多重耐药鲍曼不动杆菌颅内感染的药学监护

Pharmaceutical care for patients with multidrug-resistant Acinetobacter baumannii meningitis

目的:探讨临床药师参与多重耐药鲍曼不动杆菌(Multidrug-resistant Acinetobacter baumannii,MDRAB)颅内感染的药学监护模式。方法:通过2例MDRAB颅内感染成功治疗案例,结合相关指南和文献报道,综述MDRAB颅内感染的治疗策略,并介绍临床药师协助医师完善治疗方案的过程。结果:MDRAB引起的颅内感染应选择敏感、易透过血脑屏障的抗菌药物联合治疗方案,并尽早去除植入的异物和脑脊液引流管。临床药师可从抗菌药物选择、抗感染治疗疗程等方面作为切入点,为患者开展药学监护。结论:对MDRAB颅内感染患者实施药学监护,可优化抗菌药物治疗方案,并督促医师用足疗程、尽早去除植入的异物和脑脊液引流管,提高MDRAB颅内感染药物治疗的有效性和安全性。

OBJECTIVE To investigate the mode of pharmaceutical care for patients with multidrug resistant（MDR）A.baumannii meningitis.METHODS Combining with related guidelines and pharmaceutical care for two patients with MDR A.baumannii meningitis,treatment strategies were reviewed for patients with MDR A.baumannii meningitis.RESULTS Combination regimens with antibacterial drugs sensitive for MDR A.baumannii and highly variable CSF concentrations were provided.Implants and cerebrospinal fluid drainage shunts were removed as soon as possible.The main points of pharmaceutical care carried out by clinical pharmacists included choice of antibiotics and duration of therapy,etc.CONCLUSION Clinical pharmacists can provide pharmaceutical care for patients with MDR A.baumannii meningitis through optimization of therapy regimen using PK/PD theory,adequate duration of antibiotics and removal of shunts as soon as possible to improve efficacy and safety of drug therapy.