1例肺部感染合并颅内感染患者的抗感染治疗与药学监护  

Anti-infective Treatment and Pharmaceutical Care of One Patient with Pulmonary Infection Complicated with Intracranial Infection

作　　者：甘菊文 孙伟[2] 邓晓兰 刘华[4] 廖晓飞[4] GAN Ju-wen;SUN Wei;DENG Xiao-lan;LIU Hua;LIAO Xiao-fei(Department of Respiratory and Critical Care Medicine,Ganzhou People's Hospital,Ganzhou Jiangxi 341000,China;Department of Neurology,Ganzhou People's Hospital,Ganzhou Jiangxi 341000,China;Department of Pharmacy,Haikou People's Hospital,Haikou 570208,China;Pharmacy Department,Ganzhou People's Hospital,Ganzhou Jiangxi 341000,China)

机构地区：[1]赣州市人民医院呼吸与危重症医学科,江西赣州341000 [2]赣州市人民医院神经内科,江西赣州341000 [3]海口市人民医院药学部,海口570208 [4]赣州市人民医院药剂科,江西赣州341000

出　　处：《抗感染药学》2025年第1期17-22,共6页Anti-infection Pharmacy

基　　金：2022年江西省卫生健康委科技计划项目(编号:202212414);2022年赣州市“科技+国家区域医疗中心”联合科技计划项目(编号:2022-YB1495)。

摘　　要：目的:分析1例肺部感染合并颅内感染患者的抗感染治疗过程与药学监护要点,为临床抗菌药物的合理用药和用药安全提供参考。方法和结果:该肺癌患者因发热(39℃)、头痛就诊于当地医院,综合降钙素原水平和肺部CT检查结果,初步考虑为肺部感染,遂予阿奇霉素+哌拉西林-他唑巴坦钠;但次日又出现意识不清、唤之不醒等症状,为进一步治疗而我院神经内科;临床综合患者发热、神志模糊、颈抵抗等症状,以及血象和脑脊液检查结果,判断患者还存在颅内感染,遂经验性予万古霉素+美罗培南;3 d后,患者感染症状和相关指标均明显好转,且脑脊液宏基因组学二代测序提示肺炎链球菌,临床考虑美罗培南对肺炎链球菌有较强抗菌作用,遂停用了万古霉素;6 d后,患者再次出现颅内感染表现,考虑肺炎链球菌对美罗培南耐药,遂又加用万古霉素;之后,感染得到控制,但患者出现严重耳鸣和听力下降,临床考虑这可能与万古霉素有关,遂再次停用万古霉素,而改用利奈唑胺,并予对症治疗;但治疗1周后,患者颅内感染反而加重,遂将治疗方案调整为莫西沙星+头孢曲松;之后,患者的感染症状和相关指标逐渐好转,而出院随访显示其听力也部分恢复。结论:颅内感染是较为复杂和严重的感染,临床在制定抗感染治疗方案时,应充分考虑抗菌药物的抗菌谱和对血脑屏障的通过情况,并且要做好对药物不良反应的药学监护和处置准备,以保证患者的治疗效果和用药安全。Objective:To analyze the anti-infective treatment process and pharmaceutical care key points of one patient with pulmonary infection complicated with intracranial infection,and provide reference for rational use and medication safety of clinical antibacterial drugs.Methods and Results:The patient with lung cancer was treated at a local hospital due to fever(39℃)and headache.Based on the procalcitonin level and lung CT examination results,it was initially considered as pulmonary infection,so azithromycin+piperacillin-tazobactam sodium were administrated.However,on the next day,there were symptoms such as unconsciousness and not waking up,so the patient was admitted to Department of Neurology of our hospital for further treatment.Based on the clinical combination of fever,confusion,neck resistance and other symptoms of the patient,as well as the hemogram and cerebrospinal fluid examination results,it was determined that the patient still had intracranial infection,so vancomycin+meropenem were empirically administrated.After 3 days,the patient's infection symptoms and related indicators were significantly improved,and the cerebrospinal fluid metagenomic next-generation sequencing indicated Streptococcus pneumoniae.Clinically considering that meropenem had a strong antibacterial effect on Streptococcus pneumoniae,vancomycin was discontinued.After 6 days,intracranial infection recurred in the patient.Considering that Streptococcus pneumoniae was resistant to meropenem,vancomycin was added.Later,the infection was controlled,but the patient developed severe tinnitus and hearing loss,which might be related to vancomycin in clinical consideration,so vancomycin was discontinued again and linezolid was used instead,and symptomatic treatment was given.However,after 1 week of treatment,the intracranial infection worsened,so the treatment regimen was adjusted to moxifloxacin+ceftriaxone.After that,the patient's infection symptoms and related indicators were gradually improved,and the discharge follow-up showed that the heari

关 键 词：颅内感染 肺部感染 药学监护 肺炎链球菌 万古霉素 听力损害 药物不良反应 

分 类 号：R97[医药卫生—药品] R512.3[医药卫生—药学]