临床药师参与1例萜烯诺卡菌肺部感染患者治疗的药学实践  

Pharmaceutical practice in the management of pulmonary infection with Nocardia terpenica by clinical pharmacists

作　　者：吴庆荣 张丽华 张宇 杨雨婷 张浩 龚享文 宋晓兵 WU Qingrong;ZHANG Lihua;ZHANG Yu;YANG Yuting;ZHANG Hao;GONG Xiangwen;SONG Xiaobing(Department of Pharmacy,The Fifth People's Hospital of Ganzhou City,Ganzhou 341000,Jiangxi Province,China;Department of Respiratory Medicine,The Fifth People's Hospital of Ganzhou City,Ganzhou 341000,Jiangxi Province,China)

机构地区：[1]赣州市第五人民医院药剂科,江西赣州341000 [2]赣州市第五人民医院呼吸科,江西赣州341000

出　　处：《药物流行病学杂志》2025年第2期224-230,共7页Chinese Journal of Pharmacoepidemiology

基　　金：江西省中医药管理局科技计划项目(2023B0466)。

摘　　要：1例慢性阻塞性肺疾病患者继发性肺部感染入院,在未明确病原菌时给予哌拉西林他唑巴坦联合左氧氟沙星抗感染,后加用HRZE抗结核治疗方案,但患者仍高热且咳黄脓痰、伴气喘,完善支气管镜肺泡灌洗液病原宏基因组测序结果提示萜烯诺卡菌。临床药师根据患者病情变化,结合相关指南和文献,先后建议采用多种抗感染药物,包括复方磺胺甲噁唑片、利奈唑胺葡萄糖注射液、阿米卡星注射液联合亚胺培南西司他丁钠,并对患者治疗中出现的磺胺不耐受以及利奈唑胺导致骨髓抑制等不良反应的处理和药物调整提出建议,医师均采纳。最终在临床医师和药师的协作下患者病情好转,带药出院。出院后经用药宣教并随访,成功康复。在本案例中,临床药师利用自身专业协助临床医师优化罕见感染的药物治疗方案,实现了职业价值。A case of secondary pulmonary infection in a patient with acute exacerbation of chronic obstructive pulmonary disease was admitted.The patient was initially giren piperacillin-tazobactam combined with levofloxacin for anti-infective treatment before the pathogen was identified.lafer,the HRZE anti-tuberculosis regimen was added,but the patient continued to experience high fever,yellow purulent sputum,and dyspnea.Subsequent,bronchoalveolar lavage fluid pathogen metagenomic sequencing revealed Nocardia terpenica.Clinical pharmacists,based on the patient's condition changes and in accordance with relevant guidelines and literature,suggested using various antimicrobial agents,including compound sulfamethoxazole tablets,linezolid glucose injection,amikacin injection combined with imipenem-cilastatin,to manage the patient's intolerance to sulfonamides and the bone marrow suppression induced by linezolid and to provide medication suggestions.The clinician adopted all the suggestions.Through the collaborative efforts of physicians and clinical pharmacists,the patient's condition improved,allowing for discharge with medication.Post-discharge,medication education and follow-up were conducted,leading to successful recovery.In this case,the clinical pharmacist reviewed domestic and international literature on Nocardia terpenica and the characteristics of antimicrobial drugs,and utilized their expertise to assist clinicians in treating rare infection cases,realizing their professional value.

关 键 词：萜烯诺卡菌 肺部感染 抗感染治疗 骨髓抑制 临床药师 药学监护 

分 类 号：R969.3[医药卫生—药理学]