临床药师参与1例难治性耐药铜绿假单胞菌肺部感染的药物治疗实践  

Clinical Pharmacists′Practice in Drug Treatment of Pulmonary Infection Induced by Difficult-to-Treat Resistance Pseudomonas Aeruginosa:A Case Report

作　　者：何旭露 何菊英 HE Xulu;HE Juying(The First Affiliated Hospital of the Army Medical University,Chongqing,China 400037)

机构地区：[1]中国人民解放军陆军军医大学第一附属医院,重庆400038

出　　处：《中国药业》2025年第4期I0001-I0005,共5页China Pharmaceuticals

摘　　要：目的探讨临床药师在难治性耐药铜绿假单胞菌感染药物治疗中的作用。方法回顾临床药师参与会诊1例难治性耐药铜绿假单胞菌肺部感染病例的经过。患者为青年男性,因车祸伤导致多处骨折并伴截瘫,入院第3天手术,术后继续予头孢曲松抗感染,3 d后因发热、炎性指标升高,换用头孢哌酮钠他唑巴坦钠抗感染,后根据痰培养结果(示铜绿假单胞菌)先后换用美罗培南、左氧氟沙星,抗感染治疗37 d后仍反复发热,拟换为多黏菌素B,但因价格较高,患者难以承受。请临床药师会诊,建议经验性予头孢他啶阿维巴坦+氨曲南(双通道)及阿米卡星抗感染,治疗有效,但仍有发热。12 d后临床药师再次会诊,根据痰细胞培养(耐碳青霉烯铜绿假单胞菌)、真菌培养(烟曲霉)等结果,将头孢他啶阿维巴坦换为伏立康唑,并调整另两种药用法;11 d后根据检查结果又将氨曲南调整为多黏菌素B,另两种药用法不变;2 d后使用多黏菌素B中出现心悸、心率加快等药品不良反应,次日临床药师会诊时考虑与多黏菌素B及伏立康唑有关,且多次痰液真菌培养阴性,建议停用此两药,续用之前经验性给药方案。11 d后病情及感染指标好转,改用左氧氟沙星抗感染。结果临床医师采纳临床药师的用药调整建议,患者的各项感染指标逐渐恢复正常,临床症状改善,肺部感染得到有效控制,左氧氟沙星单药抗感染20 d后患者病情进一步好转,准其出院。结论临床药师的参与,进一步优化了难治性耐药铜绿假单胞菌感染不同治疗阶段的用药选择,效果更佳。Objective To investigate the role of clinical pharmacists in the drug treatment of induced by difficult-to-treat resistance Pseudomonas aeruginosa(DTR-PA).Methods The process of clinical pharmacists participating in the treatment of a case of pulmonary infection induced by DTR-PA was retrospectively analyzed.The patient was a young male who suffered multiple fractures and paraplegia due to a car accident injury;on the third day of admission,he underwent the surgery and received ceftriaxone for anti-infection after surgery;after 3 d,ceftriaxone was replaced with cefoperazone sodium and tazobactam sodium for anti-infection due to fever and elevated inflammatory indicators,and the anti-infection regimen was adjusted to meropenem and levofloxacin successively based on the sputum culture(showing Pseudomonas aeruginosa);the patient still experienced recurrent fever after 37 d of anti-infection,so the anti-infection drug was planned to replaced with polymyxin B,however,he could not afford it due to the high price.After consultation,clinical pharmacists recommend the empirical treatment with ceftazidime and avibactam+aztreonam(dual channel)and amikacin for anti-infection,which was effective,but the patient still had fever.After 12 days,Based on the sputum bacterial culture(carbapenem-resistant Pseudomonas aeruginosa)and fungal culture(Aspergillus fumigatus),the clinical pharmacist recommended to replace ceftazidime and avibactam with voriconazole and adjust the usage of the other two drugs;based on the examinations,aztreonam was adjusted to polymyxin B after 11 d,while the usage of the other two drugs remained unchanged;2 d later,adverse drug reactions such as palpitations and increased heart rate occurred when using polymyxin B,which were considered to be related to polymyxin B and voriconazole during pharmaceutical consultation the following day,and clinical pharmacists suggested discontinuing these two drugs and continuing with the previous empirical dosing regimen according to the negative sputum fungal cultures.The

关 键 词：临床药师 难治性耐药铜绿假单胞菌 肺部感染 头孢他啶阿维巴坦 氨曲南 

分 类 号：R969.3[医药卫生—药理学]