陈昆 王玥媛 刘梦颖 方洁

摘 要 目的：探讨肾功能不全的重症患者头孢他啶/阿维巴坦个体化给药治疗策略，为优化头孢他啶/阿维巴坦给药方案積累经验。方法：临床药师参与1例由碳青霉烯类耐药肺炎克雷伯菌所致重症感染的急性肾功能不全患者的治疗，运用治疗药物监测（TDM）协助临床医师优化抗感染治疗方案，对患者初始给药方案选择、后续方案调整、疗效观察和不良反应监测等方面提出建议或进行药学监护。结果：TDM结果表明头孢他啶/阿维巴坦达到了理想的PK/PD靶值。患者感染得到了迅速有效的控制，且未出现不良反应。结论：临床药师可运用药学知识特长，协助临床制定合理的治疗方案，评估药物疗效，监测不良反应，保证药物治疗安全、有效、经济。

关键词 头孢他啶/阿维巴坦 急性肾功能不全 治疗药物监测 个体化用药

中图分类号：R978.11； R692.5 文献标志码：C 文章编号：1006-1533（2021）01-0074-04

A case report of ceftazidime-avibactam individualized administration

CHEN Kun1，2*， WANG Yueyuan3， LIU Mengying4， FANG Jie2**

（1. Department of Pharmacy， the Hospital affiliated to Southwest Medical University， Sichuan Luzhou 646000， China； 2. Department of Pharmacy， Ruijin Hospital affiliated to School of Medicine， Shanghai Jiao Tong University， Shanghai 200025， China； 3. Department of Pharmacy， Sichuan Provincial Key Laboratory for Personalized Drug Therapy， Sichuan Academy of Medical Sciences， Sichuan Provincial Peoples Hospital， the Hospital affiliated to University of Electronic Science and Technology of China， Chengdu 610072， China； 4. Department of Pharmacy， Nanjing Drum Tower Hospital affiliated to Medical College of Nanjing University， Nanjing 210008， China）

ABSTRACT Objective：To explore the treatment strategy of individualized administration of ceftazidime-avibactam in critically ill patients with renal impairment so as to accumulate clinical experience for the optimization of the ceftazidimeavibactam dosage regimen. Methods： The clinical pharmacists participated in the treatment of infections caused by carbapenemresistant Klebsiella pneumoniae in a patient with acute renal insufficiency and assisted clinicians in optimizing anti-infective treatment plans using therapeutic drug monitoring （TDM） and perform pharmaceutical care in the selection of patients initial dosing plan， subsequent plan adjustments， efficacy observations and adverse reaction monitoring. Results： TDM showed that the PK/PD target rate of ceftazidime-avibactam was 100% and the patient experienced rapid clearance of his carbapenem-resistant Klebsiella pneumoniae without adverse reactions. Conclusion： The clinical pharmacists can use their expertise in pharmaceutical knowledge to assist clinicians in formulating reasonable treatment plans， assess drug efficacy， monitor adverse reactions and ensure the safety， economy， effectiveness and rationality of drug treatment.

KEy WORDS ceftazidime-avibactam； acute renal insufficiency； therapeutic drug monitoring； individualized medication

近年来由碳青霉烯类耐药肠杆菌科细菌（carbapenem-resistant Enterobacteriaceae，CRE）引起的感染發生率不断升高。我国肺炎克雷伯菌对碳青霉烯类耐药率已达到26.3%，ICU病房中甚至达到了48.1%，大大限制了抗感染方案的选择[1-2]。头孢他啶/阿维巴坦（4∶1）是由头孢他啶和新型的b-内酰胺酶抑制剂阿维巴坦组成的复合制剂，它对头孢他啶不敏感的肠杆菌科细菌和铜绿假单胞菌均具有出色的体外抗菌活性。但目前头孢他啶/阿维巴坦在我国临床应用并不多，尤其对于肾功能不全患者的给药方案制定、疗效评估、耐药情况和不良反应等尚缺乏经验。……