临床药师参与耐碳青霉烯肺炎克雷伯菌血流感染伴急性肾功能衰竭患者的治疗实践

摘要

One 80-year-old male patient was hospitalized for repeated urinary hesitancy for more than 3 years. After hospitalization, the patient was transferred to the intensive care unit (ICU) because of fever, septic shock and acute renal failure. The imipenem and cilastatin was given to him after entry. And then, the result of blood culture showed carbapenem-resistantKlebsiella pneumoniae (CRKP). Bedside continuous renal replacement therapy (CRRT), anti-infective therapeutic regime was adjusted to meropenem, tigecycline and amikacin due to the deterioration of infection, the decreasing of the urine volume and the increasing of serum creatinine. Clinical pharmacist optimized the therapeutic regimen in respect of designing anti-infection regime, adjusting dose of antibacterial in CRRT, and performed entire pharmaceutical care to the patient. The patient improved markedly and transferred out of ICU without adverse drug events.%1例80岁男性患者，因“反复排尿不畅3年余”入院。住院期间出现发热、脓毒性休克、急性肾功能衰竭转入重症监护病房（ICU）。入科后给予亚胺培南西司他丁抗感染治疗，但疗效不佳。后患者血培养结果为碳青霉烯耐药的肺炎克雷伯菌（CRKP），因感染加重，尿量减少，肌酐进一步升高，行床边连续肾脏替代治疗（CRRT），并调整治疗方案为美罗培南、替加环素、阿米卡星联合抗感染。在治疗期间，临床药师参与CRKP血流感染并行CRRT患者抗感染方案的制定和抗菌药物剂量的调整，全程监护患者的用药过程。患者抗感染治疗取得良好效果，治疗过程中无药品不良事件发生，病情稳定后转科。