临床药师参与1例干酪乳杆菌腹腔及血流感染的治疗实践  

Clinical pharmacist participating in the treatment of a case of intraperitoneal and bloodstream infection caused by Lactobacillus casei

作　　者：龙秀珍 黎颖然[2] 董勤 王柯懿 张文渊 LONG Xiu-zhen;LI Ying-ran;DONG Qin;WANG Ke-yi;ZHANG Wen-yuan(School of Pharmaceutial Sciences,Zunyi Medical University,Zunyi 519041,China;Department of Pharmacy,Zhongshan City People’s Hospital,Zhongshan 528403,China;Imaging Center,Zhongshan City People’s Hospital,Zhongshan 528403,China)

机构地区：[1]遵义医科大学药学院,贵州遵义519041 [2]中山市人民医院药学部,广东中山528403 [3]中山市人民医院影像中心,广东中山528403

出　　处：《中国药物应用与监测》2023年第6期458-461,共4页Chinese Journal of Drug Application and Monitoring

基　　金：中山市“十四五”重点专科建设项目(T2021015)。

摘　　要：1例58岁女性患者,因“气促10年余,加重4 h,伴畏寒、发热”入院。患者初始用药为注射用哌拉西林钠他唑巴坦钠,治疗后白细胞计数(WBC)下降,但嗜中性粒细胞百分数(NEUT%)未下降,同时降钙素原(PCT)升高。患者腹水及全血中多份标本培养出干酪乳杆菌,无药敏报告。干酪乳杆菌通常被认为是益生菌,其致病的病例报道罕见。临床药师查阅相关文献,并结合患者的具体情况,最终建议给予哌拉西林钠他唑巴坦钠(4.5 g,q 8 h,ivgtt)联合左氧氟沙星(0.5 g,qod,ivgtt)抗感染治疗,同时嘱临床警惕继发性QT间期延长。临床医生采纳会诊意见,患者感染情况得到有效控制,抗感染治疗期间未发生不良反应,最终好转出院。A 58-year-old female patient was admitted to the hospital due to shortness of breath that had been present for over 10 years,but had worsened over the past 4 hours along with chills and fever.The patient was initially treated with intravenous piperacillin sodium and tazobactam sodium.After treatment,the white blood cell count(WBC)decreased,but the procalcitonin(PCT)increased and the neutrophil percentage(NEUT%)did not decrease.Lactobacillus casei was detected in both the ascitic fluid and whole blood,and no drug sensitivity report was available.Lactobacillus casei is generally considered a probiotic,and although cases of its pathogenicity have been reported infrequently.After reviewing relevant literature and considering the specific conditions of the patient,clinical pharmacists suggested administering a combination of piperacillin sodium and tazobactam sodium(4.5 g,q 8 h,ivgtt)along with levofloxacin sodium(0.5 g,qd,ivgtt)as antimicrobial therapy.Besides,clinical pharmacists also suggested clinical vigilance for secondary QT interval prolongation.The physician adopted all of the recommendations,resulting in effective control of the patient’s infection without any adverse reactions.Subsequently,the patient’s condition improved and she was discharged.

关 键 词：干酪乳杆菌 血流感染 腹腔感染 左氧氟沙星 哌拉西林钠他唑巴坦钠 

分 类 号：R969.3[医药卫生—药理学]