1例军团菌重症肺炎抗感染治疗药学监护及文献分析

李芳; 王宁; 金典; 龙秀英; 曾尚霞; 魏京霞

doi:10.6039/j.issn.1001-0408.2024.24.20

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1例军团菌重症肺炎抗感染治疗药学监护及文献分析

药师与药学服务 | 更新时间：2024-12-26

- 1例军团菌重症肺炎抗感染治疗药学监护及文献分析
- Anti-infective treatment for a severe case of Legionella pneumonia： pharmaceutical care and literature analysis
- 中国药房 2024年35卷第24期页码：3081-3086
- 作者机构：
  
  1.成都市第六人民医院药剂科，成都　610051
  2.成都市第六人民医院神经内科，成都　610051
- 作者简介：
  
  主管药师，硕士。研究方向：临床药学。E-mail：catherine_lf@126.com
  主任医师。研究方向：脑血管病的防治。E-mail：464480368@qq.com
- 基金信息：
  
  成都市医学科研课题立项项目(2023641)
- DOI：10.6039/j.issn.1001-0408.2024.24.20
  中图分类号： R969.3
- 纸质出版日期：2024-12-30，
  
  收稿日期：2024-07-20，
  
  修回日期：2024-11-13，
- 稿件说明：
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李芳,王宁,金典等.1例军团菌重症肺炎抗感染治疗药学监护及文献分析 ^Δ[J].中国药房,2024,35(24):3081-3086.

LI Fang,WANG Ning,JIN Dian,et al.Anti-infective treatment for a severe case of Legionella pneumonia： pharmaceutical care and literature analysis[J].ZHONGGUO YAOFANG,2024,35(24):3081-3086.
李芳,王宁,金典等.1例军团菌重症肺炎抗感染治疗药学监护及文献分析 ^Δ[J].中国药房,2024,35(24):3081-3086. DOI： 10.6039/j.issn.1001-0408.2024.24.20.

LI Fang,WANG Ning,JIN Dian,et al.Anti-infective treatment for a severe case of Legionella pneumonia： pharmaceutical care and literature analysis[J].ZHONGGUO YAOFANG,2024,35(24):3081-3086. DOI： 10.6039/j.issn.1001-0408.2024.24.20.

摘要

目的

为军团菌重症肺炎抗感染治疗药学监护提供治疗思路与参考。

方法

临床药师参与1例军团菌重症肺炎患者治疗全过程，协助临床医师根据患者临床症状、体征、肺部影像学变化等，利用WUH（Winthrop-University Hospital criteria）评分系统评估感染病原体，利用其药学专业知识，建议哌拉西林钠他唑巴坦钠联合盐酸莫西沙星抗感染，实时监护患者的临床表现；及时发现患者谵妄和脂肪酶、淀粉酶、肝酶异常升高，分析原因后，先后建议调整治疗方案为哌拉西林钠他唑巴坦钠联合多西环素或阿奇霉素抗感染，并配合保肝治疗、肠内营养、肠外营养。此外，临床药师还密切关注患者的用药依从性并对其进行用药教育。

结果

临床医师采纳临床药师的建议，患者治疗后好转出院，1个月后复查无反复。

结论

临床药师在协助临床医师治疗军团菌重症肺炎时，不仅需关注患者临床症状、体征的改变，还需密切监测氟喹诺酮类、四环素类以及大环内酯类抗菌药物的不良反应，及时识别不良反应并提供治疗方案调整建议，并为患者提供全程药学监护，保证临床治疗的有效性和安全性。

Abstract

OBJECTIVE

To provide certain therapeutic ideas and references for the pharmaceutical care of severe

Legionella

pneumonia in anti-infection treatment.

METHODS

Clinical pharmacists participated in the entire treatment process of a patient with severe

Legionella

pneumonia， and assisted clinical physicians in evaluating the infecting pathogens using the WUH （Winthrop-University Hospital criteria） scoring system， based on the patient’s clinical symptoms， physical signs， and changes in pulmonary imaging. Leveraging their pharmaceutical expertise， clinical pharmacists recommended a combination of piperacillin sodium and tazobactam with moxifloxacin hydrochloride for anti-infection treatment， and closely monitored the patient’s clinical manifestations. They promptly identified delirium and abnormally elevated levels of lipase， amylase and liver enzymes， and successively suggested adjusting the treatment plan to a combination of piperacillin sodium and tazobactam with doxycycline or azithromycin for anti-infection after analyzing the causes， along with liver protection treatment， enteral nutrition， and parenteral nutrition. Additionally， clinical pharmacists closely monitor the patient’s medication adherence and provide her with medication education.

RESULTS

The clinical physicians accepted the recommendations of the clinical pharmacists， and the patient improved after treatment and was discharged. A follow-up examination one month later showed no recurrence.

CONCLUSIONS

Clinical pharmacists， when assisting clinicians in treating severe

Legionella

pneumonia， not only pay attention to changes in the patient’s clinical sy

mptoms and physical signs， but also closely monitor the adverse reactions of fluoroquinolone， tetracycline， and macrolide antibiotics. They should promptly recognize adverse reactions and provide recommendations for adjusting treatment plans， as well as offer comprehensive pharmaceutical care throughout the patient’s treatment， to ensure the effectiveness and safety of clinical therapy.

关键词

重症肺炎军团菌药学监护不良反应临床药师WUH评分系统

Keywords

Legionellapharmaceutical careadverse reactionsclinical pharmacistWUH scoring system

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