1例产ESBL肺炎克雷伯菌伴生物被膜形成致化脓性关节炎患者的药学实践

Pharmaceutical Practice for a Patient with Septic Arthritis Induced by ESBL-Producing Klebsiella Pneumoniae with Biofilm Formation

临床药师会诊1例左侧髋关节清创术后感染产超广谱β-内酰胺酶(ESBL)肺炎克雷伯菌(KP)致化脓性关节炎病例,根据病原菌药敏试验结果及抗菌药物药动学/药效学,结合患者病情,分析药敏结果和关节腔药物分布浓度,选择联合抗菌药物治疗方案,经外科积极清创换药,多次调整抗感染治疗方案,足疗程治疗,患者病情得到有效控制,治愈出院。临床药师通过全程参与临床治疗,发挥药学学科专长,协助临床医师制定个体化的治疗方案,监控肝肾功能、血钠水平,评估感染相关炎症指标的变化,保障了患者合理使用抗菌药物,提高了临床药物治疗的有效性和安全性。

A case of suppurative arthritis caused by Klebsiella pneumoniae(KP) producing extended-spectrum β-lactamase(ESBL) after debridement of left hip joint was reported.Clinical pharmacists participated in the consultation.According to the results and characteristics of drug susceptibility test of pathogenic bacteria and the pharmacokinetic/pharmacodynamic characteristics of antibiotics,combined with the characteristics of the patient’s condition,the results of combined drug susceptibility test and drug distribution concentration in the articular cavity were analyzed,and the combined antibiotic treatment scheme was selected.After surgical debridement and dressing change,the anti-infective treatment scheme was adjusted for many times,and the patient was treated with a full course of treatment.The condition was effectively controlled,and the patient was cured and discharged.Through participating in clinical treatment,clinical pharmacists give full play to their own pharmaceutical expertise,assist clinicians in formulating individualized and optimized treatment plans,regularly implement pharmaceutical care for liver and kidney function and blood sodium level monitoring,evaluate the changes of infection-related inflammatory indicators,ensure the safe,effective and reasonable use of antibiotics in patients,and improve the effectiveness and safety of clinical drug treatment.