1例产超广谱β-内酰胺酶肺炎克雷伯菌肺炎患儿的抗感染治疗分析  

Anti-Infection Treatment for One Child with Pneumonia Caused by Extended Spectrum Beta-Lactamases-Producing Klebsiella Pneumoniae

作　　者：湛敏[1] 陈泽彬[1] 欧阳珊 何艳玲 岑菡婧 Zhan Min;Chen Zebing;Ou-Yang Shan;He Yanling;Cen Hanjing(Shenzhen Children＇ s Hospital, Guangdong Shenzhen 518038, China;Guangzhou Women and Children Medical Center, Guangdong Guangzhou 510623, China)

机构地区：[1]深圳市儿童医院,广东深圳518038 [2]广州妇女儿童医疗中心,广东广州510623

出　　处：《儿科药学杂志》2018年第5期43-46,共4页Journal of Pediatric Pharmacy

摘　　要：目的:探讨产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌肺炎患儿抗感染治疗方案。方法:临床药师对1例产ESBLs肺炎克雷伯菌肺炎患儿抗感染治疗方案进行分析,寻找疗效不佳的可能原因,优化抗感染治疗方案。结果:医疗机构相关性肺炎(HCAP)患儿经验性抗感染治疗选择头孢哌酮/舒巴坦(68 mg/kg,q 12 h)合理,但给药第5天起降低头孢哌酮/舒巴坦剂量(45mg/kg,q 12 h)可能是导致疗效不佳的主要原因;肺泡灌洗液提示产ESBLs肺炎克雷伯菌感染,临床药师建议更换抗生素为亚胺培南/西司他丁(15 mg/kg,q 6 h),患儿感染得到有效控制,治愈出院。结论:产ESBLs肺炎克雷伯菌感染患儿病情评估为轻中度,可以选择含酶抑制剂的复方制剂,对于有基础疾病的患儿,头孢哌酮/舒巴坦建议选择足量足频次(如50 mg/kg,q 8 h)的给药方案;如患儿病情评估为重度,建议选择碳青霉烯类抗生素,选择碳青霉烯类药物时要考虑不同药物之间疗效和不良反应的差异。Objective： To explore the anti-infective therapy regimen for children with pneumonia caused by extended spectrum betalactamases（ ESBLs）-producing Klebsiella pneumoniae. Methods： The clinical pharmacist analyzed the anti-infective treatment of a pediatric patient with pneumonia caused by ESBLs-producing Klebsiella pneumoniae to find the possible reason for poor efficacy and optimize therapeutic schedule. Results： Cefoperazone/sulbactam（ 68 mg/kg,q 12 h） empirically given to this child with healthcareassociated pneumonia（ HCAP） was reasonable. The reduced dose of cefoperazone/sulbactam（ 45 mg/kg,q 12 h） on the fifth day might be the main reason of poor efficacy. ESBLs-producing Klebsiella pneumoniae was detected in bronchoalveolar lavage fluid,and the clinical pharmacist suggested to change it to imipenem and cilastatin（ imipenem 15 mg/kg,q 6 h）. Pulmonary infection was effectively controlled and discharged from the hospital finally. Conclusion： Compound preparations containing lactamase inhibitor can be used to treat mild or moderate pneumonia caused by ESBLs-producing Klebsiella pneumonia,and for the children with underlying disease,if cefoperazone/sulbactam is chosen,sufficient dosage and frequency is recommended,for example,50 mg/kg,q 8 h. For the severe patients,carbapenem antibiotics is recommend,but the differences of efficacy and adverse effects should be considered.

关 键 词：医疗机构相关性肺炎 超广谱Β-内酰胺酶 肺炎克雷伯菌 临床药师 

分 类 号：R725.6[医药卫生—儿科]