临床药师参与的38例复杂性尿路感染患儿的抗感染治疗会诊分析  

Analysis of Anti-infective Treatment Consultation of 38 Children with Complicated Urinary Tract Infection Involved by Clinical Pharmacists

作　　者：李桂凤[1] 周密 LI Gui-feng;ZHOU Mi(Children's Hospital of Soochow University,Suzhou Jiangsu 215001,China)

机构地区：[1]苏州大学附属儿童医院,江苏苏州215001

出　　处：《抗感染药学》2023年第3期232-238,共7页Anti-infection Pharmacy

基　　金：苏州市科技发展计划(编号:SKJYD2021166)。

摘　　要：目的:分析有临床药师参与复杂性尿路感染(complicated urinary tract infection,cUTI)患儿抗感染治疗会诊的相关特点,为临床药师开展药学会诊实践提供参考。方法:选取2022年1月—8月苏州大学附属儿童医院泌尿外科收治且有临床药师会诊的38例cUTI患儿作为研究对象,采集患儿的年龄、性别、诊断、临床表征、微生物检查结果、最终转归等信息,以及临床药师的会诊意见及其被采纳情况,分析患儿抗感染治疗会诊的相关特点。结果:38例患儿除cUTI外还多合并膀胱输尿管反流(21例,占55.26%)、肾积水(8例,占21.05%)等疾病;38例cUTI患儿的临床表现主要为发热(20例,占52.63%)、尿中的白细胞计数偏高(38例,占100.00%)和白细胞酯酶阳性(38例,占100.00%)、血中的白细胞计数(23例,占60.53%)和C反应蛋白偏高(27例,占71.05%);在微生物检查方面,38例cUTI患儿标本中共检出病原菌42株,其中主要为铜绿假单胞菌(14例,占33.33%)、大肠埃希菌(8例,占19.05%)和肺炎克雷伯菌(7例,占16.67%),且药敏结果显示三者对哌拉西林-他唑巴坦钠、美罗培南、亚胺培南-西司他丁钠、阿米卡星的敏感率均较高(>85.00%);针对38例cUTI患儿,临床药师共给出会诊意见53条,其中被采纳的意见有44条(占83.02%);44条被采纳的会诊意见涉及31例患儿,其中30例(占96.77%)的结局为有效,而其余7例患儿中结局为有效的为5例(占71.43%);38例cUTI患儿在使用抗菌药物过程中有10例发生药物不良反应,其中有8例与头孢哌酮-舒巴坦钠有关,症状表现为腹泻和皮疹。结论:患儿发生cUTI的病原菌主要为铜绿假单胞菌、大肠埃希菌和肺炎克雷伯菌,临床药师参与抗感染治疗会诊,可以在医疗团队制定抗感染治疗方案时提供专业的药学意见,以保障患儿用药的安全和有效。Objective:To analyze the relevant characteristics of anti-infective treatment consultation of children with complicated urinary tract infection(cUTI)involved by clinical pharmacists,so as to provide reference for clinical pharmacists to carry out pharmaceutical consultation practices.Methods:A total of 38 children with cUTI who were admitted to Department of Urinary Surgery,Children's Hospital of Soochow University from January 2022 to August 2022 and consulted by clinical pharmacists were selected as the research objects.The children's information were collected,such as age,gender,diagnosis,clinical manifestations,microbiological test results and final outcomes,as well as consultation opinions of clinical pharmacists and their adoption,and the relevant characteristics of anti-infective treatment consultation in children were analyzed.Results:In addition to cUTI,38 children were complicated with vesicoureteral reflux(21 cases,55.26%),hydronephrosis(8 cases,21.05%)and other diseases;the clinical manifestations of 38 children with cUTI were mainly fever(20 cases,52.63%),elevated white blood cell(WBC)count in urine(38 cases,100.00%)and positive leukocyte esterase(38 cases,100.00%),elevated WBC count in blood(23 cases,60.53%)and elevated C�reactive protein(27 cases,71.05%).In terms of microbiological test,a total of 42 strains of pathogenic bacteria were detected in 38 children with cUTI,mainly including Pseudomonas aeruginosa(14 cases,33.33%),Escherichia coli(8 cases,19.05%)and Klebsiella pneumoniae(7 cases,16.67%).The drug susceptibility test results showed that the sensitivity rates of three pathogenic bacteria to piperacillin-tazobactam sodium,meropenem,imipenem-cilastatin sodium and amikacin were all high(above 85.00%).For 38 children with cUTI,clinical pharmacists gave a total of 53 consultation opinions,44 opinions of which were adopted(83.02%),involving 31 children;the outcomes of 30 children(96.77%)were effective,while 5 of the remaining 7 cases(71.43%)had an effective outcome.Among 38 children with cUTI,1

关 键 词：临床药师 复杂性尿路感染 药学会诊 抗感染治疗 

分 类 号：R97[医药卫生—药品] R[医药卫生—药学]