临床药师参与胆道手术术后伴腹腔感染的药学会诊
|
摘要
目的:探讨临床药师对胆道手术术后伴腹腔感染患者实施药学监护的切入点和方法,为临床患者术后继发腹腔感染致病菌的综合分析及治疗提供参考。方法:临床药师参与1例胆道手术术后伴腹腔感染患者的治疗全程,了解患者的基础疾病、临床症状、实验室检查结果和用药史,结合腹腔感染的高危因素,分析术后感染致病菌,并协助医师制订个体化治疗方案。结果:通过综合分析,得出该患者腹腔感染的致病菌以铜绿假单胞菌、厌氧菌及肠球菌为主,选用头孢哌酮舒巴坦、奥硝唑及利奈唑胺有效覆盖感染菌,及时控制了感染。结论:临床药师利用药物相关知识和临床经验,参与制订抗感染个体化治疗方案,为临床患者及医务人员提供了有效的药学服务。
OBJECTIVE: To probe into the entry points and methods of pharmaceutical care for patients with abdominal infection after biliary tract surgery by clinical pharmacists, so as to provide references for the comprehensive analysis and treatment of postoperative secondary infections. METHODS: Clinical pharmacists participated in the whole course of treatment on a patient with abdominal infection after biliary tract surgery, learned about the underlying disease, clinical symptoms, laboratory test results and medication history of patients, analyzed the pathogenic bacteria of postoperative infection and assisted clinicians in formulating individualized therapeutic regimen with the combination of high risk factors of abdominal infection. RESULTS: Through comprehensive analysis, it was concluded that the pathogenic bacteria induced abdominal infection were mainly Pseudomonas aeruginosa, anaerobic bacteria and enterococcus, which can be effectively covered by cefoperazone sulbactam, ornidazole and linezolid, so that the infection was controlled in time. CONCLUSION: Clinical pharmacists have applied pharmaceutical knowledge and clinical experience to participate in the formulating of anti-infective individualized therapeutic regimen on providing effective pharmaceutical services for patients and medical staff.
OBJECTIVE: To probe into the entry points and methods of pharmaceutical care for patients with abdominal infection after biliary tract surgery by clinical pharmacists, so as to provide references for the comprehensive analysis and treatment of postoperative secondary infections. METHODS: Clinical pharmacists participated in the whole course of treatment on a patient with abdominal infection after biliary tract surgery, learned about the underlying disease, clinical symptoms, laboratory test results and medication history of patients, analyzed the pathogenic bacteria of postoperative infection and assisted clinicians in formulating individualized therapeutic regimen with the combination of high risk factors of abdominal infection. RESULTS: Through comprehensive analysis, it was concluded that the pathogenic bacteria induced abdominal infection were mainly Pseudomonas aeruginosa, anaerobic bacteria and enterococcus, which can be effectively covered by cefoperazone sulbactam, ornidazole and linezolid, so that the infection was controlled in time. CONCLUSION: Clinical pharmacists have applied pharmaceutical knowledge and clinical experience to participate in the formulating of anti-infective individualized therapeutic regimen on providing effective pharmaceutical services for patients and medical staff.
引文
[1] 李莉霞,张金莲,陈伦.292例术后感染病例药学会诊分析[J].中国药师,2014,17(1):116-119.
[2] 马小波,梁朝霞,徐庆雷,等.血培养污染菌鉴别分析与对策[J].实验与检验医学,2015,3(33):351-352.
[3] 胡红兵,杨劳荣,夏维,等.凝固酶阴性葡萄球菌致新生儿败血症的病原学及体外耐药监测[J].中华医院感染学杂志,2006,16(2):227-228,170.
[4] 杭亚平,汪红,宁长秀,等.血流感染葡萄球菌菌种分布及耐药特性分析[J].中国微生态学杂志,2015,27(2):199-202.
[5] Liu Y,Wan L,Yu Y,et al.Serum procalcitonin for differential diagnosis of blood stream infections caused by coagulasenegative Staphylococcus[J].Chin J Infect Chemother,2013,13(3):185-189.
[6] 王露霞,石凌波,郭振辉,等.血培养污染菌判定的实验室检查[J].热带医学杂志,2015,15(6):744-747,802.
[7] 周颖杰,李光辉.成人及儿童复杂性腹腔内感染的诊断与处理:美国外科感染学会及美国感染病学会指南[J].中国感染与化疗杂志,2010,10(4):241-247.
[8] 陈子晞,王弋.替加环素治疗中铜绿假单胞菌的定植与感染[J].医药导报,2014,33(7):911-913.
[9] 刘芳,周玉宝,王新刚,等.胆道感染病原菌分布与耐药性分析[J].中华医院感染学杂志,2015,25(17):3899-3900,3905.
[10] 史天陆,苏丹,王法财,等.临床药师参与胆道术后伴发多药耐药铜绿假单胞菌感染的药学监护[J].中华医院感染学杂志,2012,22(10):2177-2179.
[11] Sun Y,Cai Y,Liu X,et al.The emergence of clinical resistance to tigecycline[J].Int J Antimicrob Agents,2013,41(2):110-116.
[12] 何清,叶华,钟贵芳,等.替加环素治疗严重腹腔感染的疗效观察[J].中华医院感染学杂志,2014,24(9):2158-2160.
[13] Dizbay M,Tozlu DK,Cirak MY,et al.In vitro synergistic activity of tigecycline and colistin against XDR-Acinetobacter baumannii[J].J Antibiot(Tokyo),2010,63(2):51-53.
[14] 朱德妹,张婴元,周乐,等.利奈唑胺的体外抗菌作用研究[J].中国感染与化疗杂志,2008,8(2):81-88.
[15] 张继兰.注射用头孢哌酮舒巴坦钠致急性溶血1例[J].中国医院药学杂志,2011,31(20):1745.
[16] 倪琳,周海梅.抗菌药物降阶梯疗法的临床应用分析[J].中国医药指南,2013,11(35):97-98.
[17] 孙大勇,孙桂华,赵亚刚,等.部分头孢菌素及喹诺酮类抗生素在胆汁内的代谢特点[J].广东药学院学报,2006,22(3):292-293,296.
[2] 马小波,梁朝霞,徐庆雷,等.血培养污染菌鉴别分析与对策[J].实验与检验医学,2015,3(33):351-352.
[3] 胡红兵,杨劳荣,夏维,等.凝固酶阴性葡萄球菌致新生儿败血症的病原学及体外耐药监测[J].中华医院感染学杂志,2006,16(2):227-228,170.
[4] 杭亚平,汪红,宁长秀,等.血流感染葡萄球菌菌种分布及耐药特性分析[J].中国微生态学杂志,2015,27(2):199-202.
[5] Liu Y,Wan L,Yu Y,et al.Serum procalcitonin for differential diagnosis of blood stream infections caused by coagulasenegative Staphylococcus[J].Chin J Infect Chemother,2013,13(3):185-189.
[6] 王露霞,石凌波,郭振辉,等.血培养污染菌判定的实验室检查[J].热带医学杂志,2015,15(6):744-747,802.
[7] 周颖杰,李光辉.成人及儿童复杂性腹腔内感染的诊断与处理:美国外科感染学会及美国感染病学会指南[J].中国感染与化疗杂志,2010,10(4):241-247.
[8] 陈子晞,王弋.替加环素治疗中铜绿假单胞菌的定植与感染[J].医药导报,2014,33(7):911-913.
[9] 刘芳,周玉宝,王新刚,等.胆道感染病原菌分布与耐药性分析[J].中华医院感染学杂志,2015,25(17):3899-3900,3905.
[10] 史天陆,苏丹,王法财,等.临床药师参与胆道术后伴发多药耐药铜绿假单胞菌感染的药学监护[J].中华医院感染学杂志,2012,22(10):2177-2179.
[11] Sun Y,Cai Y,Liu X,et al.The emergence of clinical resistance to tigecycline[J].Int J Antimicrob Agents,2013,41(2):110-116.
[12] 何清,叶华,钟贵芳,等.替加环素治疗严重腹腔感染的疗效观察[J].中华医院感染学杂志,2014,24(9):2158-2160.
[13] Dizbay M,Tozlu DK,Cirak MY,et al.In vitro synergistic activity of tigecycline and colistin against XDR-Acinetobacter baumannii[J].J Antibiot(Tokyo),2010,63(2):51-53.
[14] 朱德妹,张婴元,周乐,等.利奈唑胺的体外抗菌作用研究[J].中国感染与化疗杂志,2008,8(2):81-88.
[15] 张继兰.注射用头孢哌酮舒巴坦钠致急性溶血1例[J].中国医院药学杂志,2011,31(20):1745.
[16] 倪琳,周海梅.抗菌药物降阶梯疗法的临床应用分析[J].中国医药指南,2013,11(35):97-98.
[17] 孙大勇,孙桂华,赵亚刚,等.部分头孢菌素及喹诺酮类抗生素在胆汁内的代谢特点[J].广东药学院学报,2006,22(3):292-293,296.