临床药师参与1例耐碳青霉烯阴沟肠杆菌血流感染致脓毒性休克患者抗感染治疗实践  

Clinical Pharmacist Participated in the Anti-infection Treatment of a Case of Septic Shock Caused by Carbapenem Resistant Enterobactercloacae Bloodstream Infection

作　　者：冯亚男 韩倩 刘宁 谭尧月 牟鸣[1] Feng Ya-nan;Han Qian;Liu Ning;Tan Yao-yue;Mou Ming(Department of Clinical Pharmacy,Dazhou Central Hospital,Dazhou 635000)

机构地区：[1]达州市中心医院临床药学科,达州635000

出　　处：《国外医药(抗生素分册)》2025年第2期135-139,共5页World Notes on Antibiotics

摘　　要：目的 为耐碳青霉烯类阴沟肠杆菌(CREC)感染患者的治疗提供经验依据和治疗参考。方法 临床药师参与1例耐碳青霉烯类阴沟肠杆菌(CREC)血流感染继发脓毒性休克患者的抗感染治疗。通过系统检索最新循证医学证据,结合患者病理生理特征、抗菌药物药动学/药效学(PK/PD)参数及病原菌耐药特性,运用临床药学思维,协助治疗团队制定个体化抗感染治疗方案,并进行全程药学监护。结果 医师采纳药师建议,予以多黏菌素B联合左氧氟沙星治疗后,患者感染得到有效控制,脓毒性休克血流动力学恢复稳定,期间未出现药物相关不良反应。结论 临床药师协助医师进行用药方案调整与优化对临床治疗意义重大。对于产金属酶的CREC引起的血流感染的患者,在缺乏新型β-内酰胺类(BLs)和新型β-内酰胺/β-内酰胺酶抑制剂(BL/BLIs)抗菌药物时,可考虑采用以多黏菌素B为基础的联合治疗方案。Objective To provide an empirical reference for the treatment of patients with carbapenem resistant Enterobacter cloacae(CREC)infection.Methods Clinical pharmacists participated in the anti infection treatment of a patient with septic shock caused by CREC bloodstream infection.By conducting a systematic review of the latest evidence-based medical literature and integrating the patient's pathophysiological characteristics,pharmacokinetic/pharmacodynamic(PK/PD)parameters of antimicrobial agents and the pathogen's resistance profile,the clinical pharmacists applied pharmaceutical expertise to collaborate with the multidisciplinary team in formulating an individualized anti-infective treatment regimen.Additionally,comprehensive pharmaceutical care was provided throughout the treatment course.Results Per the pharmacist's recommendation,the patient was treated by the doctor with a combination of polymyxin B and levofloxacin.The patient's infection was successfully managed,the septic shock was successfully treated,and there were no adverse drug reactions during the prescribed period.Conclusion Clinical pharmacists'assistance in optimizing medication plans is crucial for clinical treatment.In the absence of novelβ-lactams(BLs)andβ-lactam/β-lactamase inhibitors(BL/BLIs),polymyxin B-based combination therapy may be considered for patients infected with CREC producing metallo-β-lactamase(MBL).

关 键 词：耐碳青霉类烯阴沟肠杆菌 金属酶 耐碳青霉烯类肠杆菌 血流感染 多黏菌素B 

分 类 号：R978[医药卫生—药品]