摘要
1例33岁男性患者,因寒战高热1月余,右侧下肢疼痛1周入院。1月前外院诊断为感染性心内膜炎,血培养检出耐甲氧西林金黄色葡萄球菌。因再次发热入院,3次血培养和赘生物培养均为阴性。参考外院药敏结果,提出治疗方案为万古霉素+萘夫西林+利福平抗感染,未能有效控制病情,后行心脏二尖瓣置换术+赘生物摘除术。术后根据患者低热和肾功能异常情况调整抗感染方案,应用利奈唑胺3 d后患者出现发热和白细胞下降,经分析判断为利奈唑胺的不良反应,及时调整治疗方案选用万古霉素+头孢唑啉,不良反应消失。患者后续恢复情况良好,术后抗感染疗程6周已足够,并对患者进行出院教育,随访未发现感染复发。
One 33-year-old male patient was admitted to hospital because of fever more than one month and pain at the right lower limb for one week. He was diagnosed as infective endocarditis a month ago, with the blood culture of methicillin resistant Staphylococcus aureus. The temperature of the patient dropped to normal after the treatment for several days and he was discharged from hospital. Then the patient developed fever and was admitted to another hospital. Results of three sets of blood culture and vegetation cultivation were negative. Based on the previous result of blood culture, referring to the guides, clinical pharmacists suggested the combination treatment of vancomycin, nafcillin and rifampin. The effect was poor. Then the mitral valve replacement surgery and neoplasm resection were conducted on the patient. According to low-grade fever, postoperative renal dysfimction of the patient, the anti-infective drug was adjusted to linezolid. After three days, the patient developed fever and leukopenia suspected due to linezolid. Then medication was switched to vancomycin and cephazolin, the adverse reaction disappeared. The patient recovered well after six weeks＇ anti-infection treatments and was discharged from hospital with no relapse.
出处
《中国药物应用与监测》
CAS
2013年第4期209-211,共3页
Chinese Journal of Drug Application and Monitoring
关键词
临床药师
药学监护
感染性心内膜炎
Clinical pharmacist
Pharmaceutical care
Infective endocarditis
