摘要
1例62岁女性患者,因“咳痰、喘憋1个月余,发热10 d”入院,诊断为重症肺炎、呼吸衰竭等,入院后给予气管插管辅助通气、亚胺培南西司他丁联合左氧氟沙星抗感染治疗,后因支气管肺泡灌洗液(BALF)细菌培养、肺部组织培养及二代测序(NGS)结果均提示纹带棒状杆菌,故加用万古霉素(1 g,q 12 h),期间2次行血药浓度监测提示谷浓度未达标,抗感染效果不理想。临床药师细致分析万古霉素谷浓度不达标的原因,并提出两种优化的治疗方案,即万古霉素由静脉滴注改为持续静脉泵入或换用利奈唑胺。临床医师采纳意见,给予患者利奈唑胺(600 mg,q 12 h),9 d后感染得到控制,同时患者发生重度血小板(PLT)减少,临床药师建议停用利奈唑胺并给予对症支持治疗,8 d后患者PLT恢复正常,病情稳定转入普通病房。
One 62-year-old female patient was admitted to the hospital mainly due to expectoration and dyspnea for more than one month and fever for ten days.The patient was diagnosed as severe pneumonia and respiratory failure,etc.After admission,tracheal intubation was given to her for assisting ventilation and imipenem-cilastatin sodium combined with levofloxacin were given to her for anti-infection.And then vancomycin(1 g,q 12 h)was added because the results of bacterial culture of bronchoalveolar lavage fluid(BALF),lung tissue culture and the next-generation sequencing(NGS)all showed Corynebacterium striatum.But the effect of anti-infection was poor and two results of therapeutic drug monitoring all showed that the concentration of vancomycin was below the standard.Clinical pharmacists carefully analyzed the reason of low concentration of vancomycin and suggested using vancomycin with continuous venous pumping or replacing vancomycin with linezolid in order to optimize anti-infection regimen.So linezolid(600 mg,q 12 h)was given to her by physicians and the infection was controlled 9 days later.But the patient developed severe thrombocytopenia during the period of treatment.And then linezolid was stopped and the symptomatic supportive treatment was given to the patient suggested by clinical pharmacist.The count of platelets returned to normal 8 days later and the patient was transferred to the general ward with the stable condition.
作者
刘一鸣
侯继秋
郭冬杰
LIU Yi-ming;HOU Ji-qiu;GUO Dong-jie(Department of Pharmacy,the Second Hospital of JiLin University,Changchun 130041,China;Department of Pharmacy,China-Japan Friendship Hospital,Beijing 100031,China)
出处
《中国药物应用与监测》
CAS
2020年第4期238-242,共5页
Chinese Journal of Drug Application and Monitoring
关键词
临床药师
纹带棒状杆菌
肺部感染
药学监护
Clinical pharmacist
Corynebacterium striatum
Pulmonary infection
Pharmaceutical care
