临床药师参与1例泛耐药鲍蔓不动杆菌感染的治疗体会

Experiences in the Treatment Clinical Pharmacist Gave of Pandrug-resistant Acinetobacter Baumannii Infection of 1 Case

目的:临床药师参与泛耐药鲍蔓不动杆菌(PDR-Ab)的治疗,制定泛耐药鲍蔓不动杆菌的治疗方案。方法:1例43岁的女性患者,入院诊断为"重症肌无力",因呼吸困难从神经内科转入重症监护病房(ICU),住院13天后,血培养提示:鲍蔓不动杆菌对临床检测的抗菌药物均耐药。其中之一敏感是多粘菌素B,但因有神经阻滞作用,禁用于重症肌无力患者。停用所有的西药抗生素,将治疗重点转向中成药的抗生素以及按中医理论扶正固本、祛邪。使用免疫功能增强剂,参芪扶正注射液,静注人免球蛋白等免疫支持疗法。结果:患者使用糖皮质激素治疗重症肌无力,使用中药抗生素血必净注射液抗感染,参芪扶正注射液,静注人免球蛋白等免疫支持治疗肺部感染3天后基本控制,10天后好转。结论:对泛耐药鲍蔓不动杆菌感染时,应用中成药抗生素以及扶正固本、祛邪等免疫支持疗法,不失为一种可以尝试的治疗方案。

Objective：Clinical pharmacist took part in the treatment of one myasthenia gravis’ patient complicating with Pandrug-resistant Acinetobacter baumannii infection and work out the therapeutic regimen.Methods：：A 43-year-old woman,with a hospital diagnostic of myasthenia gravis,was transferred to ICU from Department of Neurology owing to dyspne.She was in hospital 13 days later and the blood culture showed infection of Pandrug-resistant Acinetobacter baumannii to all clinical detected antibiotics.Although it was sensitive drug,polymyxin B was contraindicated in myasthenia gravis due to its nerve blocking properties.According to clinical pharmacist’s opinion,all western medicine antibiotics were stopped and therapeutical emphasis was shifted to application of Chinese patent medicine antibiotics,supporting healthy energy and dispeling pathogenic according to Traditional Chinese Medicine’s theory.Her immune system was supported by applications of the body’s immune function enhancer,i.e.shen qi fu zheng parenteral solution.Results：Lung infection was basically controlled in three days after the application of glucocorticoid to myasthenia gravis,andrographolidume injection to infection,and shen qi fu zheng parenteral solution to enhance immune function.Her condition was improved in the next 10 days.Conclusion：Application of Chinese patent medicine antibiotics and measures to enhance immune function such as supporting healthy energy and dispeling pathogenic might be good ways to be tried in the treatment of Pandrug-resistant Acinetobacter baumannii infection.