临床药师对1例400 g超早产儿抗感染治疗的用药分析

Analysis of Drug Use of Anti-infective Treatment for a 400 g Super-premature Infant by Clinical Pharmacists

目的:优化超早产儿抗感染治疗方案,为临床救治超早产儿及开展全程药学监护提供参考。方法:湖南省妇幼保健院新生儿二科接生了1例胎龄25+5周、体质量400 g的超早产儿。该患儿并发症复杂,临床药师与相关医护人员以及医院感染科人员组成多学科治疗团队,以《新生儿败血症诊疗方案》《抗微生物治疗指南》《早产儿医学》等为依据,结合患儿各项实验室感染指标、生化指标、生命体征等进行分析,为患儿制定个体化抗感染诊疗方案。患儿入重症监护室后,首先给予注射用哌拉西林钠舒巴坦钠(100 mg/kg,静脉滴注,q12 h)进行抗感染治疗;考虑到患儿有败血症可能,临床药师建议停用注射用哌拉西林钠舒巴坦钠,改用注射用美罗培南(40 mg/kg,静脉滴注,q12 h);美罗培南用药7 d后,临床药师建议加用抗真菌药氟康唑注射液(5.0 mg/kg,静脉滴注,qod);美罗培南用药11 d,为避免感染加重,根据患儿药敏结果(对注射用替卡西林钠克拉维酸钾敏感),临床药师建议加用注射用替卡西林钠克拉维酸钾(75 mg/kg,静脉滴注,q8 h)进行联合抗感染治疗,同时进行医院感染处理;在感染指标平稳后,停用所有抗菌药物;后期出现大肠埃希菌感染时,临床药师建议使用注射用哌拉西林他唑巴坦钠(75 mg/kg,静脉滴注,q8 h);在感染加重后,停注射用哌拉西林他唑巴坦钠,改用注射用亚胺培南西司他丁钠(20 mg/kg,静脉滴注,q8 h);在感染指标下降后及时降阶梯治疗,使用注射用头孢他啶(50 mg/kg,静脉滴注,q12 h)。结果:医师采纳上述建议。患儿经治疗后,转归良好,生命体征平稳,出院时体质量已达3 000 g。结论:早产儿为特殊人群,在使用抗菌药物治疗前,临床药师应重点关注患儿的生命体征、感染指标及各项实验室检查结果,协助医师完善治疗方案,保障其用药的有效性和安全性。

OBJECTIVE:To optimize the anti-infective treatment plan for the super-premature infants and provide reference for the clinical treatment of the super-premature infants and the whole pharmaceutical care.METHODS:A super-premature infant with gestational age of 25+5 weeks and weight of 400 g was delivered in the second department of neonatology in Hunan Maternal and Child Health Hospital.This child suffered from complex complications.Clinical pharmacists,relevant medical staff and hospital infection department personnel formed a multidisciplinary treatment team.According to Neonatal Sepsis Treatment Scheme,Antimicrobial Treatment Guide,Premature Medicine,combining with the analysis of infection indicators,biochemical indicators,vital signs and other indicators,a individualized anti-infective diagnosis and treatment plan was developed for the child.After entering the NICU,this child was given Piperacillin sodium and sulbactam sodium for injection(100 mg/kg,ivgtt,q12 h)for antiinfective treatment;considering the possibility of sepsis,clinical pharmacists suggested that Piperacillin sodium and sulbactam sodium for injection should be stopped and Meropenem for injection(40 mg/kg,ivgtt,q12 h)should be used instead.After 7 day of meropenem treatment,clinical pharmacists suggested adding antifungal Fluconazole injection(5.0 mg/kg,ivgtt,qod).After 11 days of meropenem treatment,in order to avoid the aggravation of infection,according to the drug sensitivity results(sensitive to Ticarcillin sodium and clavulanate potassium for injection),clinical pharmacists suggested adding Ticarcillin sodium and clavulanate potassium for injection(75 mg/kg,ivgtt,q8 h)for combined anti-infective treatment,and hospital infection treatment was carried out at the same time.After the infection index was stable,all antibiotics were stopped.When E.coli infection occurred later,clinical pharmacists suggested that Piperacillin tazobactam sodium for injection(75 mg/kg,ivgtt,q8 h)should be used.After the infection aggravated,Piperacillin tazobactam sodium for injection was stopped and Imipenem cilastatin sodium for injection(20 mg/kg,ivgtt,q8 h)was used instead.The child received ladder treatment after the decline of infection index,and Ceftazidime for injection(50 mg/kg,ivgtt,q12 h)was used.RESULTS:The doctors adopted the above suggestions.After treatment,the prognosis of the child was good,the vital signs were stable,and the body weight reached 3000 g at discharge.CONCLUSIONS:For preterm infants as special group,before using antibiotics,clinical pharmacists should focus on the vital signs,infection indicators and laboratory test results of the child,so as to help doctors improve the treatment plan and ensure the effectiveness and safety of their medication.