1例广泛耐药肺炎克雷伯菌所致呼吸机相关性肺炎 治疗的药学实践

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【中图分类号】R97 【文献标识码】A

【Abstract】This article reports a postcraniotomy patient with renal insufficiency and electrolyte imbalance who developed ventilator-associated pneumonia caused by extensively drugresistant Klebsiella pneumoniae.According to the patient's pathophysiological characteristics， bacterial epidemiological characteristics，and bacterial culture results，combined with the latest guidelines and the pharmacokinetic/pharmacodynamic characteristics of antibiotics，a full-dose ceftazidime/avibactam regimen was initially suggested by the clinical pharmacist， and which was adopted by doctor.When the effect of ceftazidime/avibactam was poor and no guidelinerecommended alternatives were available， the clinical pharmacist， in conjunction with clinical experience， proposed a combination therapy of colistin sulfate and tigecycline， with the implementation of adverse reaction monitoring and mucin sulfate blood concentration monitoring.Finaly，the pneumonia was effectivelycontrolled，the inflammatory indicators such as temperatureand the white bloodcellcount returned to normal， noadverse drug reactions occurred，and the patient was successfully transferred totherehabilitation institution. Clinical pharmacists stay updated on the latest medication knowledge both domestically and internationally， recommend advanced drug treatment protocols for clinical practice，asist in managing severe infections，and playanimportant role in the clinical team.

【Keywords】Extensively drug resistant Klebsiell pneumoniae; Ventilator-associated pneumonia; Antiinfective treatment; Ceftazidimeavibactam; Colistin sulfate; Pharmaceutical care

神经外科颅脑术后的患者由于呼吸中枢受损、吞咽障碍、长期卧床，再合并误吸、排痰不利等因素，常会出现呼吸障碍，需行气管插管机械通气。（剩余14444字）