临床药师参与1例皮脂腺囊肿切除术后感染脓肿分枝杆菌治疗分析  

Clinical pharmacist participated in the treatment and analysis of a patient with Mycobacterium abscessus infection after the resection of sebaceous gland cyst

作　　者：杨苏芳 刘国华 伍成利 王海浪 何学珍 YANG Sufang;LIU Guohua;WU Chengli;WANG Hailang;HE Xuezhen(Department of Pharmacy,Jinggangshan University Affiliated Hospital,Ji’an 343000,Jiangxi Province,China;Department of Thoracic Surgery,Jinggangshan University Affiliated Hospital,Ji’an 343000,Jiangxi Province,China)

机构地区：[1]井冈山大学附属医院药剂科,江西吉安343000 [2]井冈山大学附属医院胸外科,江西吉安343000

出　　处：《药物流行病学杂志》2024年第10期1164-1169,共6页Chinese Journal of Pharmacoepidemiology

基　　金：江西省教育厅科学技术研究青年项目(GJJ2201660);江西省中医药管理局科技计划项目(2021A329);江西省中医药管理局科技计划项目(2023B1369)。

摘　　要：1例26岁女性患者因“背部皮脂腺囊肿切除术后切口反复感染”入院,入院后脓液培养结果显示脓肿分枝杆菌培养阳性。临床药师查阅相关指南和文献,分析总结抗脓肿分枝杆菌感染的药物选择、细菌耐药性、药品不良反应以及应对策略、出院后序贯治疗方案和治疗疗程,协助医师制定个体化抗感染治疗方案,初期根据细菌培养结果给予亚胺培南、阿米卡星和阿奇霉素;其次根据药敏结果更改为替加环素、阿米卡星和克拉霉素;最终由于替加环素不良反应以及患者再次出现窦道,同时考虑亚胺培南和克拉霉素耐药的可能,及时调整抗感染方案为头孢西丁、阿米卡星和阿奇霉素。治疗期间,临床药师监测药物有效性及不良反应,将药学专业知识与临床实践结合。经过该方案治疗,患者好转出院。出院后序贯给予阿奇霉素联合奥马环素继续抗感染治疗,同时通过随访,患者背部切口基本愈合。临床药师参与脓肿分枝杆菌抗感染药物选择可为患者提供个体化的用药方案,保证患者用药的安全性、有效性,并为类似患者的治疗和管理提供参考。A 26-year-old female patient was admitted to the hospital with recurrent infection of the incision after resection of a back sebaceous cyst,and the pus culture showed Mycobacterium abscessus.Clinical pharmacists reviewed relevant guidelines and literature,analyzed and summarized drug selection,drug resistance,adverse drug reactions and coping strategies,sequential treatment plans and treatment courses,and assist physicians in formulating individualised anti-infective treatment plans.Initially imipenem,amikacin and azithromycin were given according to bacterial culture results.Secondly,according to the results of drug sensitivity,they were changed to tigecycline,amikacin and clarithromycin.Finally,due to the adverse drug reaction of tigecycline and the recurrence of sinus in the patient,and considering the possibility of imipenem and clarithromycin resistance,the anti-infection regimen was adjusted in time to cefoxitin,amikacin and azithromycin.During treatment,the clinical pharmacist monitors drug effectiveness and adverse reactions,combining pharmacy expertise with clinical practice.After the treatment,the patient improved and was discharged.After discharge,azithromycin and omacycline were successively given to continue anti-infection treatment,and the incision on the patient's back basically healed through follow-up.Clinical pharmacist involvement in Mycobacterium abscessus anti-infective drug selection can provide individualised drug regimens for patients,ensure the safety and effectiveness of medication for patients,and provide references for the treatment and management of similar patients.

关 键 词：皮脂腺囊肿 脓肿分枝杆菌 感染 药学监护 

分 类 号：R969[医药卫生—药理学]