Objective To explore the pharmacokinetics/pharmacodynamics(PK/PD)parameters and influencing factors in patients with augmented renal clearance(ARC)to provide the basis for the rational use of meropenem.Methods Using the method of retrospective study,the patients with increased renal clearance who used meropenem monitored the concentration from January 2018 to December 2021.The PK/PD parameters of meropenem were analyzed,and multiple linear retrospective analyses discussed the influencing factors of meropenem valley concentration.Results A total of 58 patients were included in the study,and the trough concentration was 1.35[0.23,1.86]μg·mL-1,taking 100%fT＞MIC as PK/PD target value,the compliance rate was 20.69%.The compliance rate of daily dose＜3 g·d-1 was 8.70%,and≥3 g·d-1 was 31.43%,the difference was statistically significant.With MIC of 0.5,1,2,4,and 8 μg·mL-1,PK/PD compliance rates were 62.07%,48.28%,20.69%,8.62%and 0.Respectively.Multiple linear retrospective analyses showed that dose was an independent factor affecting meropenem valley concentration.Conclusion The PK/PD compliance rate of meropenem in patients with augmented renal clearance is low,even if MIC≤0.5 μg·mL-1,the routine dose is difficult to achieve the ideal PK/PD,so the clinical should recognize ARC and perform TDM as soon as possible,and use TDM to guide the medication regimen of meropenem for ARC patients.

Objective:To explore the clinical characteristics, mechanism and countermeasures of drug-induced second thrombocy-tosis ( ST) in order to ensure safe medication. Methods:Drug-induced ST published during 1996 and 2016 in domestic and overseas medical journals was collected and statistically analyzed in respects of age, gender, kind and distribution of drug-induced ST, treatment and outcome of ST. Results:Totally 198 cases were collected, which involved 30 different drugs of eight types mainly including antitu-mor drugs, blood system drugs and antibiotics. Among the patients, 112 ones (56. 6％) were male and the other 86 ones (43. 4％) were female. Totally 14 patients had embolization with the overall incidence of 7. 0％. Conclusion:Without timely and favorable treat-ment, drug-induced ST may lead to thrombosis. To ensure the safety of medication, platelet level should be monitored regularly during medication.

A 76-year-old man with bronchopneumonia received an IV infusion of ceftizoxime sodium 2 g twice daily.Before treatment, laboratory tests showed the following results: white blood cell count (WBC) 10.8×109/L, neutrophil 0.94, red blood cell count (RBC) 3.8×1012/L, hemoglobin (Hb) 121 g/L, total bilirubin (TBil) 12.6 μmol/L, indirect bilirubin (IBil) 8.7 μmol/L, serum creatinine (Scr) 151 μmol/L, blood urea nitrogen (BUN) 10.7 mmol/L, endogenous creatinine clearance rate 35 ml/min.On day 11, about 10 minutes after beginning infusion of the 22nd dosage of ceftizoxime, he developed low back pain with bladder distending pain and yellowish skin and sclera.Ceftizoxime sodium was withdrawn immediately.Urethral catheter drained soy sauce-colored urine 200 ml.Laboratory tests revealed the following results: WBC 15.7×109/L, neutrophil 0.68, RBC 1.1×1012/L, Hb 73 g/L, reticulocytes 0.023, TBil 83.8 μmol/L, IBil 61.8 μmol/L, Scr 127 μmol/L, BUN 11.9 mmol/L, D-dimer 9.8 mg/L, direct Coomb′s test positive, urine bilirubin (++), occult blood (++), 2-3 red blood cells per high power field.He received treatments such as hydration and urinary alkalinization, infusion of methylprednisolone, transfusion of washed red blood cells and etc.However, he had sustained low urine output, progressive jaundice, and finally died 8 hours later.Acute hemolytic anemia was considered to be induced by overdose of ceftizoxime sodium.

A 76-year-old man with bronchopneumonia received an IV infusion of ceftizoxime sodium 2 g twice daily.Before treatment, laboratory tests showed the following results: white blood cell count (WBC) 10.8×109/L, neutrophil 0.94, red blood cell count (RBC) 3.8×1012/L, hemoglobin (Hb) 121 g/L, total bilirubin (TBil) 12.6 μmol/L, indirect bilirubin (IBil) 8.7 μmol/L, serum creatinine (Scr) 151 μmol/L, blood urea nitrogen (BUN) 10.7 mmol/L, endogenous creatinine clearance rate 35 ml/min.On day 11, about 10 minutes after beginning infusion of the 22nd dosage of ceftizoxime, he developed low back pain with bladder distending pain and yellowish skin and sclera.Ceftizoxime sodium was withdrawn immediately.Urethral catheter drained soy sauce-colored urine 200 ml.Laboratory tests revealed the following results: WBC 15.7×109/L, neutrophil 0.68, RBC 1.1×1012/L, Hb 73 g/L, reticulocytes 0.023, TBil 83.8 μmol/L, IBil 61.8 μmol/L, Scr 127 μmol/L, BUN 11.9 mmol/L, D-dimer 9.8 mg/L, direct Coomb′s test positive, urine bilirubin (++), occult blood (++), 2-3 red blood cells per high power field.He received treatments such as hydration and urinary alkalinization, infusion of methylprednisolone, transfusion of washed red blood cells and etc.However, he had sustained low urine output, progressive jaundice, and finally died 8 hours later.Acute hemolytic anemia was considered to be induced by overdose of ceftizoxime sodium.