摘要
目的为藤黄微球菌致感染性心内膜炎(IE)合并重症肺炎的抗感染药物治疗及药学监护提供思路和用药参考。方法临床药师全程参与1例藤黄微球菌致IE合并重症肺炎患者的治疗过程,所有抗感染治疗方案与调整均为临床医师邀请临床药师会诊后共同协商确定。方案实施后由临床药师从最适宜治疗药物、利用稳态谷浓度和内生肌酐清除率等参数调整万古霉素剂量、监测肾功能及药物不良反应等方面对治疗的有效性和安全性进行药学监护。结果藤黄微球菌致IE患者经手术和术后足疗程的抗菌药物治疗后治愈,重症肺炎好转,原发病及治疗药物引起的肾功能下降有所恢复;临床药师通过协助临床医师制定治疗方案、实施药学监护,保证了患者抗感染治疗的效果,避免了患者进一步的肾损伤,解决了头孢哌酮舒巴坦药物热的问题。结论藤黄微球菌致IE病情较重,可选万古霉素联合利福平治疗,治疗过程中应注意监测患者的肾功能,及时调整万古霉素剂量或更换药物;临床药师提供的抗感染药学监护,保障了患者抗感染治疗的有效性和安全性,避免了严重不良反应的发生。
OBJECTIVE To provide ideas and reference for the treatment and pharmaceutical care of infective endocarditis(IE)caused by Micrococcus luteus complicated with severe pneumonia.METHODS The clinical pharmacist participated in the treatment of a patient with IE caused by M.luteus complicated with severe pneumonia;all anti-infective treatment plans were agreed upon after the doctor invited the clinical pharmacist for consultation.After the implementation of the plan,the clinical pharmacist conducted pharmaceutical care of effectiveness and safety for the plan,including adopting suitable drug,adjusting the dose of vancomycin by using parameters such as steady-state valley concentration and creatinine clearance rate,monitoring renal function and adverse drug reactions.RESULTS IE caused by M.luteus was cured after surgery and full treatment with anti-bacterial drugs,the severe pneumonia was improved,and the decline of renal function caused by drugs and the primary disease were recovered;clinical pharmacists had ensured the effect of anti-infection treatment by assisting in the formulation of treatment plans and the implementation of pharmaceutical care,avoiding further renal damage and solving the problem of cefoperazone sulbactamrelated drug fever.CONCLUSIONS IE caused by M.luteus is relatively serious,and the treatment drug can be vancomycin and rifampicin.During the treatment,it is necessary to monitor the renal function,and adjust the dose of vancomycin or change other drugs;anti-infection pharmaceutical care provided by clinical pharmacists can guarantee the effectiveness and safety of antiinfection plan,and avoid the occurrence of severe adverse drug reactions.
作者
王司允
陈俊俊
朱玉辉
李馨
张新茹
WANG Siyun;CHEN Junjun;ZHU Yuhui;LI Xin;ZHANG Xinru(Dept.of Pharmacy,the Second Hospital of Jilin University,Changchun 130041,China)
出处
《中国药房》
CAS
北大核心
2023年第9期1137-1141,共5页
China Pharmacy
基金
吉林省高教科研课题(No.JGJX2020D8)。
关键词
藤黄微球菌
感染性心内膜炎
重症肺炎
药学监护
临床药师
Micrococcus luteus
infective endocarditis
severe pneumonia
pharmaceutical care
clinical pharmacist
