多重耐药菌致颅内感染患者的药学监护
摘要
目的总结临床药师对多重耐药克雷伯杆菌引起的颅内感染患者的药学监护的经验。方法临床药师直接参与患者的抗感染治疗,协助医生进行抗菌药选择,确定抗菌药剂量、给药途径等。包括初始治疗方案中加用磷霉素,病原学明确后改用替加环素联合复方磺胺甲唑治疗多重耐药的肺炎克雷伯杆菌,当疗效不佳时采用脑室引流管给药方法,同时监测不良反应。结果医师采纳临床药师的建议,患者病情好转出院。结论临床药师参与临床治疗过程,有助于开展临床合理用药,优化治疗方案,提高治疗效果。
引文
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[21]抗菌药物临床应用指导原则修订工作组.抗菌药物临床应用管理指导原则[M].北京:人民卫生出版社,2015:4.
[22]TAK V,MATHUR P,VARGHESE P,et al.Elizabethkingia meningoseptica:an emerging pathogen causing meningitis in a hospitalized adult trauma patient[J].Indian J Med Microbiol,2013,31(3):293-295.
[23]陈文彬,潘祥林.诊断学[M].7版.北京:人民卫生出版社,2008:332.
[2]汪复,张婴元.实用抗感染治疗学[M].2版.北京:人民卫生出版社,2012:613.
[3]TUNKEL ALLAN R,HARTMAN BARRY J,KAPLAN SH-ELDON L,et al.Practice guidelines for the management of bacterial meningitis[J].Clin Infect Dis,2004,39(9):1267-1284.
[4]朱任媛,张小红,徐春英,等.2011年中国CHINET无菌体液细菌分布和耐药监测[J].中国感染与化疗杂志,2013,13(5):349-356.
[5]徐安,卓超,苏丹虹,等.2005-2014年CHINET克雷伯菌属细菌耐药性监测[J].中国感染与化疗杂志,2016,16(3):267-274.
[6]胡付品,郭燕,朱德妹,等.2016中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[7]TEMKIN E,ADLER A,LERNER A,et al.Carbapenemresistant Enterobacteriaceae:biology,epidemiology,and management[J].Ann N Y Acad Sci,2014,1323(1):22-42.
[8]ZARAKOLU P,ESER O K,ALADAG E,et al.Epidemiology of carbapenem-resistant Klebsiella pneumoniae colonization:a surveillance study at a Turkish university hospital from 2009 to 2013[J].Diagn Microbiol Infect Dis,2016,85(4):466-470.
[9]国家卫计委合理用药专家委员会.耐药革兰阴性菌感染诊疗手册[M].北京:人民卫生出版社,2015:56,84-85.
[10]戴尔宽,史玮,炀刘,等.108株耐碳青霉烯肺炎克雷伯菌的临床分布与耐药基因研究[J].中国抗生素杂志,2017,42(3):218-224.
[11]何雨峰,李宁侠,孟博,等.耐碳青酶烯类肺炎克雷伯菌分布特征及耐药性的临床分析[J].山西医药杂志,2017,46(10):1147-1150.
[12]贺吉童,陶静,倪文涛,等.多黏菌素E联合磷霉素对产碳青霉烯酶肺炎克雷伯菌的体外抗菌活性研究[J].中国药学杂志,2017,52(13):1132-1136.
[13]PONTIKIS K,KARAISKOS I,BASTANI S,et al.Outcomes of critically ill intensive care unit patients treated with fosfomycin for infections due to pandrug-resistant and extensively drug-resistant carbapenemase-producing Gramnegative bacteria[J].Int J Antimicrob Agents,2014,43(1):52-59.
[14]吕吉云,曲芬.多重耐药微生物及防治对策[M].北京:人民卫生出版社,2011:276-277.
[15]JASPAN H B,BROTHERS A W,CAMPBELL A J,et al.Multidrug-resistant Enterococcus faecium meningitis in a toddler:characterization of the organism and successful treatment with intraventricular daptomycin and intravenous tigecycline[J].Pediatr Infect Dis,2010,29(4):379-381.
[16]TUTUNCU E E,KUSCU F,GURBUZ Y,et al.Tigecycline use in two cases with multidrug-resistant acinetobacter baumannii meningitis[J].Int Infect J Dis,2010,14(Suppl3):e224-e226.
[17]WADI J A,AL RUB M A.Multidrug resistant Acinetobacter nosocomial meningitis treated successfully with parenteral tigecycline[J].Ann Saudi Med,2007,27(6):456-458.
[18]WADI J A,SELAWI F.Extended-spectrum beta-lactamase Klebsiella pneumoniae meningitis treated with tigecycline[J].Ann Saudi Med,2009,29(3):239-240.
[19]RODVOLD K A,GOTFRIED M H,CWIK M,et al.Serum,tissue and body fluid concentrations of tigecycline after a single 100 mg dose[J].J Antimicrob Chemother,2006,58(6):1221-1229.
[20]LENGERKE C,HAAP M,MAYER F,et al.Low tigecycline concentrations in the cerebrospinal fluid of a neutropenic patient with inflamed meninges[J].Antimicrob Agents Chemother,2011,55(1):449-450.
[21]抗菌药物临床应用指导原则修订工作组.抗菌药物临床应用管理指导原则[M].北京:人民卫生出版社,2015:4.
[22]TAK V,MATHUR P,VARGHESE P,et al.Elizabethkingia meningoseptica:an emerging pathogen causing meningitis in a hospitalized adult trauma patient[J].Indian J Med Microbiol,2013,31(3):293-295.
[23]陈文彬,潘祥林.诊断学[M].7版.北京:人民卫生出版社,2008:332.