摘要
目的:分析1例车祸伤患者并发人型支原体血流感染的抗感染治疗与药学监护过程,为临床人型支原体感染患者的抗感染治疗提供参考。方法与结果:患者因车祸致全身挫伤、骨折和严重腹部损伤而入院,入院后即予手术治疗,术后予头孢哌酮-舒巴坦钠;2 d后,患者的白细胞计数、中性粒细胞百分比(NEUT%)、C反应蛋白(C-reactive protein,CRP)水平均呈现异常,之后又出现发热、腹痛和降钙素原水平升高,考虑并发感染且有加重趋势,遂改用美罗培南;治疗2周后,患者的感染症状明显好转,NEUT%和CRP也较前改善;但次日,患者再次发热,且CRP水平异常升高,临床药师考虑可能继发其他感染,遂建议完善病原学检查和加用阿米卡星;2 d后,患者静脉导管尖端培养检出人型支原体,临床药师综合患者既往病情后,建议将抗感染治疗方案调整为多西环素+美罗培南;又2 d后,患者血培养也检出人型支原体,且药敏试验提示其对多西环素敏感;在多西环素治疗2周后,患者感染症状基本消失,感染指标也恢复正常,且血培养结果亦转为阴性。结论:支原体作为非典型病原体,其在临床开展经验性抗感染时常常被忽视,当经验性治疗效果不佳时,临床应充分考虑可能的病原菌,并完善病原学检查,待获取病原菌信息后,应及时开展针对性的抗感染治疗和药学监护,以保障患者的抗感染治疗效果。
Objective:To analyze the process of antimicrobial therapy and pharmaceutical care for one patient with traffic accident injury complicated by Mycoplasma hominis bloodstream infection,and provide a reference for clinical antimicrobial treatment of patients with Mycoplasma hominis infection.Methods and Results:The patient was admitted to the hospital due to systemic contusion,fracture,and severe abdominal injury caused by a traffic accident.Surgical treatment was immediately performed after admission,and cefoperazone-sulbactam sodium was administered postoperatively.Two days later,the patient's white blood cell count,neutrophil percentage(NEUT%),and C-reactive protein(CRP)levels were all abnormal.Subsequently,fever,abdominal pain,and an increase in procalcitonin level occurred,indicating concurrent infection with a trend of aggravation,so meropenem was used instead.After 2 weeks of treatment,the patient's infectious symptoms improved significantly,and NEUT%and CRP also improved compared with before.However,the next day,the patient developed fever again,and the CRP level increased abnormally.Clinical pharmacists considered the possibility of other secondary infections,so they suggested improving etiological examinations and adding amikacin.Two days later,Mycoplasma hominis was detected in the culture of the tip of the patient's intravenous catheter.After comprehensively evaluating the patient's previous conditions,clinical pharmacists suggested adjusting the antimicrobial treatment regimen to doxycycline+meropenem.Another two days later,Mycoplasma hominis was also detected in the patient's blood culture,and the drug susceptibility test showed that it was sensitive to doxycycline.After 2 weeks of treatment with doxycycline,the patient's infectious symptoms basically disappeared,the infection indicators returned to normal,and the blood culture results also turned negative.Conclusion:As an atypical pathogen,mycoplasma is often ignored in clinical empirical antimicrobial treatment.When the empirical treatment has poor effect,the possible pathogens should be fully considered,and etiological examinations should be improved.After obtaining pathogen information,targeted antimicrobial treatment and pharmaceutical care should be carried out in a timely manner to ensure the effect of antimicrobial treatment for patients.
作者
胡珺
万亭池
张洪健
滕智远
蒲婷婷
HU Jun;WAN Ting-chi;ZHANG Hong-jian;TENG Zhi-yuan;PU Ting-ting(The Second People's Hospital of Guiyang,Guiyang 550081,China;Guizhou Medical University,Guiyang 550004,China)
出处
《抗感染药学》
2025年第3期222-225,共4页
Anti-infection Pharmacy
关键词
人型支原体
血流感染
抗感染治疗
药学监护
临床药师
Mycoplasma hominis
bloodstream infection
antimicrobial therapy
pharmaceutical care
clinical pharmacist
作者简介
胡珺(1992-),女,硕士,主管药师;通信作者:万亭池(1995-),女,硕士,主管药师,电子邮箱:13022512910@163.com。
