万古霉素致患儿发热性中性粒细胞减少案例分析

Case analysis of vancomycin-induced febrile neutropenia in a child

1例10岁女性患儿因弥漫性胶质瘤行颅内占位性病变切除术,术后第13日患儿出现高热,明确诊断为中枢感染,给予美罗培南联合万古霉素静脉滴注,4 d后患儿体温恢复至正常,中枢感染逐步控制。术后第22日患儿再次出现发热伴中性粒细胞减少。临床药师会诊考虑为药物导致发热性中性粒细胞减少,建议先后停用万古霉素及美罗培南,停用万古霉素48 h后患儿体温恢复正常,3 d后复查血常规,白细胞计数恢复正常,患儿好转出院,1个月后随访患儿情况良好。

A 10-year-old female child suffered from diffuse glioma had a fever on the 13th day after resection of intracranial space-occupying lesions.The patient was clearly diagnosed with central infection,and was given intravenous infusion of meropenem combined with vancomycin.Four days later,the temperature was restored to normal,and the central infection was gradually controlled.While the fever with neutropenia occurred again on the 22th day after operation.Clinical pharmacists considered the febrile neutropenia induced by drug,and recommended to stop vancomycin and meropenem successively.The temperature of the patient returned to normal after 48 hours of withdrawal vancomycin.Blood routine examination was conducted three days later,and the white blood cell count returned to normal.The child was discharged after improvement,and the patient was followed up in good condition 1 month later.