1例免疫异常合并单核细胞增生李斯特菌血流感染孕妇抗感染治疗的药学监护  

Pharmaceutical Care of One PregnantWoman with Immune Abnormality and Listeria Monocytogenes Bloodstream Infection during Anti-infection Treatment

作　　者：何赛珠 李佳[2] 夏延哲[2] HE Sai-zhu;LI Jia;XIAYan-zhe(Shunde Women and Children's Hospital of Guangdong Medical University,Foshan Guangdong 528300,China;The First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]广东医科大学顺德妇女儿童医院,广东佛山528300 [2]中山大学附属第一医院,广州510080

出　　处：《抗感染药学》2024年第10期988-993,共6页Anti-infection Pharmacy

基　　金：广东省医院药学研究基金——抗菌药物专项研究基金(编号:2023KJ20);佛山市自筹经费类科技创新项目(编号:2220001003851);广东医科大学顺德妇女儿童医院青年人才项目(编号:2023QNRC004)。

摘　　要：目的:分析1例免疫异常合并单核细胞增生李斯特菌血流感染孕妇抗感染治疗的药学监护过程,为孕妇并发单核细胞增生李斯特菌感染的临床救治提供参考。方法与结果:该孕妇(31岁,停经16^(+4)周)因发热6d入院治疗,入院后行双侧血培养,同时予头孢呋辛经验性抗感染治疗;次日,血培养检出单核细胞增生李斯特菌,且其对青霉素、氨苄西林、美罗培南敏感;由于院内无氨苄西林,但综合细菌药敏结果和抗菌药物的抗菌谱,推测哌拉西林-他唑巴坦钠应该有效,遂将抗感染治疗方案改为哌拉西林-他唑巴坦钠;2 d后,患者无发热,但之后血培养仍检出有单核细胞增生李斯特菌;约2周后,患者再次出现发热,且甲型流感病毒抗体IgM阳性,乙型流感病毒抗体IgM弱阳性,患者及其家属考虑病情复杂,决定终止妊娠;引产后,患者3次输注哌拉西林-他唑巴坦钠均出现肌肉酸痛等症状,怀疑可能与哌拉西林-他唑巴坦钠有关,遂改用青霉素;4 d后,又改用阿莫西林-克拉维酸钾口服,但服用后出现皮疹和瘙痒,考虑为药物性皮疹,因患者已终止妊娠遂决定改用复方磺胺甲噁唑;不日,患者状况好转而出院,临床药师建议继续复方磺胺甲噁唑治疗,并定期复诊。结论:对于孕妇等特殊人群发生单核细胞增生李斯特菌感染,临床药师应充分考虑患者的具体情况,协助医生制定更个性化的治疗方案,并随病情变化进行及时调整,以保证患者的用药安全和治疗效果。Objective:To analyze the pharmaceutical care process of one pregnant woman with immune abnormality and Listeria monocytogenes bloodstream infection during anti-infection treatment,and provide reference for the clinical treatment of pregnant women complicated with Listeria monocytogenes infection.Methods and Results:A pregnant woman(31 years old,16^(+4) weeks of menelipsis)was admitted to the hospital due to fever for 6 days;after admission,bilateral blood culture was performed and cefuroxime was given for empirical anti-infection treatment.On the next day,Listeria monocytogenes was detected from the blood culture,which was sensitive to penicillin,ampicillin and meropenem.Since ampicillin was not available in the hospital and piperacillin-tazobactam sodium was speculated to be effective based on the bacterial drug susceptibility results and the antibacterial spectrum of antibacterial drugs,the anti-infection treatment regimen was switched to piperacillin-tazobactam sodium.After 2 days,the patient had no fever,but Listeria monocytogenes was still detected from the blood culture.About 2 weeks later,the patient had fever again,the influenza A virus antibody IgM was detected positive and the influenza B virus antibody IgM was detected weakly positive.The patient and her family decided to terminate the pregnancy in view of the patient's complex conditions.After induced abortion,the patient received infusions of piperacillin-tazobactam sodium for 3 times and developed symptoms such as muscle soreness,which was suspected to be related to piperacillin-tazobactam sodium,so penicillin was used instead;4 days later,amoxicillin-clavulanate potassium was taken orally,but the patient had rash and itching after administration,which were considered as drug-induced rash.Because the patient had terminated the pregnancy,compound sulfamethoxazole was used instead;the patient's condition improved soon and she was discharged from the hospital.The clinical pharmacist recommended continued treatment with compound sulfamethoxazole and reg

关 键 词：单核细胞增生李斯特菌 血流感染 孕妇 药学监护 合理用药 

分 类 号：R97[医药卫生—药品] R515.3[医药卫生—药学]