1例头孢他啶阿维巴坦联合氨曲南治疗重症肺炎失败后的药物治疗策略分析  

Strategy analysis of a case of failure in the treatment of severe pneumonia with ceftazidime avibactam and aztreonam

作　　者：王根柱 王小营 李忠东 WANG Genzhu;WANG Xiaoying;LI Zhongdong(Department of Pharmacy,Beijing Electric Power Hospital of State Grid Co.of China/Capital Medical University Electric Teaching Hospital,Beijing 100073,China)

机构地区：[1]国家电网公司北京电力医院/首都医科大学电力教学医院药剂科,北京100073

出　　处：《药物流行病学杂志》2024年第3期342-348,共7页Chinese Journal of Pharmacoepidemiology

基　　金：北京电力医院博士基金项目(B2021001)。

摘　　要：本文报道1例耐碳青霉烯类肺炎克雷伯菌所致重症肺炎,先后经替加环素联合美罗培南、头孢他啶阿维巴坦和头孢他啶阿维巴坦联合氨曲南治疗失败后的药物治疗策略。临床药师根据患者临床表现、肾脏功能、感染指标等的动态变化,结合细菌培养/药敏和宏基因组二代测序结果及抗菌药物药动学/药效学特点,提出硫酸黏菌素静脉滴注(75万单位,ivd,q12h,首剂150万单位)并雾化(25万单位,q12h)联合替加环素(100 mg,ivd,q12h,首剂200 mg)为基础的抗感染方案建议,为医生采纳同时实施药学监护,患者肺炎得到控制,转至康复机构。临床药师追踪前沿抗菌药物知识,利用专业优势为临床团队提供有效的技术支持,协助疑难感染病例的诊疗,体现了职业价值。To introduce a strategy for a case of severe pneumonia caused by carbapenem-resistant Klebsiella pneumonia,which have failed to treat with tigecycline combined with meropenem,ceftazidime avibactam,and ceftazidime avibactam combined with aztreonam.Clinical pharmacist made anti-infective regimen based on colistin sulfate drip(750 000 units,ivd,q12h,first dose of 1.5 million units) and atomization(250 000units,q12h) combined with tigecycline(100 mg,ivd,q12h,first dose 200 mg) according to patient's clinical manifestations,renal function,the dynamic changes of infection indicators,metagenomics next-generation sequencing results and the PK/PD characteristics of the antibacterial drugs.The anti-infection regimens(intravenous plus aerosolized colistin combined with tigecycline) proposed by the clinical pharmacist were adopted by doctors and the pneumonia was effectively controlled.Clinical pharmacists played an effective role in the clinical healthcare team by tracking frontier of antibacterial drugs,which fully embodied the professional value in optimizing treatment regimens of intractable infections.

关 键 词：耐碳青霉烯类肺炎克雷伯菌 头孢他啶阿维巴坦 氨曲南 硫酸黏菌素 替加环素 抗感染治疗 临床药师 

分 类 号：R978[医药卫生—药品]