多学科诊疗模式下多重耐药大肠埃希菌所致尿路感染合并急性缺血性脑卒中患者的临床治疗分析  

Analysis of the Clinical Treatment of Patients with Urinary Tract Infection Complicated by Acute Ischemic Stroke Caused by Multidrug-Resistant Escherichia Coli under the Multidisciplinary Diagnosis and Treatment Mode

作　　者：黄伟斌 吴宏仲 罗慎颖 黄云青 黄海涛 HUANG Wei-bin;WU Hong-zhong;LUO Shen-ying;HUANG Yun-qing;HUANG Hai-tao(Puning People's Hospital,Puning,Guangdong 515300,China)

机构地区：[1]普宁市人民医院,广东普宁515300

出　　处：《抗感染药学》2023年第8期795-800,共6页Anti-infection Pharmacy

基　　金：广东省基础与应用基础研究省企联合项目(编号:2022A1515220144)。

摘　　要：目的:分析1例多重耐药大肠埃希菌所致复杂性尿路感染合并急性缺血性脑卒中患者的多学科诊疗(multidisciplinary diagnosis and treatment,MDT)过程,为临床药师参与类似患者的MDT实践提供参考。方法:该患者因“突发寒战发热,腰部酸胀,排尿不畅”至医院急诊就诊,入院检查显示较为明显的尿路感染指征,并且NIHSS评分显示存在急性缺血性脑卒中。结果:针对患者的尿路感染,临床先经验性使用左氧氟沙星治疗,但治疗数日后感染指征未见好转且有加重趋势,加之尿培养结果为大肠埃希菌,其对左氧氟沙、头孢呋辛、头孢西丁、头孢他啶均耐药;遂于入院第5天组织多学科会诊,会诊专家一致认为患者有感染加重为脓毒血症甚至感染性休克的风险,于是将抗感染治疗方案调整为美罗培南(0.5 g,q8h)+复方磺胺甲噁唑(0.96 g,q12h);治疗2 d后,感染指征仍未见好转,遂再组织多学科会诊,认为感染已进展为脓毒血症,建议将抗感染治疗方案调整为美罗培南(首剂2 g,维持1 g,q8h)+阿米卡星(0.3 g,q24h);1周后,患者感染指征明显好转,遂仅保留美罗培南(1 g,q12h);又1周后,患者感染指征基本消失,遂停用所有抗菌药物,患者也顺利出院。结论:临床药师利用自身专业特长,参与到患者的MDT过程中,为患者的药物治疗提供更加个性化的支持,确保患者治疗的安全和有效。Objective:To analyze the multidisciplinary diagnosis and treatment(MDT)process of one patient with urinary tract infection complicated by acute ischemic stroke caused by multidrug-resistant Escherichia coli,and provide reference for clinical pharmacists to participate in MDT practices in similar patients.Methods:The patient visited the hospital's emergency department due to"sudden chills,fever,soreness in the waist,and difficulty in urinating".The examination at admission showed that the patient had obvious indications of urinary tract infection,and the NIHSS score revealed the presence of acute ischemic stroke.Results:For the patient's urinary tract infection,levofloxacin was used clinically for empirical treatment.However,after several days of treatment,the infection indications had not improved and showed a trend of aggravation;in addition,the urine culture result revealed infection with Escherichia coli,which was resistant to levofloxacin,cefuroxime,cefoxitin and ceftazidime.On the 5th day after admission,a multidisciplinary consultation was implemented,and experts participating in the consultation unanimously believed that the patient was at the risk of worsening the infection to sepsis or even septic shock,so the anti-infective treatment regimen was adjusted to meropenem(0.5 g,q8h)+compound sulfamethoxazole(0.96 g,q12h);after 2 days of treatment,the infection indications had not improved and a multidisciplinary consultation was implemented again,and it was believed that the infection had progressed to septicopyemia.It was recommended that the anti-infective treatment regiment was adjusted to meropenem(2 g for the first dose,1 g,q8h for maintenance treatment)+amikacin(0.3 g,q24h).One week later,the patient's infection indications improved obviously,so only meropenem(1 g,q12h)was given;another week later,the patient's infection indications disappeared basically,so all antibacterial drugs were discontinued,and the patient was discharged from the hospital.Conclusion:Clinical pharmacists can participate in the p

关 键 词：多学科诊疗模式 多重耐药大肠埃希菌 尿路感染 急性缺血性脑卒中 药学监护 

分 类 号：R97[医药卫生—药品] R691.3[医药卫生—药学]