胆总管取石术后并发腹腔感染患者抗感染治疗的药学监护

Pharmaceutical Care of Anti-infective Therapy in Patients Complicated by Intra-abdominal Infection after Choledocholithotomy

目的:分析胆总管取石术后并发腹腔感染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:患者在行胆总管取石术后出现持续发热、切口周围红肿等感染症状而转入我院,随后在腹腔切口分泌物中先后检查出鹑鸡肠球菌(Enterococcus gallinae,EG)和聚团肠杆菌(Enterobacter aggregatus,EA),临床药师根据2种细菌的药敏试验结果和临床实际情况,建议调整利奈唑胺的使用记录,以及加用依替米星、替加环素和亚胺培南-西司他丁钠,这些建议都得到了医生的采纳。结果:在使用利奈唑胺治疗10 d后,患者的微生物检查结果未再回报EG;而针对EA感染,在先后使用依替米星、替加环素和亚胺培南-西司他丁钠治疗半个多月后,患者的体温基本恢复正常,降钙素原水平也明显下降,遂顺利出院。结论:临床药师在开展抗感染治疗的药学监护过程中,凭借自身专业特长,可协助医生制定出更为个性化的治疗,不仅可以提高整个医疗团队的工作效能,更可以保障患者的治疗效果和用药安全。

Objective:To analyze the process of pharmaceutical care of anti-infective therapy in patients complicated by intra-abdominal infection after choledocholithotomy,so as to provide reference for the anti-infective therapy of such patients.Methods:A patient was transferred to our hospital with symptoms of infection such as persistent fever and peri-incisional redness and swelling after choledocholithotomy,and then Enterococcus gallinae(EG)and Enterobacter aggregatus(EA)were detected successively in the abdominal incision secretions.Based on the drug susceptibility test results for 2 bacteria and the actual clinical circumstances,the clinical pharmacist recommended an adjustment to the administration record of linezolid,as well as the addition of etimicin,tigecycline,and imipenem-cilastatin sodium,all of which were accepted by the physician.Results:After 10 days of treatment with linezolid,no EG was reported on the patient's microbiological test results;for EA infection,after treatment with etimicin,tigecycline and imipenem-cilastatin sodium successively for more than half a month,the patient's body temperature basically returned to normal,and the level of procalcitonin also decreased significantly,and the patient was discharged from hospital successfully.Conclusion:During pharmaceutical care of anti-infective therapy,clinical pharmacists can assist physicians in developing more personalized therapies based on their professional expertise,which can not only improve the work efficiency of the entire medical team,but also guarantee the therapeutic effect and medication safety of patients.