1例慢性鼻窦炎继发脑脓肿患者的抗感染治疗与药学监护  

Anti-infection Treatment and Pharmaceutical Care of a Patient with Chronic Sinusitis Secondary Brain Abscess

作　　者：卢娴 韩国强[2] 钱鑫[2] LU Xian;HAN Guo-qiang;QIAN Xin(Panzhou An'ning Hospital,Panzhou Guizhou 553500,China;Guizhou Provincial People's Hospital,Guiyang 550002,China)

机构地区：[1]盘州市安宁医院,贵州盘州553500 [2]贵州省人民医院,贵阳550002

出　　处：《抗感染药学》2024年第10期994-999,共6页Anti-infection Pharmacy

摘　　要：目的:分析1例慢性鼻窦炎患者继发脑脓肿的抗感染治疗药学监护过程,为临床类似患者的诊治提供参考。方法与结果:该患者因“发热、头痛8d”来院治疗,综合患者的头颅CT结果和症状表现,初步考虑为病毒性脑膜炎,遂经验性予阿昔洛韦;2 d后,患者仍有发热、头痛,不排除细菌感染可能,遂加用头孢曲松;之后,MRI提示,患者左侧上颌窦、筛窦、额窦等炎症与脑脓肿病灶位于同一侧,加之脑脊液宏基因组二代测序检查回报牙髓卟啉单胞菌和口腔普雷沃菌,结合患者存在慢性鼻窦炎,不排除脓肿来源于鼻窦可能,遂停用头孢曲松而改用美罗培南;随后,患者体温有所下降,但CT检查提示脑疝形成可能,遂行手术治疗,考虑颅内感染多由革兰阳性菌所致,故经验性加用万古霉素;之后,颅内脓性分泌物标本中果然检出星座链球菌;3d后,由于万古霉素血药浓度低于推荐值下限,于是对其调整了给药频次,并加用了奥硝唑;经过1个多月的治疗,患者恢复良好。结论:对于存在慢性鼻窦炎的患者,其所发生的颅内感染,临床上应充分考虑口鼻部常见菌播散感染的可能,并积极开展病原学检查,而在治疗上应尽量覆盖可能的常见菌,从而为患者的康复提供保障。Objective:To analyze the pharmaceutical care process of one patient with chronic sinusitis and secondary brain abscess during anti-infection treatment,and provide reference for the diagnosis and treatment of similar patients in clinical practice.Methods and Results:A patient visited the hospital for treatment due to"fever and headache for 8 days".According to the patient's head CT results and symptoms,the patient was initially diagnosed with viral meningoencephalitis,so acyclovir was given empirically.Two days later,the patient still had fever and headache,and bacterial infection could not be ruled out,so ceftriaxone was added.Later,the MRI showed that the patient's left maxillary sinus,ethmoid sinus,frontal sinus inflammations were located on the same side as the brain abscess lesions.In addition,metagenomic next-generation sequencing of cerebrospinal fluid reported Porphyromonas endodontalis and Prevotella oralis.As the patient had chronic sinusitis,the possibility of abscess originating from the paranasal sinus could not be ruled out,so ceftriaxone was discontinued and meropenem was used instead;subsequently,the patient's body temperature dropped,but the CT scan indicated the possibility of brain herniation,then the patient received surgical treatment.Considering that intracranial infection was mostly caused by Gram-positive bacteria,vancomycin was added empirically.Later,Streptococcus constellatus was detected in the intracranial purulent secretion specimens.Three days later,the plasma concentration of vancomycin was lower than the recommended value lower limit,then the dosing frequency was adjusted and ornidazole was added.After treatment for more than one month,the patient recovered well.Conclusion:For the intracranial infection in patients with chronic sinusitis,full consideration should be given to the possibility of disseminated infections of common bacteria in the mouth and nose and etiological examinations should be carried out actively.The treatment should cover possible common bacteria as much as pos

关 键 词：慢性鼻窦炎 脑脓肿 牙髓卟啉单胞菌 星座链球菌 口腔普雷沃菌 抗感染治疗 药学监护 临床药师 

分 类 号：R97[医药卫生—药品] R512.3[医药卫生—药学]