临床药师参与替加环素治疗重症急性胰腺炎继发感染的药学实践

Participation of clinical pharmacists in the tigecycline treatment for secondary infection of severe acute pancreatitis

重症急性胰腺炎(evere acute pancreatitis,SAP)是一种严重且危及生命的疾病,在入院时或72 h内可出现胰腺坏死和器官衰竭,造成早期器官功能衰竭的主要原因是胰腺或胰周坏死组织继发感染,强调早期有效的抗菌药物治疗。然而泛耐药(XDR)细菌的出现已成为有效治疗的障碍,迫使临床医师选用特殊使用级抗菌药物替加环素。临床药师参与1例由泛耐药菌导致SAP继发感染的治疗,根据患者临床症状、体征、实验室检查等临床情况协助医师综合分析替加环素是否可用于胰腺炎的继发感染治疗,并为患者制定个体化抗感染方案及药学监护。医师采纳药师分析及建议,患者感染得到了有效控制。替加环素可用于由耐甲氧西林金黄色葡萄球菌及泛耐药鲍曼不动杆菌所致的急性重症胰腺炎继发感染的治疗,但需注意使用指征并进行胰腺炎相关的体征和实验室检查等药学监护。

Severe acute pancreatitis （SAP） is a life-threatening disease. Pancreatic necrosis and organ failure may occur within 72 hours after hospitalization. The main cause of early organ failure is pancreatic or peripancreatic necrosis, with secondary infections. Early effective antimicrobial therapy is important. However, the emergence of pan-drug resistant （XDR） bacteria has become an obstacle to effective treatment, forcing clinicians to use tigecycline, the specific grade of antimicrobial drug. Clinical pharmacists participated in the treatment of one case of secondary infection caused by pan-resistant bacteria causing SAP. Pharmacists analyzed whether tigecycline might be used for the secondary infection treatment of pancreatitis and discussed antiinfection treatment with doctors. Individualized monitoring was implemented. The pharmacist＇s recommendation was adopted by the physician. The patient＇s infection was effectively controlled. Tigecycline can be used for secondary infection of acute severe pancreatitis caused by methicillin-resistant Staphylococcus aureus and pan-resistant Acinetobacter baumannii, but attention should be paid to the indications of tigecycline. Pharmaceutical care ofpancreatitis-related signs and laboratory tests are necessary.