胡天鑫

[摘要]目的对1例蛛网膜下腔出血术后并发耐碳青霉烯类肠杆菌科细菌（CRE）肺炎患者的抗感染治疗进行分析，探讨抗感染治疗药物选择，为临床合理用药提供参考。方法临床药师通过药学会诊的方式参与一例颅脑术后合并肺部感染耐碳青霉烯肺炎克雷伯菌的抗感染方案的制订、优化和监护。结果当最低抑菌浓度（MIC）≤8μg/ml 时可考虑给予碳青霉烯联合替加环素的治疗方案，增加替加环素剂量，同时延长碳青霉烯的输注时间。通过实施优化的治疗方案，患者得到有效治疗，临床症状好转，病原学结果转阴。结论临床药师深入临床实践，对患者药物治疗过程进行药学监护，能更好地发挥自身的价值。

[关键词]临床药师;药学监护;肺部感染;耐碳青霉烯肺炎克雷伯菌

[中图分类号] R961 [文献标识码] A  [文章编号]2095-0616（2021）22-0235-03

Pharmaceutical care by clinical pharmacists： a case of pulmonary infection with carbapenem-resistant Enterobacteriaceae upon subarachnoid hemorrhage surgery

HU  Tianxin

Department of Pharmacy， Tangdu Hospital， Air Force Medical University， Shaanxi， Xi'an 710038， China

[Abstract] Objective To analyze the anti-infection treatment of a patient with a complication of carbapenem- resistant Enterobacteriaceae （CRE） pneumonia upon subarachnoid hemorrhage surgery， and to explore the selection of anti-infection treatment drugs， so as to provide reference for clinical rational drug use. Methods Clinical pharmacists participated in the formulation， optimization and monitoring of the anti-infection scheme on the patient with pulmonary infection of carbapenem-resistant Klebsiella pneumoniae after craniocerebral operation through pharm aceuticalconsultation . Results  When m inim al inhibitory concentration （MIC）≤8μg/ml， the treatment scheme of carbapenem combined with tigecycline could be considered， and the dosage of tigecycline could be increased and the infusion time of carbapenem could be prolonged. Through the implementation of an optimized treatment plan， the patients were effectively treated， the clinical symptoms were improved， and the etiological results turned negative. Conclusion Clinical pharmacists can give full play to their own value by deeply participating in clinical practice and taking pharmaceutical care of patients during drug treatment.

[Key words] clinical pharmacist; pharmaceutical care; pulmonary infection; carbapenem-resistant Klebsiella pneumoniae

顱脑术后合并肺部感染已成为神经外科院内感染的常见情况之一。气管切开、持续昏迷时间过长、误吸等因素与术后继发肺部感染均有较大关联。常见的感染病原菌主要有肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌等。由于产超广谱β内酰胺酶，这些细菌会对常用药物如青霉素类、头孢菌素类、加酶抑制剂的复合制剂等产生耐药性。碳青霉烯类被认为是治疗这类细菌感染的一线抗菌药物，但是近年来，随着抗生素的滥用，耐碳青霉烯类肠杆菌科细菌（carbapenem-resistant Enterobacteriaceae， CRE）在临床上越来越多地被检出，其中最常见的为大肠埃希菌和肺炎克雷伯菌，极大地增加了临床抗感染治疗的难度[1]。……