临床药师参与1例严重急性肾功能不全合并MRSA感染的药学实践

Pharmacy Practice of Clinical Pharmacists Participating in a Case of Severe Acute Renal Insufficiency with MRSA Infection

目的:探讨临床药师在严重急性肾功能不全合并耐甲氧西林金黄色葡萄球菌(MRSA)感染患者救治中的作用。方法:临床药师参与1例严重急性肾功能不全合并MRSA感染会诊病例的治疗方案讨论,建议将初始抗感染方案中头孢唑肟剂量减半为2.0 g,ivgtt,2次/日;1周后患者病情未见好转,建议停用头孢唑肟,换用亚胺培南/西司他丁钠0.5 g,q8 h;确认患者感染MRSA后,建议按说明书剂量给予利奈唑胺。结果:医师采纳药师建议,治疗过程中无明显不良反应发生,患者病情得到了有效控制,治愈后出院。结论:临床药师参与药学监护有助于临床合理用药,确保用药安全。

OBJECTIVE：To evaluate the role of clinical pharmacists participating in the medical treatment of severe acute renal insufficiency with MRSA infection. METHODS：Clinical pharmacists participating in the treatment discussing of a case of severe acute renal insufficiency with MRSA infection. Considering the creatinie clearance rate,clinical pharmacists suggested halving the dose of ceftizo-xime sodium in initial anti-infection regimen to 2.0 g,ivgtt,2 times a day. It was not improved after one week.Clinical pharmacists suggested giving imipenem / cilastatin sodium 0.5 g,q8 h instead of ceftizoxime. It was suggested to given linezolid according to the instruction dose after ensuring MRSA injection. RESULTS：Doctors adopted clinical pharmacists’ suggestion. There was no obvious adverse reaction in the treatment process. Patient’s condition was effectively controlled. Patient was cured and discharged from hospital. CONCLUSIONS：The clinical pharmacists’ participating in treatment can provide rational clinical medication and ensure medication safety.