临床药师参与1例肾功能亢进患者抗感染治疗的药学实践

Pharmaceutical practice in anti-infective treatment of a patient with augmented renal clearance

1例20岁男性患者因“外伤后颈痛伴截瘫5 h”入院,临床诊断:大颈椎骨折脱位伴截瘫(C5)。行脊柱融合术、颈前路椎体次全切、人工骨植入、钛板内固定术,术后血培养检出耐甲氧西林金黄色葡萄球菌,给予万古霉素治疗后疗效欠佳,测得其血药浓度偏低,临床医师拟增加其剂量以提高血药浓度,临床药师考虑患者属肾功能亢进,建议更换为利奈唑胺,医师予以采纳,后患者感染症状得到有效控制,顺利转出。

A 20-year-old male patient was admitted to hospital due to neck pain and paraplegia after trauma for 5 hours and was diagnosed as fracture and dislocation of the large cervical spine with paraplegia(C5).After operation of spine fusion,subtotal resection of anterior cervical vertebral body,artifi cial bone implantation,and titanium plate internal fi xation,methicillin-resistant Staphylococcus aureus was detected in his blood.And vancomycin showed poor effect and its blood concentration was low.And then the clinician intended to increase the dose of vancomycin while the pharmacist advised to use linezolid based on the augmented renal clearance of the patient.Finally,the infection was quickly controlled after giving linezolid and the patient was successfully transferred.