1例股骨头置换术后感染患者的药学监护

Pharmaceutical care on a patient with infection after femoral head replacement

1例59岁男性患者,因左股骨头置换术后肿胀疼痛10 d入院。患者3个月前行左股骨头置换术,近10天来切口部肿胀疼痛,并有脓性液体渗出。入院后行清创术+假体取出旷置术,并行脓液细菌培养。术后经验性给予左氧氟沙星联合万古霉素抗感染。5 d后脓液培养结果示:大肠埃希菌,临床药师根据药敏结果建议改用头孢哌酮钠/舒巴坦钠抗感染,临床采纳。用药10 d后导管尖端细菌培养检出大肠埃希菌,CRP、N均较前明显上升;入院第20天切口分泌物细菌培养结果回报:大肠埃希菌,对头孢哌酮钠/舒巴坦钠中介,临床药师再次会诊时建议改用亚胺培南西司他丁钠抗感染,并行切口清创术。3 d后,患者血常规逐渐恢复正常,病情得到控制。

One 59-year-old male patient was admitted to hospital because of swelling and pain for 10 days after left femoralhead replacement. The patient received left femoral head replacement 3 months ago and had been feeling notch pain for 10 dayswith purulent oozing. The patient underwent debridement and prosthesis extraction indwelling, and took pus for bacteria culture.Levofloxacin and vancomycin were empirically given for anti-infection. Five days later, the results of pus culture showed Escherichiacoli. According to the antibiotic sensitivity test results, the clinical pharmacist advised to give cefoperazone sodium and sulbactamsodium for injection. About 10 days later, Escherichia coli was detected in the catheter tip culture again, while C reactive protein andneutrophil increased significantly. On the 20th day after admission, the bacterial culture of incision secretion still showed Escherichiacoli, intermediary towards cefoperazone sodium and sulbactam sodium. The clinical pharmacist recommended imipenem andcilastatin sodium as well as incision debridement. Three days later, the result of routine blood test gradually returned to normal andthe infection was under control.