临床药师参与1例复杂胆道感染患者的个体化抗感染治疗实践

Pharmaceutical practice of clinical pharmacist's in individual anti-infection treatment for complicated biliary tract surgery

目的探讨临床药师在肝内外胆管结石伴胆道感染患者抗感染治疗中的作用。方法临床药师参与1例胆道术后感染患者的治疗过程,根据患者血常规、血生化、体温、血培养及病原菌特点等病情变化协助临床医师调整抗感染治疗方案,先后提出经验性胆道感染的药物选择、针对合并胆道感染和肺部感染换用左氧氟沙星、根据血培养及胆汁培养结果分析污染菌及致病菌、抗木糖氧化产碱杆菌的药物选择等,治疗过程中密切观察药物治疗效果和药品不良反应,并对患者进行用药教育。结果临床医师部分采纳临床药师建议,患者病情好转,治疗22 d后痊愈出院。结论临床药师参与临床治疗,为患者提供药学服务,结合患者个体化病情,通过解读细菌培养结果制定抗感染治疗方案,对复杂性胆道感染的治疗可发挥重要作用。

Objective To explore the role of clinical pharmacists participating in anti-infective treatment for a patient with intra-and ex-trahepatic bile duct stone accompanying infection of biliary tract. Methods Clinical pharmacists participated in the treatment process of one patient with intra-and extrahepatic bile duct stone accompanying infection of biliary tract,assisted physicians to adjust antibiotics therapy plan according to the blood routine examination,blood biochemical examination,body temperature,blood culture and character-istics of pathogenic bacteria of the patient,and given several suggestions as the drug selection for empirical biliary tract infections,re-placement levofloxacin for biliary tract infection complicated with pulmonary infection. The pathogenic bacterium or contamination bacte-rium based on the result of blood culture and bacterial culture were identified. Therapeutic efficacy and ADR should be observed closely during treatment,and medication education should be performed for the patient. Results Physicians adopted the suggestions of clinical pharmacists. The patient was improved and discharged from hospital with drugs 22 days later. Conclusions The clinical pharmacists involving in clinical treatment,provide pharmaceutical service play an important role in the treatment of complex biliary tract infection by interpreting the result of bacterial culture and developing anti-infective therapy in combination with patient individual condition.