临床药师参与一例老年患者泛耐药鲍曼不动杆菌感染的药物治疗实践  

Clinical pharmacists participated in the case analysis of an elderly patient with XDRAB infection

作　　者：闫永悦 苑新文 YAN Yongyue;YUAN Xinwen(Department of Pharmacy,Tianjin Xiqing Hospital,Tianjin 300380,China)

机构地区：[1]天津市西青医院药剂科,天津300380

出　　处：《中国处方药》2025年第3期58-60,共3页Journal of China Prescription Drug

摘　　要：目的探讨临床药师在严重耐药细菌感染病例中的价值体现,为临床泛耐药鲍曼不动杆菌的抗感染治疗提供参考,同时观察大剂量抗菌药物抗感染治疗的不良反应及耐受性。方法1例老年慢性阻塞性肺疾病合并支气管扩张患者,感染泛耐药鲍曼不动杆菌,临床药师参与其抗菌药方案的制定,采取以舒巴坦及其复方制剂联合多黏菌素B静脉及雾化吸入基础方案,根据药物PK/PD理论优化给药方式,同时全程监护该老年患者应用大剂量舒巴坦及多黏菌素B对肾功能影响及药物不良反应,并对该患者院内感控措施提供建议。结果经过临床药师在整个治疗过程中抗感染方案的制定及全程监护,经足疗程抗感染方案治疗后患者症状明显好转、胸CT感染影像提示炎症明显吸收,对治疗过程中的药物不良反应正确处理,未发生耐药菌的病区内传播爆发。结论临床药师通过自身药学专业知识为临床诊疗提供药学专业思维,对患者的药物治疗起到了积极作用,与临床医生形成良好共促的协作关系,同时有助于提高整个医疗机构抗菌药物合理用药水平。Objective To explore the value of clinical pharmacists in severe drug-resistant bacterial infections and to provide reference for anti-infection treatment of XDRAB in clinical practice.At the same time,the adverse reactions and tolerability of the elderly patients treated with high-dose antibiotics were observed.Methods An elderly patient with chronic obstructive pulmonary disease combined with bronchiectasis infected with XDRAB,clinical pharmacists involved in the development of their antimicrobial regimens.A basic plan was adopted,which involved sulbactam and its compound preparations in combination with intravenous and nebulized polymyxin B.The dosing method was optimized based on the pharmacokinetic/pharmacodynamic(PK/PD)theory.Meanwhile,the clinical pharmacists monitored the adverse drug reactions of high-dose sulbactam and polymyxin B on renal function and the adverse drug reactions throughout the treatment process,and provided suggestions on the nosocomial infection control measures for this patient.Results During the entire treatment course,clinical pharmacists formulated the anti-infective protocol and conducted comprehensive monitoring.Upon completion of the full-course anti-infective treatment,the patient exhibited a marked amelioration of symptoms.The thoracic CT scan demonstrated a significant reduction in the area of infection,indicating effective absorption of the inflammation.All adverse drug reactions that occurred during the treatment were managed appropriately,and no intra-ward outbreak of the spread of drug-resistant bacteria was observed.Conclusion Clinical pharmacists provide pharmaceutical professional thinking for clinical diagnosis and treatment through their own pharmaceutical professional knowledge,it provides a positive effect on the drug treatment of patients and forming a good co-operative relationship with the clinician.At the same time,it is helpful to improve the level of rational use of antibiotics in the whole medical institutions.

关 键 词：泛耐药鲍曼不动杆菌 舒巴坦 多黏菌素B 老年患者 

分 类 号：R47[医药卫生—护理学]