Practice of clinical pharmacist participating in the treatment of a case of mixed shock caused by severe scrub typhus

HUANG Xiaoyan; XIE Jingwen; XIA Yanzhe; LI Jia

doi:10.6039/j.issn.1001-0408.2025.05.17

您当前的位置：

首页 >

文章列表页 >

Practice of clinical pharmacist participating in the treatment of a case of mixed shock caused by severe scrub typhus

更新时间：2025-09-26

- Practice of clinical pharmacist participating in the treatment of a case of mixed shock caused by severe scrub typhus
- ZHONGGUO YAOFANG Vol. 36, Issue 5, Pages: 600-605(2025)
- 作者机构：
  
  1.中山大学附属第六医院药学部，广州　510655
  2.广州市黄埔区中六生物医学创新研究院，广州　510655
  3.中山大学附属第一医院药学部，广州　510080
- 作者简介：
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2025.05.17
  CLC： R969.3
- Received：02 December 2024，
  
  Revised：2025-02-07，
  
  Accepted：08 February 2025，
  
  Published：15 March 2025
- 稿件说明：
移动端阅览
黄小艳,谢静文,夏延哲,等.临床药师参与1例重症恙虫病致混合性休克的药学实践[J].中国药房,2025,36(05):600-605.

HUANG Xiaoyan,XIE Jingwen,XIA Yanzhe,et al.Practice of clinical pharmacist participating in the treatment of a case of mixed shock caused by severe scrub typhus[J].ZHONGGUO YAOFANG,2025,36(05):600-605.
黄小艳,谢静文,夏延哲,等.临床药师参与1例重症恙虫病致混合性休克的药学实践[J].中国药房,2025,36(05):600-605. DOI： 10.6039/j.issn.1001-0408.2025.05.17.

HUANG Xiaoyan,XIE Jingwen,XIA Yanzhe,et al.Practice of clinical pharmacist participating in the treatment of a case of mixed shock caused by severe scrub typhus[J].ZHONGGUO YAOFANG,2025,36(05):600-605. DOI： 10.6039/j.issn.1001-0408.2025.05.17.

摘要

目的

为重症恙虫病患者的抗感染方案调整、不良反应识别及个体化药学监护提供参考。

方法

临床药师参与1例重症恙虫病致混合性休克并行连续性肾脏替代治疗及体外膜肺氧合的患者抗感染的药学监护过程。患者初始给予美罗培南（1 g， q12 h，ivdrip）联合多西环素（0.1 g，q12 h，po）治疗，因其肠道功能差，后改为美罗培南（1 g，q8 h，ivdrip）联合奥马环素（100 mg，qd，ivdrip）治疗。患者情况逐渐变差，感染未受控制，临床药师建议临床医生将抗感染方案调整为美罗培南（2 g，q8 h，ivdrip）联合替加环素（100 mg首剂；50 mg，q12 h维持；ivdrip）。临床医生采纳临床药师的建议。治疗后患者症状好转，感染指标明显下降，感染受控。但因患者胆红素持续上升，为减少药物性肝损伤风险，临床药师建议临床医生可将替加环素替换为阿奇霉素（0.5 g，qd，ivdrip）。

结果

治疗后肺泡灌洗液及血标本宏基因组高通量测序提示患者恙虫病东方体被完全清除。

结论

替加环素是重症恙虫病患者的一个有效选择。对于极危重的恙虫病患者，采用替加环素联合阿奇霉素治疗可能是清除恙虫病东方体更有效的方案。

Abstract

OBJECTIVE

To provide valuable insights for the adjustment of anti-infectious regimens， identification of adverse reactions， and individualized pharmaceutical care in patients with critically severe scrub typhus.

METHODS

Clinical pharmacists actively participated in the pharmaceutical care process for a patient with severe scrub typhus leading to mixed shock undergoing continuous renal replacement therapy and extracorporeal membrane oxygenation. Initially， the patient received meropenem （1 g， q12 h， ivdrip）， in combination with doxycycline （0.1 g， q12 h， po）， which was later switched to meropenem （1 g， q8 h， ivdrip） along with omacycline （100 mg， qd， ivdrip） due to impaired gastrointestinal function. However， as the patient’s condition progressively deteriorated and the infection became uncontrolled， the clinical pharmacists recommended that the clinicians adjust the anti-infective regimen to meropenem （2 g， q8 h， ivdrip） combined with tigecycline （100 mg for first dose； 50 mg， q12 h for maintenance； ivdrip）. The clinicians followed the advice of the clinical pharmacists. After treatment， the patient’s symptoms exhibited significant improvement， accompanied by a notable decrease in inflammatory markers， indicating that the infection had been successfully controlled. However， due to continuously increasing bilirubin levels， in order to reduce the risk of drug-induced liver injury， the clinicians changed tigecycline to azithromycin （0.5 g， qd， ivdrip） following the recommendation of the clinical pharmacists.

RESULTS

Ultimately， metagenomic next-generation sequencing of the bronchoalveolar lavage fluid and blood specimens indicated that

Orientia tsutsugamushi

had been completely eradicated in the patient.

CONCLUSIONS

Tigecycline may be a viable therapeutic choice for patients with severe scrub typhus. In the context of critically ill patients with scrub typhus， combining tigecycline with azithromycin might potentially enhance the efficacy in eliminating

Orientia tsutsugamushi

关键词

Keywords

references

SINGH O B ， PANDA P K . Scrub typhus [EB/OL ] . （ 2024-03-17 ）[ 2024-08-15 ] . https：//www.ncbi.nlm.nih.gov/books/NBK558901/ https://www.ncbi.nlm.nih.gov/books/NBK558901/ .

TAYLOR A J ， PARIS D H ， NEWTON P N . A systematic review of mortality from untreated scrub typhus （ Orientia tsutsugamushi ） [J ] . PLoS Negl Trop Dis ， 2015 ， 9 （ 8 ）： e0003971 .

姜天俊，江佳富，齐文杰，等 . 恙虫病临床诊疗专家共识 [J ] . 中国人兽共患病学报， 2024 ， 40 （ 1 ）： 1 - 6 .

JIANG T J ， JIANG J F ， QI W J ， et al . Expert consensus on the clinical diagnosis and treatment of scrub typhus [J ] . Chin J Zoonoses ， 2024 ， 40 （ 1 ）： 1 - 6 .

KIM Y S ， YUN H J ， SHIM S K ， et al . A comparative trial of a single dose of azithromycin versus doxycycline for the treatment of mild scrub typhus [J ] . Clin Infect Dis ， 2004 ， 39 （ 9 ）： 1329 - 1335 .

PHIMDA K ， HOONTRAKUL S ， SUTTINONT C ， et al . Doxycycline versus azithromycin for treatment of leptospi- rosis and scrub typhus [J ] . Antimicrob Agents Chemother ， 2007 ， 51 （ 9 ）： 3259 - 3263 .

KABIR K I ， JOHN J ， SATAPATHY A K ， et al . Oral azithromycin versus doxycycline in the treatment of children with uncomplicated scrub typhus：a randomized controlled trial [J ] . Pediatr Infect Dis J ， 2022 ， 41 （ 3 ）： 224 - 229 .

临床常用四环素类药物合理应用多学科专家共识编写组，中华预防医学会医院感染控制分会，中国药理学会临床药理分会 . 临床常用四环素类药物合理应用多学科专家共识 [J ] . 中华医学杂志， 2023 ， 103 （ 30 ）： 2281 - 2296 .

Editing Group for Multidisciplinary Expert Consensus on the Rational Use of Tetracyclines Commonly Used in Clinical Practice ， Hospital Infection Control Branch of Chinese Preventive Medicine Association ， Clinical Pharmacology Branch of Chinese Pharmacological Society . Multidisciplinary expert consensus on the rational use of tetracyclines commonly used in clinical practice [J ] . Natl Med J China ， 2023 ， 103 （ 30 ）： 2281 - 2296 .

QUADE B R ， RAMÍREZ-HERNÁNDEZ A ， BLANTON L S . In vitro susceptibility of Rickettsia species to eravacycline，omadacycline，and tigecycline [J ] . Antimicrob Agents Chemother ， 2021 ， 65 （ 8 ）： e0066521 .

WATKINS R R ， DERESINSKI S . Omadacycline：a novel tetracycline derivative with oral and intravenous formulations [J ] . Clin Infect Dis ， 2019 ， 69 （ 5 ）： 890 - 896 .

LEE S M ， KWON H Y ， IM J H ， et al . In vitro activity of tigecycline against Orientia tsutsugamushi [J ] . Yonsei Med J ， 2016 ， 57 （ 4 ）： 1034 - 1037 .

VARGHESE G M ， DAYANAND D ， GUNASEKARAN K ， et al . Intravenous doxycycline，azithromycin，or both for severe scrub typhus [J ] . N Engl J Med ， 2023 ， 388 （ 9 ）： 792 - 803 .

连续性肾替代治疗抗菌药物剂量调整共识专家组，中国药学会医院药学专业委员会，中国医药教育协会感染疾病专业委员会 . 连续性肾替代治疗抗菌药物剂量调整专家共识：2024年版 [J ] . 中华肾脏病杂志， 2024 ， 40 （ 2 ）： 158 - 174 .

Expert Group of Antimicrobial Dosing Optimization Du- ring Continuous Renal Replacement Therapy ， Chinese Pharmaceutical Association Hospital Pharmacy Professional Committee ， Infectious Diseases Professional Committee of China Medical Education Association . Expert consensus on antimicrobial dosing optimization during continuous renal replacement therapy：2024 edition [J ] . Chin J Nephrol ， 2024 ， 40 （ 2 ）： 158 - 174 .

中国医师协会呼吸医师分会危重症医学专业委员会，中华医学会呼吸病学分会危重症医学学组 . 体外膜式氧合治疗成人重症呼吸衰竭推荐意见 [J ] . 中华结核和呼吸杂志， 2019 ， 42 （ 9 ）： 660 - 684 .

The Critical Care Medicine Professional Committee of the Respiratory Physicians Branch of the Chinese Medical Association ， Critical Care Medicine Group ， Respiratory Medicine Branch ， Chinese Medical Association . Recommendations for the use of extracorporeal membrane oxygenation in adult patients with severe respiratory failure [J ] . Chin J Tuberc Respir Dis ， 2019 ， 42 （ 9 ）： 660 - 684 .

张玉，陈孝，张毕奎，等 . 新型冠状病毒肺炎临床合理用药专家共识 [J ] . 中国医院药学杂志， 2020 ， 40 （ 6 ）： 593 - 605 .

ZHANG Y ， CHEN X ， ZHANG B K ， et al . Expert consensus on rational drug use in clinical practice for COVID-19 [J ] . Chin J Hosp Pharm ， 2020 ， 40 （ 6 ）： 593 - 605 .

JARURATANASIRIKUL S ， THENGYAI S ， WONGPOOWARAK W ， et al . Population pharmacokinetics and Monte Carlo dosing simulations of meropenem during the early phase of severe sepsis and septic shock in critically ill patients in intensive care units [J ] . Antimicrob Agents Chemother ， 2015 ， 59 （ 6 ）： 2995 - 3001 .

LERTWATTANACHAI T ， MONTAKANTIKUL P ， TANGSUJARITVIJIT V ， et al . Clinical outcomes of empirical high-dose meropenem in critically ill patients with sepsis and septic shock：a randomized controlled trial [J ] . J Intensive Care ， 2020 ， 8 ： 26 .

VEINSTEIN A ， DEBOUVERIE O ， GRÉGOIRE N ， et al . Lack of effect of extracorporeal membrane oxygenation on tigecycline pharmacokinetics [J ] . J Antimicrob Chemother ， 2012 ， 67 （ 4 ）： 1047 - 1048 .

HAHN J ， CHOI J H ， CHANG M J . Pharmacokinetic changes of antibiotic，antiviral，antituberculosis and antifungal agents during extracorporeal membrane oxyge- nation in critically ill adult patients [J ] . J Clin Pharm Ther ， 2017 ， 42 （ 6 ）： 661 - 671 .

Views

107

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Anti-infection treatment and pharmaceutical care for a patient with severe pneumonia caused by Chlamydia psittaci

特殊配方强化肠外营养支持治疗危重症患者的临床研究

Research advance of population pharmacokinetics of imipenem-cilastatin in special status populations

Related Author

LI Jun

LAI Zongqiang

SHANG Yongguang

庞晓军杜正隆苏方赵志梅骆萍曾德福

ZUO Jianli

HE Yao

LI Fushu

CHEN Xing

Related Institution

Dept. of Pharmacy， the Second Affiliated Hospital of Guangxi Medical University

Dept. of Pharmacy， China-Japan Friendship Hospital

Address：8th Floor, Sihuan Building, No. 129 Daping Main Street, Yuzhong District, Chongqing, China Postal code：400042
Technical support is provided by Beijing Founder Electronics co., LTD 渝ICP备15012710号公网安备50010302001817
It is recommended to read the content of this site in Chrome&IE9+. Please switch to extreme mode in browser 360.
Cookies We use cookies to help provide and enhance our service and tailor content. By continuing, you agree to the use of cookies.

⁰