临床药师对1例盖尔森基兴奴卡菌致颅内感染患者抗感染治疗的用药分析

Drug Use Analysis of Anti-infective Treatment for a Patient with Nocardia Cyriacigeorgica Caused Intracranial Infection by Clinical Pharmacists

临床药师对1例盖尔森基兴奴卡菌致颅内感染老年男性患者的抗感染治疗方案进行分析,参考国内外抗微生物治疗指南及临床资料,结合患者病情变化提出用药建议。该颅内感染患者入院初期血培养出耐甲氧西林溶血葡萄球菌而脑脊液无病原学阳性结果,初始治疗以抗耐甲氧西林溶血葡萄球菌感染为目标,先后使用万古霉素、利奈唑胺、利福平、替加环素等药物;入院中期患者脑脊液宏基因二代测序报盖尔森基兴奴卡菌,修正病原学诊断后,以抗盖尔森基兴奴卡菌感染为治疗目标,先后使用利奈唑胺、美罗培南、磺胺甲噁唑-甲氧苄啶、头孢曲松、米诺环素进行抗感染治疗。盖尔森基兴奴卡菌致颅内感染无标准抗感染方案,临床药师应通过参考指南及相关循证资料并结合临床实际,协助医师调整治疗方案,保障患者用药安全性和有效性。

Clinical pharmacists analyzed the anti-infective treatment plan for an elderly male patient with Nocardia cyriacigeorgica caused intracranial infection.Referring to antimicrobial therapy guidelines and domestic and foreign clinical information,suggestions were put forward according to the changes of the patient’s condition.Methicillin-resistant Staphylococcus haemolyticus(MRSH)was found in the blood culture of the patient with intracranial infection,while the pathogenic bacteria was not found in the cerebrospinal fluid of the patient.Vancomycin,linezolid,rifampicin and tigecycline were used successively for the initial treatment of MRSH infection;Nocardia cyriacigeorgica was found in the cerebrospinal fluid of the patient in the mid-stage of hospitalization by metagenomic next generation sequencing.After corrected by the pathogenic diagnosis,linezolid,meropenem,sulfamethoxazole-trimethoprim,ceftriaxone and minocycline were used successively for the treatment of Nocardia cyriacigeorgica infection.There is no standard medication regimens for intracranial infection by Nocardia Cyriacigeorgica yet.To ensure the safety and effectiveness of patients’medication,clinical pharmacists should assist physicians in adjusting treatment plans by referring to guidelines and relevant evidence-based materials and combining with clinical practice.