1例血管内导管相关感染患者的药学监护

Pharmaceutical care for a patient with catheter-related bloodstream infection

目的探讨血管内导管相关感染的药学监护内容。方法通过剖析1例血管内导管相关感染患者的药学监护,探讨如何依据患者病情制定个体化治疗方案、监测万古霉素血药浓度及万古霉素相关肾毒性的防治。结果怀疑血管内导管相关感染时应根据患者病情、导管的重要性、经验治疗的效果决定是否拔除导管并制定下一步诊治方案。病原体明确后,及时根据相关指南选择针对性治疗药物。病情危重的高龄老年患者是发生万古霉素肾毒性的高危人群,应警惕万古霉素相关肾毒性的发生,密切监测万古霉素血清谷浓度以保证疗效、降低肾毒性。结论血管内导管相关感染患者病情复杂,应结合患者病情制定个体化的诊治方案,并对患者进行全程的药学监护,密切监测万古霉素血清谷浓度和肾功能变化,保障患者的用药安全。

Objective To f ind appropriate approaches for clinical pharmacists to carry out pharmaceutical care on patients with intravascular catheter-related infection.Methods Pharmaceutical care of a patient with catheter-related bloodstream infection（CRBSI） was analyzed to explore how to make individual therapeutic schedule,optimize vancomycin therapy with therapeutic drug monitoring（TDM） and the importance of vancomycin-induced nephrotoxicity.Results The individual treatment and the next stage treatment program of CRBSI patients should be based on patients＇ pathogenetic condition,the importance of catheter and the effect of initial empirical treatment.Intravenous antimicrobial treatment should be given to patients according to the specific pathogen isolated.Vancomycin-induced nephrotoxicity often occurred in elderly patients with critical condition.Trough serum vancomycin concentration should be closely monitored for curative effect and precautions of vancomycin-induced nephrotoxicity.Conclusion Patients with CRBSI were often in complex situation.The individual treatment program should be made based on the patient＇s pathogenetic condition.Clinical pharmacist way carry out whole-range pharmaceutic care on them,closely monitor the trough serum vancomycin concentration and renal function,and cooperate with doctors to ensure the safety medication in patients.