| 摘要: |
| 目的:探讨产超广谱 茁鄄内酰胺酶(ESBLs)肺炎克雷伯菌肺炎患儿抗感染治疗方案。 方法:临床药师对 1 例产 ESBLs 肺炎克雷伯菌肺炎患儿抗感染治疗方案进行分析,寻找疗效不佳的可能原因,优化抗感染治疗方案。 结果:医疗机构相关性肺炎(HCAP)患儿经验性抗感染治疗选择头孢哌酮/舒巴坦(68 mg/ kg,q 12 h)合理,但给药第 5 天起降低头孢哌酮/ 舒巴坦剂量(45mg/ kg,q 12 h)可能是导致疗效不佳的主要原因;肺泡灌洗液提示产 ESBLs 肺炎克雷伯菌感染,临床药师建议更换抗生素为亚胺培南/西司他丁(15 mg/ kg,q 6 h),患儿感染得到有效控制,治愈出院。 结论:产 ESBLs 肺炎克雷伯菌感染患儿病情评估为轻中度,可以选择含酶抑制剂的复方制剂,对于有基础疾病的患儿,头孢哌酮/ 舒巴坦建议选择足量足频次(如 50 mg/kg,q 8 h)的给药方案;如患儿病情评估为重度,建议选择碳青霉烯类抗生素,选择碳青霉烯类药物时要考虑不同药物之间疗效和不良反应的差异。 |
| 关键词: 医疗机构相关性肺炎 超广谱 茁鄄内酰胺酶 肺炎克雷伯菌 临床药师 |
| DOI：10.13407/j.cnki.jpp.1672-108X.2018.05.014 |
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| 基金项目: |
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| Anti-Infection Treatment for One Child with Pneumonia Caused by Extended Spectrum Beta-Lactamases-Producing Klebsiella Pneumoniae |
| Zhan Min 1 , Chen Zebing 1 , Ou-Yang Shan 2 , He Yanling 2 , Cen Hanjing 2 |
| (1. Shenzhen Children's Hospital,Guangdong Shenzhen 518038, China; 2. Guangzhou Women and Children Medical Center, Guangdong Guangzhou 510623, China) |
| Abstract: |
| Objective: To explore the anti-infective therapy regimen for children with pneumonia caused by extended spectrum beta-lactamases (ESBLs)-producing Klebsiella pneumoniae. Methods: The clinical pharmacist analyzed the anti-infective treatment of a pediatric patient with pneumonia caused by ESBLs-producing Klebsiella pneumoniae to find the possible reason for poor efficacy and
optimize therapeutic schedule. Results: Cefoperazone/ sulbactam (68 mg/kg, q 12 h) empirically given to this child with healthcare-
associated pneumonia (HCAP) was reasonable. The reduced dose of cefoperazone/ sulbactam (45 mg/kg, q 12 h) on the fifth day
might be the main reason of poor efficacy. ESBLs-producing Klebsiella pneumoniae was detected in bronchoalveolar lavage fluid, and the clinical pharmacist suggested to change it to imipenem and cilastatin (imipenem 15 mg/ kg, q 6 h). Pulmonary infection was effectively controlled and discharged from the hospital finally. Conclusion: Compound preparations containing lactamase inhibitor can be used to treat mild or moderate pneumonia caused by ESBLs-producing Klebsiella pneumonia, and for the children with underlying disease, if cefoperazone/sulbactam is chosen, sufficient dosage and frequency is recommended, for example, 50 mg/ kg, q 8 h. For the severe patients, carbapenem antibiotics is recommend, but the differences of efficacy and adverse effects should be considered. |
| Key words: healthcare-associated pneumonia extended spectrum β-lactamases-producing Klebsiella pneumoniae clinical pharmacist |
