1例泛耐药鲍曼不动杆菌肺部感染患者的药学监护

摘要

目的：探讨临床药师在泛耐药鲍曼不动杆菌（XDRAB）感染患者药物治疗中的作用。方法：临床药师参与1例XDRAB感染的重症社区获得性肺炎患者的治疗，从初始用药方案评估、病原菌判定、治疗药物选择、不良反应处理等方面进行全面的药学监护并提出建议：给予莫西沙星0.4 g，ivgtt，qd+美罗培南0.5 g，ivgtt，q8 h+利奈唑胺0.6 g，ivgtt，q12 h，进行初始抗感染治疗；给予头孢哌酮钠舒巴坦钠3.0 g，ivgtt，q8 h+替加环素50 mg，ivgtt，q12 h，抗XDRAB感染治疗；给予丁二磺酸腺苷蛋氨酸1.0 g，ivgtt，qd+还原型谷胱甘肽1.8 g，ivgtt，qd，保肝治疗。结果：采用上述治疗25 d后，患者无发热，血象、肝功能指标降至接近正常值。结论：临床药师参与抗感染治疗及药学监护，积极为医师提供合理用药建议，有助于提高患者临床治愈率。%OBJECTIVE:To explore the role of clinical pharmacists in the treatment of pan-drug resistant Acinetobacter bau-mannii infection. METHODS:Clinical pharmacists participated in the treatment for a severe pneumonia case of pan-drug resistant A. baumannii infection. Clinical pharmacists supplied overall pharmaceutical care and suggestions with respects to initial medication scheme evaluation,pathogen judgment,therapy drug selection,ADR disposal,etc.,including anti-infective treatment of moxifloxa-cin 0.4 g,ivgtt,qd+meropenem 0.5 g,ivgtt,q8 h+linezolid 0.6 g,ivgtt,q12 h;anti-pan-drug resistant A. baumannii infection of cefoperazone sodium and sulbactam sodium 3.0 g,ivgtt,q8 h+tigecycline 50 mg,ivgtt,q12 h;liver protection of ademetionine 1, 4-Butanedisulfonate 1.0 g,ivgtt,qd+reduced glutathione 1.8 g,ivgtt,qd. RESULTS:After 25 d treatment,the patient hadn’t been fe-vered,and hemogram and hepatic function index decreased to normal value. CONCLUSIONS:Clinical pharmacist should be en-gage in anti-infective treatment and pharmaceutical care,and provide physicians reasonable medication suggestion so as to promote care rate in the clinic.