1例鹑鸡肠球菌颅内感染患者的药学监护

Pharmaceutical care on a patient with Enterococcus gallinarum-induced intracranial infection

1例35岁男性患者,因脑脊液鼻漏伴发热3个月余入院。患者3个月前行脑膜瘤手术,术后遗留脑脊液鼻漏。术后3个月内间断发热,脑脊液反复培养出鹑鸡肠球菌,院外一直行抗感染治疗且疗效差。入院后给予美罗培南联合去甲万古霉素抗感染治疗1周,效果差,患者持续高热,体温波动在38.5-39.7℃之间,脑脊液鼻漏持续存在,血常规示白细胞呈上升趋势,脑脊液常规检查示白细胞升高,脑脊液生化检查示蛋白高。临床药师会诊提出联合治疗方案：给予氨苄西林钠（4 g,q 6 h）;奥硝唑（0.5 g,q 12 h）;硫酸庆大霉素24 wu,持续泵入;联合治疗3-11 d后,患者感染得到有效控制。治疗17 d后,患者痊愈出院。同时药师对治疗方案中抗菌药物的选择、用法用量、滴注速度、疗程及药品不良反应等进行药学监护,为医师和护士提供药学建议,保障患者用药安全、有效。

A 35-year-old male patient was admitted to hospital mainly because of cerebrospinal fluid（CSF） rhinorrhea accompanied by fever for 3 months. The patient suffered a meningioma surgery 3 months ago and developed CSF rhinorrhea after surgery. And then, the patient got intermittent fever for 3 months and Enterococcus gallinarum was showed in the culture of CSF repeatedly. The effect of anti-infective therapy was poor. After admission, meropenem and vancomycin were given to the patient for 1 week. But the fever and CSF rhinorrhea was continued. His body temperature fluctuated from 38.5 ℃ to 39.7 ℃. The white blood cells in blood and CSF were higher as well as the protein in CSF. The continuous infusion of ampicillin sodium（4 g, q 6 h）, ornidazole（0.5 g, q 12 h） and gentamicin sulfate 240 000 units were given to him after clinical pharmacist consultation. The patient improved 3 – 11 days later and was discharged 17 days later. During the whole treatment, pharmacists performed pharmaceutical care in antibiotics selection, drug dosage, infusion rate and adverse drug reactions, thus to ensure medication safety and effective.