失代偿性肝硬化合并单核细胞增多性李斯特菌脑膜炎患者抗感染治疗的药学监护

Pharmaceutical Care of Anti-infective Treatment in a Patient with Decompensated Liver Cirrhosis Complicated with Listeria Monocytogenes Meningitis

目的:分析1例失代偿性肝硬化合并单核细胞增多性李斯特菌(Listeria monocytogenes,LM)脑膜炎患者抗感染治疗的药学监护过程,为该类患者的抗感染治疗提供参考。方法与结果:临床药师在开展药学查房时发现,1例失代偿性肝硬化合并自发性细菌性腹膜炎患者在入院第2天中枢神经系统感染的相关症状,遂将抗感染治疗方案调整为美罗培南联合万古霉素,同时临床药师对抗感染治疗开展药学监护;入院第4天,患者脑脊液的宏基因组二代测序结果显示为LM,临床药师建议加用氨苄西林和庆大霉素(80 mg,q8h);入院第6天,患者的临床症状和相关指标明显改善,于是停用美罗培南和万古霉素,经过21 d治疗,患者好转出院。结论:诸如失代偿性肝硬化等严重基础疾病的患者发生感染时,临床药师利用自身专业特长协助医生制定合理的初始经验性抗感染治疗方案,不仅可以有效控制当前感染,还可以辅助判断后续感染的感染部位和可能病原菌,从而开展更有针对性的治疗和药学监护,以确保患者的治疗效果。

Objective:To analyze the pharmaceutical care process of anti-infective treatment in a patient with decompensated liver cirrhosis complicated with Listeria monocytogenes meningitis,so as to provide reference for anti-infective treatment in this type of patient.Methods and Results:During pharmaceutical ward rounds,the clinical pharmacist found that a patient with decompensated liver cirrhosis complicated with spontaneous bacterial peritonitis had symptoms related to central nervous system infection on the second day of admission,so the anti-infective treatment regimen was adjusted to meropenem combined with vancomycin,and the clinical pharmacist carried out the pharmaceutical care of anti-infective treatment.On Day 4 of admission,the metagenomic second-generation sequencing result of the patient's cerebrospinal fluid showed LM,so the clinical pharmacist suggested adding ampicillin and gentamicin(80 mg,q8h).Soon,the clinical symptoms and related indicators of the patient were significantly improved,so meropenem and vancomycin were stopped,and the patient recovered and was discharged soon.Conclusion:When patients with severe underlying diseases such as decompensated liver cirrhosis experience infection,clinical pharmacists can assist doctors in developing a reasonable initial empirical anti-infective treatment regimen with their professional expertise,which can not only effectively control the current infection,but also assist in determining the infection sites and potential pathogens for subsequent infections,thus carrying out more targeted treatment and pharmaceutical care to ensure the treatment efficacy of patients.