| 摘要: |
| 目的:探讨获得性免疫缺陷患儿播散性葡萄球菌感染的个体化抗感染治疗策略,为临床合理用药提供参考。方法:临床
药师参与并指导了1 例获得性免疫缺陷患儿皮肤播散性葡萄球菌感染的治疗过程。通过综合分析病原学检测结果、药动学/ 药
效学(PK/ PD)特征以及个体化的药学问诊信息,药师对治疗方案中的抗菌药物选择、剂量调整、不良反应监测及免疫支持治疗
进行了系统化、全方位的药学干预。结果:初始氟氯西林治疗无效后换用万古霉素,但其稳态谷浓度(5. 7 μg/ mL) 低于目标值
(10~20 μg/ mL),结合患儿肌酐清除率(198. 17 mL/ min)明确肾功能亢进(ARC)导致药物暴露不足。药师追溯病史发现,患儿
因肾病综合征使用利妥昔单抗致B 细胞耗竭及免疫球蛋白(Ig)G 降低(3. 53 g/ L)。药师建议补充免疫球蛋白并调整方案为利
奈唑胺(剂量优化)联合阿奇霉素,治疗后体温、炎症指标逐渐恢复正常,血小板计数稳定,出院后随访1 个月无复发。结论:免
疫缺陷患儿深部皮肤感染的治疗需综合宿主免疫抑制状态、ARC 及混合感染因素,通过多学科协作制定个体化治疗方案,临床
药师参与药学监护可提升播散性葡萄球菌感染治疗的合理用药水平和安全性。 |
| 关键词: 免疫缺陷 人葡萄球菌感染 利奈唑胺 药学监护 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2025.08.009 |
|
| 基金项目: |
|
| Clinical Pharmaceutical Practice of Individualized Treatment for Disseminated Staphylococcus Hominis SkinInfection in a Child with Acquired Immunodeficiency |
| Sun Mengjie1, Chen Huiying2, Cai Heping2 |
| (1. Bengbu Hospital of Traditional Chinese Medicine, Anhui Bengbu 233002,
China; 2. Anhui Provincial Children’s Hospital, Hefei 230000, China) |
| Abstract: |
| Objective: To probe into the individualized anti-infection treatment strategies for disseminated Staphylococcus hominis
infection in children with acquired immunodeficiency, and to provide references for rational drug use in clinical practice. Methods:
Clinical pharmacists participated in and guided the treatment of disseminated S. hominis skin infection of a child with acquired immune
deficiency. By analyzing the results of pathogen detection, pharmacokinetic/ pharmacodynamic ( PK/ PD) characteristics, and
individualized medication inquiry information, the pharmacists performed systematic and comprehensive pharmaceutical intervention in
the treatment regimen, including selection of antibiotics, dose adjustment, adverse drug reaction monitoring, and immunosupportive
therapy. Results: After the initial flucloxacillin treatment was ineffective, vancomycin was used instead. However, its steady-state
trough concentration (5. 7 μg/ mL) was lower than the target value (10 to 20 μg/ mL). Combined with the creatinine clearance rate
(198. 17 mL/ min) of the children, it was confirmed that augmented renal clearance (ARC) led to insufficient drug exposure. Upon
reviewing the medical history, the pharmacists identified B-cell depletion and significant reduction in immune globulin (Ig)G levels
(3. 53 g/ L) due to prior rituximab administration for nephrotic syndrome. The pharmacists suggested that immunoglobulin should be
supplemented and the regimen should be adjusted to linezolid (dose optimization) combined with azithromycin. After treatment, the
body temperature and inflammatory indicators returned to normal state, and the platelet count was stable, there was no recurrence at
1-month follow-up. Conclusion: Treating deep skin infections in children with immune deficiency necessitates a holistic consideration of
the host’s immune suppression status, ARC, and potential mixed infections. Through multidisciplinary collaboration, tailored treatment
regimens can be developed. The involvement of clinical pharmacists in pharmaceutical care enhances the rationality and safety of treating
disseminated S. hominis infection. |
| Key words: immunodeficiency Staphylococcus hominis infection linezolid pharmaceutical care |
