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1例产超广谱β-内酰胺酶肺炎克雷伯菌重症肺炎患者的药学监护
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| 篇名： | 1例产超广谱β-内酰胺酶肺炎克雷伯菌重症肺炎患者的药学监护 |
| TITLE： | |
| 摘要： | 目的：探讨临床药师在重症肺炎患者用药中的作用。方法：临床药师参与1例产超广谱β-内酰胺酶（ESBLs）肺炎克雷伯菌重症肺炎患者的治疗过程。初始用药方案为头孢哌酮他唑巴坦、莫西沙星联合更昔洛韦，临床药师根据患者血象感染指标升高建议停用头孢哌酮他唑巴坦和莫西沙星，加用美罗培南；根据患者痰培养结果回报建议停用更昔洛韦，继续使用美罗培南；根据患者临床症状改善情况，建议对产ESBLs肺炎克雷伯菌需给予头孢哌酮舒巴坦降阶梯序贯治疗，并建议停用头孢哌酮舒巴坦和阿奇霉素。结果：医师采纳临床药师建议。经治疗后，患者体温、实验室指标恢复正常，痰培养结果转阴，胸部CT提示感染灶较前明显吸收，患者出院后经回访发现其预后良好。结论：临床药师通过积极参与患者的药物治疗实践，结合实验室指标及痰培结果，为患者提供药学监护，调整用药方案，提高了对重症肺炎患者的救治率及药物治疗的安全性和有效性，同时对促进抗菌药物的合理使用具有重要意义。 |
| ABSTRACT： | OBJECTIVE： To probe the role of clinical pharmacists in drug use of patients with severe pneumonia. METHODS： Clinical pharmacists participated in the treatment for a patient with ESBLs producing Klebsiella pneumoniae severe pneumonia. The patient was given cefoperazone tazobactam combined with moxifloxacin and ganciclovir initially. Clinical pharmacists suggested stopping cefoperazone tazobactam and moxifloxacin and additionally using meropenem according to the elevation of hemogram infection indexes； suggested stopping ganciclovir and continuously using meropenem according to the results of sputum culture； suggested providing cefoperazone sulbactam de-escalation sequential therapy for ESBLs producing Klebsiella pneumoniae and stopping cefoperazone sulbactam and azithromycin according to clinical symptoms of the patient. RESULTS： The physicians adopted the suggestions of clinical pharmacists. After treatment， body temperature and lab indexes of the patient recovered to normal； the result of sputum culture turned to negative. Chest CT showed that the infection focus was obviously absorbed compared to before. After discharged from hospital and followed up， the patient was found to have a good prognosis. CONCLUSIONS： Through actively participating in drug therapy， based on lab indexes and results of sputum culture， clinical pharmacists provide pharmaceutical care and adjust medication plan to improve treatment rate of patients with severe pneumonia and the safety and effectiveness of drug treatment， be of great significance to promote the rational use of antibiotics. |
| 期刊： | 2018年第29卷第3期 |
| 作者： | 孙琼华，吕亚青，郑文灿 |
| AUTHORS： | SUN Qionghua，LYU Yaqing，ZHENG Wencan |
| 关键字： | 产超广谱β-内酰胺酶；肺炎克雷伯菌；重症肺炎；临床药师；药学监护 |
| KEYWORDS： | ESBLs producing； Klebsiella pneumoniae； Severe pneumonia； Clinical pharmacist； Pharmaceutical care |
| 阅读数： | 371 次 |
| 本月下载数： | 18 次 |
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