1例肾移植术后继发马红球菌和曲霉菌感染患者的药学监护

Pharmaceutical Care of a Patient with Secondary Infection of Rhodococcus Equi and Aspergillus After Renal Transplantation

目的探讨临床药师在肾移植术后合并马红球菌、曲霉菌感染患者药物治疗中的作用。方法临床药师通过参与1例肾移植术后合并马红球菌、曲霉菌感染患者的治疗,对其抗感染用药选择、药品不良反应(ADR)等实施药学监护。结果临床药师基于患者的药物敏感性试验结果及指南推荐治疗方案,考虑患者为肾移植术后状态且长期服用他克莫司,抗感染方案建议调整为予利奈唑胺联合红霉素治疗马红球菌,以及予卡泊芬净治疗曲霉菌,同时建议动态监测血小板计数及胃肠道反应。临床医师采纳了临床药师的建议,患者的感染指标好转,ADR得到有效控制。结论临床药师参与肾移植术后继发马红球菌和曲霉菌感染患者的药学监护,可提高患者的合理用药水平,保障用药安全。

Objective To investigate the role of clinical pharmacists in drug treatment of patients with infections of Rhodococcus equi and Aspergillus after kidney transplantation.Methods Clinical pharmacists participated in the treatment of a patient with infection of Rhodococcus equi and Aspergillus after kidney transplantation,and implemented pharmaceutical care for the selection of anti-infective drugs and adverse drug reactions(ADRs).Results Based on the drug sensitivity test results of the patient and guidelines,the clinical pharmacist recommended a treatment plan.Due to the patient′s long-term use of tacrolimus after kidney transplantation,the anti-infection plan was recommended to be adjusted to the combination of linezolid and erythromycin for the treatment of Rhodococcus equi,and cabozantine for the treatment of Aspergillus.Meanwhile,it was recommended to dynamically monitor platelet count and gastrointestinal reactions.The clinical physician adopted the advice of the clinical pharmacist,and the patient′s infection indicators improved,and ADRs were effectively controlled.Conclusion Clinical pharmacists participating in pharmaceutical care of a patient with secondary infection of Rhodococcus Equi and Aspergillus after renal transplantation can improve the rational drug use,and ensure the medication safety of patients.