临床药师参与1例糖尿病酮症酸中毒患者抗感染治疗分析

Analysis of anti-infective therapy participated by clinical pharmacists for a patient with diabetic ketoacidosis

临床药师参与1例糖尿病酮症酸中毒尿路感染合并血流感染,后因长期使用抗菌药物导致艰难梭菌相关腹泻患者的治疗。临床药师通过日常药学查房、药学会诊,根据患者病情、病原学检测结果,查阅国内外指南并与临床医师讨论后,考虑患者为导管相关耐碳青霉烯类肺炎克雷伯菌血流感染,拔除股静脉导管,给予替加环素100mg,q12h联合亚胺培南西司他丁1g,q8h抗感染治疗。后期会诊针对抗菌药物导致艰难梭菌相关腹泻,药师建议患者口服万古霉素125mg,q6h,医师采纳意见。患者治疗效果较好,未出现不良反应,最终好转出院。临床药师在抗感染药学实践中发挥了积极有效作用,体现了临床药师多学科协助诊疗的职业价值。

Clinical pharmacists participated in the treatment of a case of diabetic ketoacidosis with urinary tract infection and bloodstreanm infection,which was later caused by Clostridium difficile-related diarrhea due to long-term use of antibacterial drugs.According to the patient's condition and pathogenic test results,clinical pharmacists consulted domestic and foreign guidelines through daily pharmaceutical rounds and consultations.After discussing with clinicans, considered that the patient had catheter-related carbapenem-resistant Klebsiella pneumoniae bloodstream infection. It was suggested to remove the femoral vein catheter and use tigecycline 100 mg, q12h combined with imipenem cilastatin 1 g, q8h for anti-infection treatment at the same time. In the later consultation, the patient was advised to take vancomycin 125 mg, q6h orally for the diarrhea of Clostridium difficile associated with antibiotics by physicians and clinicans adopted the opinions. The patient recovered without other adverse drug reactions, and discharged finally. Clinical pharmacists played an active and effective role in the practice of anti-infective pharmacology, which fully embodied the professional value in multidisciplinary collaborative diagnosis and treatment.