临床药师参与围产期李斯特菌病治疗一例

Clinical practice of clinical pharmacist participating in the treatment,for a case of perinatal listeriosis

产单核细胞李斯特菌(LM)属于李斯特菌属,可引起局灶性感染、败血症、脑膜炎、流产、死胎,甚至导致死亡,被称为李斯特菌病(listeriosis)。妊娠女性为LM易感人群。本文记录1例临床药师全程参与围产期李斯特菌病患者的抗感染治疗过程:在初始目标治疗阶段,临床药师推荐采用治疗李斯特菌病一线抗感染方案青霉素联合庆大霉素,但临床采用该方案出现疗效不佳的情况;在调整目标治疗阶段,临床药师分析围产期药物代谢动力学变化,建议测定庆大霉素血药峰浓度,并协助感染科医师调整抗感染方案;在患者仍有间断低热时,临床药师结合LM特点建议停用铁剂,医师采纳后,患者感染得到有效控制。

Listeria monocytogenes(LM)belongs to the genus Listeria and is the only human pathogen in the genus Listeria. It can cause focal infections,sepsis,meningitis,miscarriage,stillbirth,and even death. It is called Listeriosis(Listeriosis). This paper recorded a case of clinical pharmacist participating in the whole process of anti-infective treatment of perinatal Listeriosis. The first-line anti-infective regimen recommended by the clinical pharmacist for listeriosis was ampicillin or penicillin ± gentamicin,however,the clinical efficacy of the regimen was poor. In the stage of adjusting the target treatment,the clinical pharmacist analyzed the changes of perinatal pharmacokinetics,and suggested to determine the peak concentration of blood gentamicin,and assisted the infection physician to adjust the patient’s target anti-infection plan. When the patient still had intermittent low fever,the clinical pharmacist suggested to stop iron according to the characteristics of LM. After the doctor adopted it,the patient’s infection was effectively controlled.