida glabrata were isolated (181 strains in total). The resistance rates to fluconazole were 12.3% and 57.4% respectively. The CFRs of 200 mg/d fluconazole for Candida albicans and Candida glabrata were both less than 90%(85.85% and 38.08% respectively). The CFR of 400 mg/d fluconazole for Candida albicans was more than 90%(90.15%), and that for Candida glabrata was less than 90%(45.54%). When the MICs of Candida albicans and Candida glabrata were ≤4 mg / L, the PTAs of 200 mg/d were greater than 90%; and when the MICs of Candida albicans and Candida glabrata were ≤8 mg / L, the PTAs of 400 mg/d were greater than 90%. Conclusions 400 mg/d fluconazole can be up to standard for urinary tract infection caused by Candida albicans infection,conversely, both 2 of dosage regimens can not be up to standard in Candida glabrata urinary tract infection. It is recommended to use other drugs recommended by relevant guidelines, such as amphotericin B.

Key words: fungal urinary tract infection, Monte Carlo simulation, dosage regimens, Candida spp.