替加环素致多重耐药菌感染患者低纤维蛋白原血症的药学监护

The pharmaceutical care of a multidrug-resistant bacterial infection patient with tigecycline-induced hypofibrinogenemia

目的为临床治疗多重耐药菌感染患者使用替加环素致低纤维蛋白原血症的药学监护和替加环素的安全使用提供参考。方法临床药师通过参与1例多重耐药菌感染患者使用替加环素致低纤维蛋白原血症的案例,对替加环素与低纤维蛋白原血症不良反应的相关性进行判断,并结合相关文献分析替加环素致低纤维蛋白原血症发生的危险因素和可能机制;建议医师停用替加环素,并给予人纤维蛋白原和血浆纠正。结果与结论替加环素与患者的低纤维蛋白原血症有关。医师采纳临床药师意见,患者纤维蛋白原水平恢复至正常水平。替加环素致低纤维蛋白原血症发生的危险因素包括大剂量、长疗程用药,以及患者自身合并肾功能不全。临床药师及时给予医师停药建议,并建议在必要时输注人纤维蛋白原和血液制品进行纠正,避免了严重且危及生命的凝血障碍的发生,保障了替加环素使用的安全性。

OBJECTIVE To provide reference for pharmaceutical care of multidrug-resistant bacterial infection patients with tigecycline-induced hypofibrinogenemia and the safe use of tigecycline.METHODS Clinical pharmacists participated in a case of hypofibrinogenemia caused by tigecycline with multidrug-resistant bacterial infection,to determine the correlation of hypofibrinogenemia and tigecycline,and to analyze the risk factors and possible mechanisms of the occurrence of hypofibrinogenemia caused by tigecycline in combination with relevant literature.Clinical pharmacists recommended that physicians discontinued tigecycline and provided human fibrinogen and plasma for correction.RESULTS&CONCLUSIONS Tigecycline was associated with hypofibrinogenemia of the patient.The physician followed the advice of clinical pharmacists and the patient’s fibrinogen level returned to normal.The risk factors of hypofibrinogenemia induced by tigecycline included high dose,long course of treatment,and complication with renal dysfunction.Clinical pharmacists should timely advise physicians to stop taking the drug,and give human fibrinogen and blood product infusion for correction when necessary,so as to avoid the occurrence of serious lifethreatening coagulation disorders and ensure the safety of tigecycline use.