临床药师会诊多重耐药及泛耐药细菌感染79例分析  

Analysis of 79 Cases of Multidrug-resistant and Pandrug-resistant Bacterial Infection Consulted by Clinical Pharmacist

作　　者：梁智明[1] 梁碧怡[1] 

机构地区：[1]广东佛山市中医院临床药学室,佛山市528000

出　　处：《中国药房》2011年第22期2098-2101,共4页China Pharmacy

摘　　要：目的:调查临床药师对多重耐药及泛耐药细菌感染病例进行会诊的效果,探讨多重耐药及泛耐药细菌感染的特点与治疗策略。方法:回顾性调查79例经临床药师会诊的多重耐药、泛耐药细菌感染病例,分析病原菌分布、耐药情况、治疗方案、治疗结果及药学监护相关情况。结果:临床药师提供的用药方案接受率为91.1%,其中临床有效率为93.94%,细菌清除率为67.42%,没有出现菌群失调;泛耐药菌以鲍曼不动杆菌及铜绿假单胞菌为主,多重耐药菌以产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌、耐甲氧西林金黄色葡萄球菌(MRSA)及阴沟肠杆菌为主,对多种临床常用抗菌药物有高度耐药性;对多重耐药菌,亚胺培南/西司他丁、万古霉素、头孢西丁、左氧氟沙星、阿米卡星等有较好效果;4例泛耐药菌感染病例采用哌拉西林/他唑巴坦+左氧氟沙星、头孢美唑+阿米卡星、头孢西丁+磷霉素,取得了治愈的效果。结论:临床药师参与多重耐药感染病例治疗取得良好效果,应充分重视临床药师工作,发挥其重要作用;需高度重视泛耐药菌、多重耐药菌的耐药问题,可采用选择敏感率高的药物、联合用药、口服肠道活菌制剂等策略进行治疗,同时应加强抗菌药物合理应用和分级使用等管理措施,控制耐药细菌的蔓延。OBJECTIVE： To investigate the effect of clinical pharmacist consultation on multidrug-resistant （MDR） and pandrug-resistant （PDR） bacterial infection, and to discuss the characteristics and treatment strategies of MDR and PDR bacterial infection. METHODS： 79 cases of MDR and PDR bacterial infection which consulted by clinical pharmacist were investigated retrospectively. Distribution of pathogenic bacteria, drug resistance, therapeutic regimen, therapeutic efficacy effects and pharmaceutical care were analyzed. RESULTS： 91.1% therapeutic regimens supported by clinical pharmacists were accepted in the clinic. 93.94% of them were effective; the rate of bacterial clearance was 67.42%, and no dysbacteriosis. The main PDR bacteria were Acinetobacter baumanii and Pseudomonas aeruginosa, while the main MDR bacteria were bacteria producing extended spectrum beta-lactamases（ESBLs） Escherichia coli, MRSA and Enterobacter cloacae. Those bacteria were resistant to multiple commonly used antibiotics. These drugs, including imipenem/cystatins, vancomycin, cefoxitin, levofloxacin, amikacin, were effective to patients infected by MDR bacteria. Four patients infected by PDR bacteria were completely cured by piperacillin/tazobactam combined with levofloxacin, cefmetazole combined with amikacin or cefoxitin combined with fosfomycin, respectively. CONCLUSION： Clinical pharmacist participating in therapy for MDR bacteria infection have been achieved good therapeutic efficacy. Great importance should be attached to clinical pharmacists’ work to play their important role. There are many effective methods to deal with MDR and PDR bacterial infection, including choosing sensitive antibacterial, combined antibacterials treatment, oral intestinal alive bacterium preparation, and strengthening strict antibiotics management, and rational use of it and classification application and preventing drug-resistant bacteria from spreading.

关 键 词：临床药师 药学会诊 多重耐药细菌 泛耐药细菌 

分 类 号：R978.1[医药卫生—药品] R969.3[医药卫生—药学]