1例化脓性脑膜炎、脑脓肿伴硬膜下脓肿患儿抗感染治疗的药学监护

Pharmaceutical Care of Anti-infective Treatment in One Child with Purulent Meningitis,and Cerebral Abscess with Subdural Abscess

目的:分析1例化脓性脑膜炎、脑脓肿伴硬膜下脓肿患儿抗感染治疗的药学监护过程,为临床类似的严重中枢神经系统感染的抗感染治疗提供参考。方法与结果:患者因头痛伴发热、失语数日而从外院转入南京市儿童医院治疗,根据入院检查和既往病情,明确诊断为化脓性脑膜炎、脑脓肿伴硬膜下脓肿,遂选用能通过血脑屏障的美罗培南和万古霉素进行经验性抗感染治疗;治疗近30 d后,患者体温基本恢复正常,感染指标和言语功能也较前明显改善,其间二代测序提示可疑病原菌为具核梭杆菌;在药学监护时,临床药师根据患者体质量变化和病情变化建议对美罗培南和万古霉素的剂量进行调整,临床医生采纳了;在入院治疗第34天,患者出现粒细胞减少和肝功能轻度异常,考虑为抗感染药物所致,故加用地榆升白片和还原型谷胱甘肽对症治疗;第50天,MRI和CT检查提示,患儿左侧额叶脑脓肿较前明显缩小,但仍可见脓腔,考虑当前抗感染治疗方案不能完全灭杀病原菌,故加用甲硝唑;又5 d后,患者病情大为好转,遂出院。结论:对于化脓性脑膜炎、脑脓肿伴硬膜下脓肿这类严重中枢神经系统感染患儿,临床药师应协助医生首选能通过血脑屏障的抗菌药物;而在药学监护过程中,临床药师应关注患者病情变化,并据此及时调整治疗方案,以帮助患者获得更好的疗效。

Objective:To analyze the pharmaceutical care process of anti-infective treatment in one child with purulent meningitis,and cerebral abscess with subdural abscess,and provide reference for the anti-infective treatment of clinically similar severe central nervous system infections.Methods and Results:The patient was transferred to Children's Hospital of Nanjing Medical University from external hospital because of"headache,fever,and aphasia for several days".Based on the examination results at admission and past medical history,the patient was diagnosed with purulent meningitis,and cerebral abscess with subdural abscess,and meropenem and vancomycin that could pass the blood-brain barrier were used for empiric anti-infective treatment;after nearly 30 days of treatment,the patient's body temperature basically returned to normal,and the infection indicators and speech function were also significantly improved.During the period,the next-generation sequencing indicated that the suspected pathogenic bacteria were Fusobacterium nucleatum;during pharmaceutical care,the clinical pharmacists recommended adjusting the dosage of meropenem and vancomycin based on the changes in the patient's body mass and disease conditions,and clinicians accepted the recommendations.On the 34th day of hospitalization,the patient developed granulocytopenia and mild abnormalities in liver functions,which were considered to be caused by anti-infective drugs;so burnet root leukopoietic tablets and reduced glutathione were added for symptomatic treatment.On the 50th day,MRI and CT scan showed that the child's cerebral abscess of the left frontal lobe was significantly smaller than before,but the abscess cavity was still visible.Considering that the current anti-infective treatment regimen could not completely kill the pathogenic bacteria,metronidazole was added.Five days later,the patient's conditions improved greatly and he/she was discharged.Conclusion:For children with severe central nervous system infections such as purulent meningitis and cerebral abscess with subdural abscess,clinical pharmacists should assist clinicians in selecting antibacterial drugs that can pass the blood-brain barrier;and during pharmaceutical care,clinical pharmacists should notice the patient's conditions and adjust the treatment regimens promptly to help the patients to achieve good curative effect.