临床药师参与骨髓移植术后铜绿假单胞菌败血症患儿的治疗实践  

Pharmaceutical Practice for Treatment of Children with Pseudomonas Aeruginosa Sepsis after Bone Marrow Transplantation by Clinical Pharmacists

作　　者：于丽婷 蒋樾廉 李岚[1] 张顺国 Yu Liting;Jiang Yuelian;Li Lan;Zhang Shunguo(Shanghai Children’s Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心,上海200127

出　　处：《儿科药学杂志》2022年第5期14-17,共4页Journal of Pediatric Pharmacy

摘　　要：目的:为临床药师参与重度再生障碍性贫血患儿骨髓移植术后铜绿假单胞菌感染治疗提供参考。方法:临床药师参与1例重度再生障碍性贫血患儿骨髓移植术后出现铜绿假单胞菌败血症的治疗实践,其先后使用了美罗培南、去甲万古霉素、万古霉素、阿米卡星等抗菌药物,氟康唑、伏立康唑、米卡芬净等抗真菌药物,复方磺胺甲噁唑预防卡氏肺孢子虫,症状未见明显好转,其后患儿血培养为碳青霉烯类耐药铜绿假单胞菌,临床药师参加会诊后将抗感染治疗方案调整为:头孢他啶/阿维巴坦、环丙沙星和米卡芬净。结果:治疗方案调整5 d后患者体温恢复正常,感染指标明显好转。结论:临床药师参与可为骨髓移植后患儿败血症的治疗提供更具有针对性的治疗方案。Objective:To provide reference for clinical pharmacists to participate into the treatment of Pseudomonas aeruginosa infection in children with severe aplastic anemia after bone marrow transplantation.Methods:Clinical pharmacists participated into the treatment of P.aeruginosa sepsis in a child with severe aplastic anemia after bone marrow transplantation,and the initial treatment including antibacterial drugs such as meropenem,norvancomycin,vancomycin and amikacin,anti⁃fungal drugs such as fluconazole,voriconazole and micafennet,and compound sulfamethoxazole was used to prevent Pneumocystis carinii,yet the symptoms were not significantly improved.The blood culture of the child was carbapenem⁃resistant P.aeruginosa.After consultation,the clinical pharmacists adjusted the anti⁃infection treatment regimen to ceftazidime/avibatam,ciprofloxacin and micafenstine.Results:The body temperature returned to the normal state after 5 d of adjustment of the treatment regimen,and the infection indicators were improved significantly.Conclusion:The participation of clinical pharmacists can provide more targeted treatment for sepsis in children after bone marrow transplantation.

关 键 词：临床药师 再生障碍性贫血 骨髓移植术 铜绿假单胞菌 

分 类 号：R969.3[医药卫生—药理学]