1例围产期菌血症患者的药学监护

Pharmaceutical care on a peripartal patient with bacteremia

1例36岁女性患者,因停经35+6周,阴道流液1 h于2018年11月2日入院。入院后行剖宫产术,由于患者既往青霉素类、头孢类药物试敏阳性,给予克林霉素预防感染(1.2 g,bid,ivgtt)。患者术后出现产褥感染,停用克林霉素,更换为莫西沙星(0.4 g,qd,ivgtt)。11月5日,患者仍有发热,血培养结果:革兰阴性杆菌阳性。补充诊断菌血症。请临床药师会诊,经过详细询问患者病史及近期用药史,临床药师建议尽快拔除导尿管,将莫西沙星调整为注射用美罗培南(1.0 g,q 8 h,ivgtt)。11月8日患者无发热,药敏结果回报为产ESBLs大肠埃希菌,对美罗培南敏感,继续行原治疗方案。经过有效的抗感染治疗,患者后续三次血培养结果均为阴性,病情逐渐好转后出院。

A 36-year-old female patient was admitted to the hospital on November 2 nd,2018 due to menopause for 35+6 weeks and vaginal liquid flowing for 1 hour.After admission,cesarean section was performed.Clindamycin(1.2 g,bid,ivgtt)was given to her for preventing infection because of her positive susceptibility to penicillins and cephalosporins.The patient developed puerperal infection after operation and clindamycin was replaced by moxifloxacin(0.4 g,qd,ivgtt).On November 5 th,the patient still had fever.Results of blood culture showed gram-negative bacilli positive.Bacteremia was diagnosed and the consultation of clinical pharmacist was applied for.After asking detailed medical history and recent medication history,clinical pharmacist suggested removing the catheter as soon as possible and replacing moxifloxacin by meropenem(1.0 g,q 8 h,ivgtt).On November 8 th,the patient had no fever.The result of drug susceptibility was Escherichia coli(ESBLs-positive)which was sensitive to meropenem.The present therapy was continued.After effective anti-infective treatment,subsequent 3 times results of blood culture were negative and the patient was discharged with improved condition.