头孢他啶联合阿米卡星对铜绿假单胞菌感染的药学干预分析
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摘要
目的探讨对铜绿假单胞菌(PA)感染患者行药学干预的临床疗效及安全性。方法选取医院2015年8月至2017年5月收治的PA感染患者84例,依据初始给药方案有无优化(采用头孢他啶联合阿米卡星治疗少于3次/日)来确定是否进行干预,观察组(44例)为已经优化或接受干预患者,对照组(40例)为拒绝干预患者;记录两组患者治疗前的临床资料及病情分布情况。结果观察组患者的疗程、住院时间、体温恢复时间均短于对照组,治疗好转例数及细菌清除率均高于对照组(P<0.05);治疗3 d后,两组患者白细胞(WBC)、中性粒细胞(NEUT)恢复正常比例差异无统计学意义(P>0.05),治疗7 d后,观察组患者WBC和NEUT恢复正常比例高于对照组(P<0.05);治疗过程中,观察组有1例、对照组有2例患者因使用头孢哌酮舒巴坦而出现轻度过敏反应,临床表现为全身性皮疹,及时停药并进行抗过敏治疗后均明显好转。结论对PA感染患者进行给药方案干预,可明显提升临床疗效,且安全性较好,值得临床推广。
Objective To investigate the clinical efficacy and safety of pharmaceutical intervention on Pseudomonas aeruginosa(PA)infection.Methods Totally 84 patients with PA infection admitted to our hospital from August 2015 to May 2017 were selected,whether the intervention was played or not according to whether the initial dosing regimen was optimized or not(with ceftazidime combined with amikacin therapy less than 3 times/day).The observation group(44 cases) had been optimized or accepted the intervention,and the control group(40 cases) was refused intervention.The clinical data and the distribution of the disease before and after treatment were recorded in the two groups.Results The course of treatment,hospitalization time and recovery time of body temperature of the observation group were lower than those of the control group,and the cases of improved patients and bacterial clearance rate were higher than those of the control group(P < 0.05).After 3 d of treatment,the proportion of WBC and NEUT returned to normal in the two groups was not statistically significant(P > 0.05).After 7 d of treatment,the proportion of WBC and NEUT returned to normal in the observation group was higher than that in the control group(P < 0.05).In the treatment,there were 1 case with mild allergic reactions due to the use of cefoperazone sulbactam in the observation group,and 2 cases in the control group,the clinical manifestation was systemic rash,and the symptoms were obviously improved after the drug withdrawal and giving anti-allergy treatment in time.Conclusion The intervention of PA infection can significantly improve the clinical efficacy,and has good safety,which is worthy of clinical promotion.
Objective To investigate the clinical efficacy and safety of pharmaceutical intervention on Pseudomonas aeruginosa(PA)infection.Methods Totally 84 patients with PA infection admitted to our hospital from August 2015 to May 2017 were selected,whether the intervention was played or not according to whether the initial dosing regimen was optimized or not(with ceftazidime combined with amikacin therapy less than 3 times/day).The observation group(44 cases) had been optimized or accepted the intervention,and the control group(40 cases) was refused intervention.The clinical data and the distribution of the disease before and after treatment were recorded in the two groups.Results The course of treatment,hospitalization time and recovery time of body temperature of the observation group were lower than those of the control group,and the cases of improved patients and bacterial clearance rate were higher than those of the control group(P < 0.05).After 3 d of treatment,the proportion of WBC and NEUT returned to normal in the two groups was not statistically significant(P > 0.05).After 7 d of treatment,the proportion of WBC and NEUT returned to normal in the observation group was higher than that in the control group(P < 0.05).In the treatment,there were 1 case with mild allergic reactions due to the use of cefoperazone sulbactam in the observation group,and 2 cases in the control group,the clinical manifestation was systemic rash,and the symptoms were obviously improved after the drug withdrawal and giving anti-allergy treatment in time.Conclusion The intervention of PA infection can significantly improve the clinical efficacy,and has good safety,which is worthy of clinical promotion.
引文
[1]石建,杭永付,高杰,等.老年人铜绿假单胞菌感染中比阿培南给药方案的优化[J].中国医院药学杂志,2017,37(2):161-163.
[2]李怡,宋香清,桂万弟.T>MIC%指导优化的哌拉西林/他唑巴坦抗菌方案对59例铜绿假单胞菌感染患者的临床观察[J].药学实践杂志,2017,35(3):262-266.
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[5]池慧琼.基于决策树模型的耐多药铜绿假单胞菌感染治疗的成本效果分析[J].海峡药学,2017,29(4):234-237.
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[7]符珏.药动学/药效学预测参数的定量分析在评价与优化哌拉西林钠舒巴坦钠抗铜绿假单胞菌感染方案中的作用[J].中国药房,2016,27(6):777-780.
[8]姚欣凯,李苌清,吴亚陵,等.应用PK/PD模型和蒙特卡洛模拟优化ICU中铜绿假单胞菌感染的初始给药方案[J].中国药房,2015,26(8):1060-1063.
[9]Cotrina-Luque J,Gil-Navarro MV,Acosta-García H,et al.Continuous versus intermittent piperacillin/tazobactam infusion in infection due to or suspected pseudomonas aeruginosa[J].International Journal of Clinical Pharmacy,2015,38(1):1-10.
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[11]彭从逸.我院铜绿假单胞菌的临床分布及耐药性分析[J].海峡药学,2016,28(11):222-225.
[12]Sahota JS,Smith CM,Radhakrishnan P,et al.Bacteriophage Delivery by Nebulization and Efficacy Against Phenotypically Diverse Pseudomonas aeruginosa from Cystic Fibrosis Patients[J].J Aerosol Med Pulm Drug Deliv,2015,28(5):353-360.
[13]陈芳辉.临床药师参与慢性肾衰竭合并多重耐药铜绿假单胞菌感染的药学实践[J].今日药学,2016,83(9):669-671.
[14]张伟,李擎擎.药学干预对临床合理应用喹诺酮类药物的效果评估[J].安徽医学,2015,12(3):301-303.
[15]吴柳婷,黄艳芳,罗洁丽.1例多重耐药铜绿假单胞菌椎间隙感染患者的药学监护[J].中国药师,2017,20(4):694-696.
[2]李怡,宋香清,桂万弟.T>MIC%指导优化的哌拉西林/他唑巴坦抗菌方案对59例铜绿假单胞菌感染患者的临床观察[J].药学实践杂志,2017,35(3):262-266.
[3]Somayaji R,Parkins MD.Tobramycin inhalation powder:an efficient and efficacious therapy for the treatment of Pseudomonas aeruginosa infection in cystic fibrosis[J].Therapeutic Delivery,2015,6(2):121-137.
[4]杨虹.铜绿假单胞菌感染患者治疗方案的优化与药学干预研究[D].太原:山西医科大学,2016.
[5]池慧琼.基于决策树模型的耐多药铜绿假单胞菌感染治疗的成本效果分析[J].海峡药学,2017,29(4):234-237.
[6]Abdul-Aziz MH,Lipman J,Mouton JW,et al.Applying pharmacokinetic/pharmacodynamic principles in critically ill patients:optimizing efficacy and reducing resistance development[J].Seminars in Respiratory Critical Care Medicine,2015,36(1):136-139.
[7]符珏.药动学/药效学预测参数的定量分析在评价与优化哌拉西林钠舒巴坦钠抗铜绿假单胞菌感染方案中的作用[J].中国药房,2016,27(6):777-780.
[8]姚欣凯,李苌清,吴亚陵,等.应用PK/PD模型和蒙特卡洛模拟优化ICU中铜绿假单胞菌感染的初始给药方案[J].中国药房,2015,26(8):1060-1063.
[9]Cotrina-Luque J,Gil-Navarro MV,Acosta-García H,et al.Continuous versus intermittent piperacillin/tazobactam infusion in infection due to or suspected pseudomonas aeruginosa[J].International Journal of Clinical Pharmacy,2015,38(1):1-10.
[10]王仙,徐传新.铜绿假单胞菌致肺部感染合并血液感染患者的药学监护[J].医药导报,2017,36(2):220-222.
[11]彭从逸.我院铜绿假单胞菌的临床分布及耐药性分析[J].海峡药学,2016,28(11):222-225.
[12]Sahota JS,Smith CM,Radhakrishnan P,et al.Bacteriophage Delivery by Nebulization and Efficacy Against Phenotypically Diverse Pseudomonas aeruginosa from Cystic Fibrosis Patients[J].J Aerosol Med Pulm Drug Deliv,2015,28(5):353-360.
[13]陈芳辉.临床药师参与慢性肾衰竭合并多重耐药铜绿假单胞菌感染的药学实践[J].今日药学,2016,83(9):669-671.
[14]张伟,李擎擎.药学干预对临床合理应用喹诺酮类药物的效果评估[J].安徽医学,2015,12(3):301-303.
[15]吴柳婷,黄艳芳,罗洁丽.1例多重耐药铜绿假单胞菌椎间隙感染患者的药学监护[J].中国药师,2017,20(4):694-696.