重症坏死性胰腺炎患者使用头孢他啶/阿维巴坦的案例分析

Case analysis of a severe necrotising pancreatitis patient treated with ceftazidime-avibactam

目的通过分析病例为头孢他啶/阿维巴坦(CAZ/AVI)的临床合理应用提供参考。方法临床药师参与1例碳青霉烯类耐药肺炎克雷伯菌(CRKP)血流感染和复杂腹腔感染的重症坏死性胰腺炎患者的用药分析,对于如何使用CAZ/AVI进行治疗提出相关的药学建议,协助临床医师完善治疗方案。结果与讨论 CAZ/AVI联合用药对CRKP具有良好的抗菌活性和临床效果,安全性高。临床使用前需进行碳青霉烯酶耐药表型、基因鉴定或药敏试验,并且关注在特殊情况下如急性肾损伤、肾替代治疗过程中剂量的应用,密切结合患者病情的变化,以促进CAZ/AVI的临床合理应用。

Objective To provide a reference for reasonable clinical application of ceftazidime-avibactam(CAZ/AVI).Methods The clinical pharmacist participated in the treatment of a severe necrotising pancreatitis patient with CAZ/AVI,who infected with carbapenem-resistant Klebsiella pneumoniae(CRKP)in blood stream and complicated intra-abdominal infections.The clinical pharmacist afforded pharmaceutical related advice about how to optimize use of CAZ/AVI and improve the antimicrobial regimens.Results and Conclusion CAZ/AVI combination therapy showed obvious antibacterial activities and clinical effects against CRKP with high safety.Carbapenenase resistance phenotype,gene identification or drug sensitivity test should be conducted before clinical usage.In addition,the application of dose in special cases such as the patients with acute kidney injury and renal replacement therapy should be focused so as to promote the reasonable clinical application of CAZ/AVI.