1例基于万古霉素治疗药物监测的新生儿败血症药学监护

Pharmaceutical care on a case of neonatal septicemia based on vancomycin therapeutic drug monitoring

1例24d女性新生儿,因“皮肤苍白、颜面发绀4h”为主诉入院,患儿系第2胎第2产,母孕35周+4d。患儿既往因早产儿(适于胎龄儿)、新生儿湿肺、新生儿肺炎、急性呼吸窘迫综合征入院治疗好转出院,本次入院后诊断为新生儿感染、新生儿贫血、新生儿肺炎、早产儿(适于胎龄儿),给予美罗培南抗感染疗效不佳,血培养为耐甲氧西林金黄色葡萄球菌,改用万古霉素进行抗感染治疗,初期万古霉素治疗效果仍不佳,根据血药浓度结果调整给药剂量后疗效提高,患儿后出现肝功能异常和血药浓度过高,临床药师分析评估患儿用药方案、及时协助医生调整给药方案、积极参与应对肝功能损伤并全程对患儿用药安全进行监测,提高了抗感染治疗的有效性,同时也降低了药物相关不良反应的发生,最终患儿好转出院。

A 24-day female neonate was admitted to the hospital due to pale skin and cyanosis for 4 hours. It was the second birth of its mother pregnant for 35 weeks and 4 days. It had a previous medical history of hospitalized treatment for premature (suitable for gestational age), wet lung of neonate, neonatal pneumonia and acute respiratory distress syndrome. After admission, neonatal infection, neonatal anemia, neonatal pneumonia and premature infants (suitable for gestational age) were diagnosed. The antiinfection effect of meropenem was not good. Blood culture showed methicillin-resistant Staphylococcus aureus. And vancomycin was given to the patient. The initial effect of vancomycin was still not good and improved after dose adjustment. But the patient developed liver injury and had a high blood concentration of vancomycin. Clinical pharmacists analyzed and evaluated the medication plan, assisted the doctor to adjust the medication plan in time, dealed with liver injury and continuously monitored the medication safety throughout the course of the whole treatment, which not only improved the effectiveness of anti-infective treatment, but also reduced the adverse drug reactions. The neonate eventually improved and discharged.