临床药师对难治性嗜麦芽窄食单胞菌脓毒血症患儿的药学监护

Pharmaceutical Care for a Child with Refractory Stenotrophomonas maltophilia Sepsis by Clinical Pharmacist

目的:探讨临床药师在儿童难治性嗜麦芽窄食单胞菌脓毒血症治疗中的药学监护,为该病患儿的治疗提供参考。方法:临床药师参与难治性嗜麦芽窄食单胞菌脓毒血症患儿的诊疗过程。根据患儿的病理生理特点及抗菌药物的药动学/药效学特性,临床药师建议抗感染方案调整为头孢哌酮钠舒巴坦钠160 mg/(kg·d),每8 h给药1次+左氧氟沙星10 mg/kg,每12 h给药1次;针对患儿全身炎症反应重的临床表现,临床药师建议加用甲泼尼龙琥珀酸钠1 mg/kg,每12 h给药1次抗炎辅助治疗;同时,临床药师在整个治疗过程中对患儿进行个体化用药监护(包括头孢哌酮钠舒巴坦钠血药浓度监测、不良反应监测以及氧气雾化给药教育等),并对患儿随访1年。结果:医师采纳临床药师的建议。患儿的脓毒血症得以控制,病情好转予以出院;随访中患儿未出现软骨及关节损伤等不良反应。结论:免疫力低下、入住重症监护病房时间长、气管插管、恶性肿瘤等是嗜麦芽窄食单胞菌感染的高危因素。头孢哌酮钠舒巴坦钠的治疗药物监测在儿童重症感染治疗中非常必要,权衡利弊、满足一定条件后,儿童可以使用喹诺酮类抗菌药物抗感染;在有效的抗感染治疗下,小剂量糖皮质激素可减轻脓毒血症患儿全身炎症反应。

OBJECTIVE:To investigate the pharmaceutical care for a child with refractory Stenotrophomonas maltophilia sepsis by clinical pharmacists,and to provide reference for the treatment of children with this disease.METHODS:Clinical pharmacist participated in drug therapy for a child with refractory S.maltophilia sepsis.Based on the pathophysiological characteristics of the child and the PK/PD characteristics of the antimicrobials,clinical pharmacists suggested that the anti-infection regimen should be adjusted as cefoperazone sodium and sulbactam sodium 160 mg/(kg·d),every 8 hours combined with levofloxacin 10 mg/kg,every 12 hours.For clinical manifestations of severe inflammatory reaction,the clinical pharmacist suggested receiving methylprednisolone sodium succinate 1 mg/kg additionally,every 12 hours,for anti-inflammatory adjuvant therapy.At the same time,clinical pharmacist provided individualized pharmaceutical care(including the detection of blood concentration of cefoperazone sodium and sulbactam sodium,the detection of ADR and medication education of oxygen atomization)during the treatment,and followed up the child for one year.RESULTS:The doctors adopted the suggestions of clinical pharmacists.The sepsis was controlled,the child’s condition were improved and then discharged.During the follow-up,the child did not suffered from ADR,such as cartilage and joint injury.CONCLUSIONS:Hypoimmunity,long stay in intensive care unit,endotracheal intubation and malignant tumor are the high risk factors of S.maltophilia infection.The monitoring of therapeutic drugs of cefoperazone sodium and sulbactam sodium is very necessary in the treatment of severe infection in children.After weighing the advantages and disadvantages and meeting certain conditions,children can use quinolones for anti-infection;based on the effective anti-infection treatment,low-dose glucocorticoid can reduce the systemic inflammatory respense in patients with sepsis.