1例行CRRT的多重耐药铜绿假单胞菌所致VAP患者的抗感染治疗实践

Anti-infective treatment practice in a patient with ventilator-associated pneumonia caused by multidrug-resistant Pseudomonas aeruginosa undergoing continuous renal replacement therapy

1例76岁男性患者,行连续性肾脏替代治疗(CRRT),继发多重耐药铜绿假单胞菌(MDR-PA)所致呼吸机相关性肺炎(VAP),入院后给予万古霉素(1 g,q 12 h,ivgtt)+哌拉西林钠他唑巴坦钠(4.5 g,q 8 h,ivgtt)经验性抗感染治疗,治疗5d后患者感染情况加重,临床提请临床药师会诊,临床药师根据患者情况结合抗菌药物PK/PD靶值和CRRT滤过特点参考相关文献资料,建议优化抗感染方案为美罗培南(2 g,q 8 h,ivgtt,延长滴注时间至3 h)+阿米卡星(首剂10 mg·kg^(-1),后7.5mg·kg^(-1),q 24 h,ivgtt),临床采纳。实施上述方案治疗7 d后,患者感染症状好转。停止CRRT治疗后,临床药师根据肌酐清除率再次调整抗感染治疗方案并继续治疗10 d后,患者生命体征平稳,转入康复科继续治疗。

A 76-year-old male patient with continuous renal replacement therapy(CRRT)and ventilator-associated pneumonia(VAP)caused by multidrug-resistant Pseudomonas aeruginosa(MDR-PA)was given vancomycin(1 g,q 12 h,ivgtt)combined with piperacillin sodium and tazobactam sodium(4.5 g,q 8 h,ivgtt)after admission.After 5 days of treatment,the infection was aggravated.Clinical pharmacists was requested for clinical consultation.Clinical pharmacists recommended to optimize the anti-infection regimen of meropenem(2 g,q 8 h,ivgtt,prolonged infusion time to 3 h)+amikacin(first dose 10 mg·kg^(-1),last 7.5 mg·kg^(-1),q 24 h,ivgtt)according to the pharmacokinetics/pharmacodynamics(PK/PD)target value of antibiotics,the characteristics of CRRT and relevant literature,which adopted by clinical.7 days later,the infection symptoms of the patient were improved.After discontinuation of the CRRT,the anti-infective regimen was adjusted by the clinical pharmacists according to the creatinine clearance rate.The patient was transferred to the rehabilitation department with stable vital signs after 10 days.