1例重症患者抗感染个体化给药策略分析

石晓萍; 吕迁洲; 杨婉花; 方洁

doi:10.3969/j.issn.1006-0111.2017.06.018

1例重症患者抗感染个体化给药策略分析

doi: 10.3969/j.issn.1006-0111.2017.06.018

1.
复旦大学附属中山医院药剂科, 上海 200032
2.
上海交通大学医学院附属瑞金医院药剂科, 上海 200025

The individualized anti-infective treatment strategy for a critically ill patient

1.
Department of Pharmacy, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200032, China
2.
Department of Pharmacy, Ruijin Hospital Affiliated to School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China

摘要: 目的探讨对于重症感染的患者如何根据其特殊的病理生理状况制订个体化抗感染治疗方案。方法临床药师参与1例急性泛发性发疹性脓疱病继发血流感染和肺部感染患者的抗感染治疗，通过分析其病理生理状况，运用治疗药物监测，协助临床医生制订个体化的给药方案。结果患者初始抗感染治疗方案效果不佳，临床药师根据患者的个体情况和血药浓度监测结果调整给药方案，患者的感染得到控制，病情好转。结论确保重症患者给药剂量达到药动学/药效学目标值是治疗成功的关键。
- 急性泛发性发疹性脓疱病 /
- 药物监测 /
- 万古霉素 /
- 阿米卡星
Abstract: Objective To design individualized anti-infective therapy for a critically ill patient. Methods Based on pathophysiological conditions and therapeutic drug levels,clinical pharmacists assisted physicians to optimize individual anti-infective medication regimens for a patient with acute generalized exanthematous pustulosis secondary to blood stream infection and pulmonary infection. Results The patient responded poorly to initial treatment. After the medication regimen adjustments byclinical pharmacists according to the individual situation and therapeutic drug monitoring results,patient's condition was improved and the infection was under control. Conclusion The key to successful treatment is to ensure the dosage administered to the critically ill patients reach the target value of pharmacokinetics and pharmacodynamics.
- acute generalized exanthematous pustulosis /
- therapeutic drug monitoring /
- vancomycin /
- amikacin

[1]	Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the infectious diseases society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children[J]. Clin Infect Dis, 2011,52(3):e18-e55.
[2]	Truong J, Levkovich BJ, Padiglione AA. Simple approach to improving vancomycin dosing in intensive care:a standardised loading dose results in earlier therapeutic levels[J]. Intern Med J, 2012,42(1):23-29.
[3]	万古霉素临床应用剂量专家组. 万古霉素临床应用剂量中国专家共识[J]. 中华传染病杂志, 2012,30(11):641-646.
[4]	桑德福. 热病:桑德福抗微生物治疗指南[M]. 范洪伟译. 44版.北京:中国协和医科大学出版社, 2014:96-109.
[5]	Martin JH, Norris R, Barras M, et al. Therapeutic monitoring of vancomycin in adult patients:a consensus review of the American society of health-system pharmacists, the infectious diseases society of America, and the society of infectious diseases pharmacists[J]. Clin Biochem Rev, 2010,31(1):21-24.
[6]	van Hal SJ, Fowler VJ. Is it time to replace vancomycin in the treatment of methicillin-resistant Staphylococcus aureus infections?[J]. Clin Infect Dis, 2013,56(12):1779-1788.
[7]	Roberts JA, Abdul-Aziz MH, Lipman J, et al. Individualised antibiotic dosing for patients who are critically ill:challenges and potential solutions[J]. Lancet Infect Dis, 2014,14(6):498-509.
[8]	Rostas SE, Kubiak DW, Calderwood MS. High-dose intravenous vancomycin therapy and the risk of nephrotoxicity[J]. Clin Ther, 2014,36(7):1098-1101.
[9]	Arimura Y, Yano T, Hirano M, et al. Mitochondrial superoxide production contributes to vancomycin-induced renal tubular cell apoptosis[J]. Free Radic Biol Med, 2012,52(9):1865-1873.
[10]	Mulazimoglu L, Drenning SD, Yu VL. In vitro activities of two novel oxazolidinones (U100592 and U100766), a new fluoroquinolone (trovafloxacin), and dalfopristin-quinupristin against Staphylococcus aureus and Staphylococcus epidermidis[J]. Antimicrob Agents Chemother, 1996,40(10):2428-2430.
[11]	Jacqueline C, Caillon J, Le Mabecque V, et al. In vitro activity of linezolid alone and in combination with gentamicin, vancomycin or rifampicin against methicillin-resistant Staphylococcus aureus by time-kill curve methods[J]. J Antimicrob Chemother, 2003,51(4):857-864.
[12]	Singh SR, Bacon AR, Young DC, et al. In vitro 24-hour time-kill studies of vancomycin and linezolid in combination versus methicillin-resistant Staphylococcus aureus[J]. Antimicrob Agents Chemother, 2009,53(10):4495-4497.
[13]	Chiang FY, Climo M. Efficacy of linezolid alone or in combination with vancomycin for treatment of experimental endocarditis due to methicillin-resistant Staphylococcus aureus[J]. Antimicrob Agents Chemother, 2003,47(9):3002-3004.
[14]	Beibei L, Yun C, Mengli C, et al. Linezolid versus vancomycin for the treatment of gram-positive bacterial infections:meta-analysis of randomised controlled trials[J]. Int J Antimicrob Agents, 2010,35(1):3-12.
[15]	穆玉, 范春芳, 朱铁梁, 等. 重症患者利奈唑胺所致血小板减少危险因素分析[J]. 中国感染与化疗杂志, 2012,12(1):10-14.
[16]	Kalil AC, Metersky ML, Klompas M, et al. Executive summary:management of adults with hospital-acquired and ventilator-associated pneumonia:2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society[J]. Clin Infect Dis, 2016,63(5):575-582.
[17]	Zelenitsky SA, Harding GK, Sun S, et al. Treatment and outcome of Pseudomonas aeruginosa bacteraemia:an antibiotic pharmacodynamic analysis[J]. J Antimicrob Chemother, 2003,52(4):668-674.
[18]	Kato H, Hagihara M, Hirai J, et al. Evaluation of Amikacin Pharmacokinetics and Pharmacodynamics for Optimal Initial Dosing Regimen[J]. Drugs RD, 2017,17(1):177-187.
[19]	Duszynska W, Taccone FS, Hurkacz M, et al. Therapeutic drug monitoring of amikacin in septic patients[J]. Crit Care, 2013,17(4):R165.
[20]	付双双, 唐惠林, 段京莉. 抗感染药物治疗药物监测的Meta分析[J]. 中国新药杂志, 2013,22(15):1840-1848.
[21]	梅清, 喻婷, 朱玉林, 等. 万古霉素单用及联合利福平或磷霉素对耐甲氧西林金黄色葡萄球菌防耐药突变浓度的研究[J]. 中国药理学通报, 2011,27(7):944-947.
[22]	胡文, 邓国泉, 伍婷, 等. 万古霉素单用与联用磷霉素治疗耐甲氧西林金黄色葡萄球菌肺部感染的疗效比较[J]. 实用中西医结合临床, 2012,12(4):6-7.
[23]	中华医学会呼吸病学分会《雾化吸入疗法在呼吸疾病中的应用专家共识》制定专家组. 雾化吸入疗法在呼吸疾病中的应用专家共识[J]. 中华医学杂志, 2016,96(34):2696-2708.

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1例重症患者抗感染个体化给药策略分析

doi: 10.3969/j.issn.1006-0111.2017.06.018

The individualized anti-infective treatment strategy for a critically ill patient

计量

1例重症患者抗感染个体化给药策略分析

doi: 10.3969/j.issn.1006-0111.2017.06.018

1. 复旦大学附属中山医院药剂科, 上海 200032

2. 上海交通大学医学院附属瑞金医院药剂科, 上海 200025

English Abstract

The individualized anti-infective treatment strategy for a critically ill patient

1. Department of Pharmacy, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200032, China

2. Department of Pharmacy, Ruijin Hospital Affiliated to School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China

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留言板

1例重症患者抗感染个体化给药策略分析

doi: 10.3969/j.issn.1006-0111.2017.06.018

The individualized anti-infective treatment strategy for a critically ill patient

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出版历程

1例重症患者抗感染个体化给药策略分析

doi: 10.3969/j.issn.1006-0111.2017.06.018

1. 复旦大学附属中山医院药剂科, 上海 200032 2. 上海交通大学医学院附属瑞金医院药剂科, 上海 200025

English Abstract

The individualized anti-infective treatment strategy for a critically ill patient

1. Department of Pharmacy, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200032, China 2. Department of Pharmacy, Ruijin Hospital Affiliated to School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China

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目录

1. 复旦大学附属中山医院药剂科, 上海 200032

2. 上海交通大学医学院附属瑞金医院药剂科, 上海 200025

1. Department of Pharmacy, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200032, China

2. Department of Pharmacy, Ruijin Hospital Affiliated to School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China