潘　蕾，刘玉娟，蒋　淼，方忠宏(.复旦大学附属金山医院药剂科，上海　0508； .复旦大学附属金山医院消化内科，上海　0508)



头孢吡肟相关性腹泻案例分析

潘蕾1*，刘玉娟1#，蒋淼2，方忠宏1(1.复旦大学附属金山医院药剂科，上海201508； 2.复旦大学附属金山医院消化内科，上海201508)

DOI10.14009/j.issn.1672-2124.2016.02.037

摘要目的：探讨抗菌药物相关性腹泻(antibiotic associated diarrhea，AAD)的发病原因和治疗方法，为临床治疗提供借鉴，供临床药师学习。方法：介绍临床药师参与1例特点显著、具有学习意义的头孢吡肟相关性腹泻患者的治疗过程，并结合患者的重点临床资料以及病情变化的显著特点进行分析与总结。结果：经调整用药方案，仅24 h后患者的腹痛、体温、血常规等指标即明显好转；仅治疗5 d，患者的血常规白细胞计数为11.87×109/L，中性粒细胞百分比为73.91%。结论：临床对AAD应尽早发现，尽早调整治疗方案，对提高医疗质量有重大影响，其临床急症表现会快速转危为安，建议临床在进行抗感染治疗时予以重视。

关键词头孢吡肟； 抗菌药物相关性腹泻； 艰难梭菌

Case Report: Cefepime Induced Antibiotic Associated Diarrhea

PAN Lei1, LIU Yujuan1, JIANG Miao2, FANG Zhonghong1(1.Dept.of Pharmacy, Jinshan Hospital Affiliated to Fudan University, Shanghai 201508, China; 2.Dept.of Gastroenterology, Jinshan Hospital Affiliated to Fudan University, Shanghai 201508, China)

ABSTRACTOBJECTIVE：To probe into the pathogenesis and treatment regimen of antibiotic associated diarrhea(AAD), so as to provide reference for the clinical treatment and experience for the clinical pharmacists. METHODS: To introduce the treatment process of one significant case with AAD participated by the clinical pharmacists through summarizing and analyzing the essential clinical data and distinctive features of condition changes. RESULTS: After the adjustment of medication regimen, the patient’s abdominal pain relieved, body temperature dropped and white cell counts recovered after only 24 hours. After treatment of 5 d, the routine blood leukocyte count was 11.87×109/L, ratio of neutrophile granulocyte was 73.91%. CONCLUSIONS: The clinic should identify AAD as early as possible and adjust treatment regimen timely, which can improve the quality of medical care; and the clinical emergency could turn the corner rapidly. It is suggested that the clinic should attach more importance to the anti-infective therapy.

KEYWORDSCefepime; Antibiotic associated diarrhea; Clostridium difficile

抗菌药物相关性腹泻(antibiotic associated diarrhea，AAD)是指应用抗菌药物后发生的腹泻。其临床发病率约为5%～35%，与患者年龄(≥65岁)、基础疾病、质子泵抑制剂的使用以及所使用的抗菌药物种类有关[1]。引起AAD的抗菌药物中，以头孢菌素列首位[2]。AAD的病原菌，以艰难梭菌感染在近年来引起越来越多的关注。据英国2008年提供的统计数据表明，1999年有499例患者的死因是由于感染了艰难梭菌，2005年有1 999例，2006年上升到3 393例[3]。Pépin J等[4]对加拿大艾弟地区的艰难梭菌发病率研究发现，1999、2002年的发病率分别为每10万人中有22.2人和25.2人，到2003年发病率升高近4倍，为每10万人中有92.2人，说明艰难梭菌感染防治日趋严峻。……