1例头孢唑林致患者艰难梭菌感染的诊疗分析与药学监护

Analysis of Diagnosis and Treatment and Pharmaceutical Care of One Patient with Clostridium Difficile Infection Caused by Cefazolin

目的:分析1例头孢唑林致患者艰难梭菌感染的诊疗与药学监护过程,为临床抗菌药物用药安全提供参考。方法:该患者因“腰骶部疼痛,伴双下肢麻木3年,加重半年”入院治疗,第6天行手术治疗,术前术后使用头孢唑林预防术后感染;第9~10天,患者出现发热、腹泻、腹痛等症状,遂邀请临床药师进行会诊,临床药师通过查阅相关文献资料,结合患者的当前病症、检查结果和用药史,提出了相应的药学建议。结果:临床药师分析后,考虑此为抗生素相关性腹泻,并建议完善艰难梭菌相关检查;第14天,艰难梭菌检查确为阳性,遂建议使用万古霉素治疗(125 mg,q6h,口服);2周后,患者逐渐可解成形大便,且腹痛消失。结论:头孢唑林引起艰难梭菌感染在临床上较为少见,临床药师从药学的专业角度,几乎第一时间怀疑到了头孢唑林,并且认为艰难梭菌可能是致病菌,做到早发现、早处理,提升了临床的诊治质量。

Objective:To analyze the diagnosis,treatment and pharmaceutical care process of one patient with Clostridium difficile infection caused by cefazolin,and provide reference for the clinical medication safety of antibacterial drugs.Methods:The patient was admitted to the hospital for"lumbosacral pain,accompanied by numbness in both lower extremities for 3 years,and worsening for half a year".On the 6th day after admission,the patient received surgery,and cefazolin was used before and after surgery to prevent postoperative infection;on the 9th and 10th days,the patient developed the symptoms such as fever,diarrhea,and abdominal pain;so a clinical pharmacist was invited for consultation.The clinical pharmacist consulted relevant literature and gave pharmaceutical suggestions based on the patient's current symptoms,examination results,and medication history.Results:After analysis,the clinical pharmacist considered it to be antibiotic-associated diarrhea,and suggested the tests related to Clostridium difficile;on the 14th day,the Clostridium difficile test showed positive result,so the treatment with vancomycin(125 mg,q6h,orally)was recommended;after 2 weeks of treatment,the formed stool was produced and the abdominal pain disappeared.Conclusion:Clostridium difficile infection caused by cefazolin is relatively rare in clinical practice.Clinical pharmacists can suspect it is caused by cefazolin very quickly based on their pharmaceutical knowledge and believes that Clostridium difficile may be the pathogenic bacterium,achieving the purpose of early detection and early treatment and improving the quality of clinical diagnosis and treatment.