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外科手术部位感染(SSI)是医疗保健相关感染的常见原因[1],大多数SSI发生的平均时间为术后12 d[2]。耐甲氧西林金黄色葡萄球菌(MRSA)是指对已经批准的所有β内酰胺类抗菌药物有交叉耐药的金黄色葡萄球菌[3]。感染MRSA外科伤口较严重的患者,建议静脉输注糖肽类、利奈唑胺或达托霉素治疗[3]。因临床应用万古霉素经验丰富,为胃肠外首选[4]。但其治疗窗窄、不良反应多、血药浓度影响因素较多等特点,根据患者临床情况实施治疗药物监测(TDM)和个体化用药显得尤为重要。笔者介绍1例临床药师对足损伤术后感染MRSA患者进行药学监护的体会。
The pharmaceutical care by clinical pharmacists for a foot injury patient with postoperative MRSA infection
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摘要:
目的 探讨临床药师在术后感染MRSA患者药物治疗监护中作用。 方法 通过参与制订抗感染治疗方案、选择抗菌药物、识别MRSA感染高危因素、评估万古霉素疗效、利用TDM技术调整剂量,以及对万古霉素不良反应监护及处理。 结果 在临床药师的药学监护下,患者得到有效治疗,避免了万古霉素相关不良反应的进一步伤害。 结论 临床药师在促进患者及时康复、精准安全用药中发挥了重要作用。 -
关键词:
- 临床药师 /
- 万古霉素 /
- 耐甲氧西林金黄色葡萄球菌 /
- 药学监护
Abstract:Objective To explore the clinical pharmacist’s role in drug therapy and monitoring for the patient with postoperative MRSA infection. Methods Clinical pharmacists participated in planning anti-infective treatment, antimicrobial medication selection, identification of high-risk factors for MRSA infection, evaluation of vancomycin efficacy, dosage adjustment using TDM technology, monitoring and management of vancomycin adverse reactions. Results With the pharmaceutical care provided by clinical pharmacists, the patient received effective treatment with minimal vancomycin-related adverse reactions. Conclusion Clinical pharmacists played an important role in accelerating patient recovery by rational and safe medication use. -
Key words:
- clinical pharmacist /
- vancomycin /
- MRSA /
- pharmaceutical care
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