临床药师参与耐药诺卡菌及尖端赛多孢菌肺部感染的药学实践
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摘要
临床药师参与了1例耐药诺卡菌及罕见尖端赛多孢菌肺部感染病例的药物治疗过程,通过查阅多方循证证据提出首选大剂量磺胺联合亚胺培南覆盖耐药诺卡菌,并进行药学监护及用药教育。其后患者再发肺部尖端赛多孢菌感染,临床药师再次会诊并予以用药建议并药学监护。其后患者病情好转出院。临床药师在临床发挥了主观能动性,在临床耐药菌、罕见真菌感染的个体化治疗及合理用药中体现其作用,协助医师制订和优化药物治疗方案,保证了用药的安全、有效。
Clinical pharmacists participated in the drug treatment process for drug-resistant nocardia combined with rare Scedosporium apiospermum lung infection. By reviewing literature, clinical pharmacists advised the use of high-dose sulfonamides in combination with imipenem to kill nocardia, at the same time, conducting pharmaceutical care and ADR monitoring. The lungs of the patient re-infected with Scedosporium apiospermum,and the clinical pharmacists were consulted again and recommended medication and pharmacological monitoring.Physicians adopted clinical pharmacists' suggestions. The patient's condition was improved and was discharged.Clinical pharmacists demonstrated their useful roles in individualized treatment of clinical drug-resistant bacteria and rare fungal infections, and rational drug use to assist physicians in formulating and optimizing drug treatment programs to ensure the safety and effectiveness of drug use.
Clinical pharmacists participated in the drug treatment process for drug-resistant nocardia combined with rare Scedosporium apiospermum lung infection. By reviewing literature, clinical pharmacists advised the use of high-dose sulfonamides in combination with imipenem to kill nocardia, at the same time, conducting pharmaceutical care and ADR monitoring. The lungs of the patient re-infected with Scedosporium apiospermum,and the clinical pharmacists were consulted again and recommended medication and pharmacological monitoring.Physicians adopted clinical pharmacists' suggestions. The patient's condition was improved and was discharged.Clinical pharmacists demonstrated their useful roles in individualized treatment of clinical drug-resistant bacteria and rare fungal infections, and rational drug use to assist physicians in formulating and optimizing drug treatment programs to ensure the safety and effectiveness of drug use.
引文
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[10]Rahman FU,Irfan M,Fasih N,et al. Pulmonary scedosporiosis mimicking aspergilloma in an immunocompetent host:a case report and review of the literature[J]. Infection,2016,DOI:10.1007/s15010-015-0840-4.
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[13]Gregory AL,Georgios C,Russell E,et al. Scedosporium infection in a tertiary care cancer center:a review of 25cases from 1989-2006[J]. Clinic Infect Dis,2006,43(12):1580-1584.
[14]HolleJ,LeichsenringM,MeissnerPE.Nebulized voriconazole in infections with Scedosporium apiospermum——Case report and review of the literature[J]. J Cystic Fibrosis,2014,11(13):400-402.
[15]Box H. Pharmacodynamics of voriconazole for invasive Pulmonary Scedosporiosis[J]. Antimicrob Agents Chemother,2018,62(5):e02516-e02517.
[2]Martínez Tomás R,Menéndez Villanueva R,Reyes Calzada S,et al. Pulmonary nocardiosis:risk factors and outcomes[J]. Respirology,2014,34(10):837-839.
[3]Khare V,Gupta P,Himanshu D,et al. Emergence of co-trimoxazole resistant Nocardia brasiliensis causing fatal pneumonia[J]. BMJ Case Rep,2013,DOI:10.1136/bcr-2013-009069.
[4]Gilbert DN,Chambers HF,George ME,et al.桑福德抗微生物治疗指南(新译46版)[M].北京:中国协和医科大学出版社,2017:70.
[5]Valdezate S,Garrido N,Carrasco G,et al. Epidemiology and susceptibility to antimicrobial agents of the main Nocardia species in Spain[J]. Antimicrob Chemother,2017,72(2):754-761.
[6]McTaggart LR,Doucet J,Witkowska M,et al. Antimicrobial susceptibility among clinical Nocardia species identified by multilocus sequence analysis[J]. Antimicrob Agents Chemother,2015,1(59):269-275.
[7]Panackal AA,Marr KA. Scedosporium/Pseudallescheria infections[J]. Semin Respir Crit Care Med,2004,11(25):171-181.
[8]HorréR,Jovani?B,Marklein G,et al. Fatal pulmonary scedosporiosis[J]. Mycoses,2003,7(46):418-420.
[9]Serda KA,Sybren DHG,Guarro J. Clinical characteristics and epidemiology of pulmonary pseudallescheriasis[J].Rev Iberoam Micol,2012,29(1):1-13.
[10]Rahman FU,Irfan M,Fasih N,et al. Pulmonary scedosporiosis mimicking aspergilloma in an immunocompetent host:a case report and review of the literature[J]. Infection,2016,DOI:10.1007/s15010-015-0840-4.
[11]Tortorano AM. ESCMID and ECMM joint guidelines on diagnosis and management of hyalohyphomycosis:Fusarium spp.,Scedosporium spp. and others[J]. Clinic Microbiol Infect,2014,20(3):27-46.
[12]Troke P,Aguirrebengoa K,Arteaga C,et al. Treatment of Scedosporiosis with voriconazole:clinical experience with 107 patients[J]. Antimicrob Agents Chemother,2008,52(5):1743-1750.
[13]Gregory AL,Georgios C,Russell E,et al. Scedosporium infection in a tertiary care cancer center:a review of 25cases from 1989-2006[J]. Clinic Infect Dis,2006,43(12):1580-1584.
[14]HolleJ,LeichsenringM,MeissnerPE.Nebulized voriconazole in infections with Scedosporium apiospermum——Case report and review of the literature[J]. J Cystic Fibrosis,2014,11(13):400-402.
[15]Box H. Pharmacodynamics of voriconazole for invasive Pulmonary Scedosporiosis[J]. Antimicrob Agents Chemother,2018,62(5):e02516-e02517.