1例血液透析患者并发导管相关性感染与肺部感染的抗感染治疗药学监护  

Pharmaceutical Care in Anti-infective Treatment for a Hemodialysis Patient Complicated by Catheter-related Infection and Pulmonary Infection

作　　者：莫玉娜 MO Yu-na(Department of Pharmacy,Libo County People's Hospital,Qiannan Guizhou 558400,China)

机构地区：[1]荔波县人民医院药剂科,贵州黔南558400

出　　处：《抗感染药学》2024年第9期888-891,共4页Anti-infection Pharmacy

摘　　要：目的:分析1例血液透析患者并发导管相关性感染与肺部感染的抗感染治疗药学监护过程,为临床透析患者的抗感染治疗提供参考。方法与结果:该患者因“透析过程中出现寒战1 h”入院治疗,入院检查显示,导管口皮肤红肿,白细胞计数16.71×109/L、中性粒细胞百分比93.40%,考虑为导管相关性感染,遂予头孢唑林抗感染治疗;第2天,患者CT检查提示存在肺部感染,临床药师会诊后,考虑导管相关性感染、肺部感染的常见病原菌谱和患者的肾功能基础,建议改用哌拉西林-他唑巴坦钠,结合患者的肌酐清除率,其用法用量宜为“2.25 g,q12h”,医生采纳了;第5天,患者血培养回报嗜麦芽窄食单胞菌,且其对哌拉西林-他唑巴坦钠敏感。结论:针对血液透析患者所并发的感染,临床在制定经验性抗感染治疗方案时应首先考虑相关感染的常见病原菌谱,并结合患者的肝肾功能,待病原学结果明确后再优化调整,以保证患者的治疗效果。Objective:To analyze the pharmaceutical care process in anti-infective treatment for a hemodialysis patient complicated by catheter-related infection and pulmonary infection,and provide reference for the anti-infective treatment of clinical dialysis patients.Methods and Results:The patient was admitted with"chills for 1 hour during dialysis".Upon admission,the examination revealed erythema and swelling at the catheter insertion site,with a white blood cell count of 16.71×109/L and a neutrophil percentage of 93.40%,suggesting catheter-related infection,so anti-infective treatment with cefazolin was initiated.On the second day of hospitalization,a CT scan revealed pulmonary infection.After consultation with a clinical pharmacist,considering the common pathogen spectrum for both catheter-related infection and pulmonary infection as well as the patient's baseline renal function,the treatment was switched to piperacillin-tazobactam sodium,with a dosage of 2.25 g every 12 hours based on the patient's creatinine clearance.This recommendation was adopted by the physician.On the fifth day,blood cultures of the patient identified Stenotrophomonas maltophilia which was sensitive to piperacillin-tazobactam sodium.Conclusion:When developing an empirical anti-infective treatment regimen for complicated infections in hemodialysis patients,clinicians should first consider the common pathogen spectrum associated with infections.Additionally,the treatment regimen should be optimized and adjusted based on clear etiological results and tailored to the patient's liver and renal function to ensure the therapeutic efficacy.

关 键 词：血液透析 导管相关性感染 肺部感染 嗜麦芽窄食单胞菌 抗感染治疗 药学监护 

分 类 号：R97[医药卫生—药品] R631.1[医药卫生—药学] R563.1