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8例NSICU耐碳青霉烯-肺炎克雷伯菌感染的治疗分析.doc

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8例NSICU耐碳青霉烯-肺炎克雷伯菌感染的治疗分析.doc
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8 NSICU - : : 2016 1 12 8 , , :8 , 75%, 50%, 25%, : CRKP , , , ; ; ; ; , , , , : ; :0731-84667573;E-mail:glycerinum@163.com , , , , : ; :0731-88618496;E-mail:L8618496@126.com - ( :2017JJ2285) Therapeutic analysis of 8 cases of carbapenem resistant Klebsiella pneumoniae infection in NSICU LIU Xiao-hui LIU Shi-kun HE Ge-fei ZHANG Shun-zhi YI Ai-chun CHEN Heng SUN Ji OUYANG Li-hui First Hospital of Changsha; Department of Pharmacy, Third Xiangya Hospital of Central South University; Abstract OBJECTIVE To research clinical effects of clinical pharmacist participation in treating carbapenem resistant Klebsiella pneumoniae (CRKP) infection in the neurosurgical intensive care unit ( NSICU) . METHODS Eight cases of CRKP infection consultation records were collected by the clinical pharmacists from January to December in 2016. The fatal rate was analyzed as the main outcome indicators, clinical effect, clearance of bacteria and incidence of adverse events were as the secondary outcome indicators. RESULTS After clinical pharmacist consultations, the effective rate was 75%, the bacterial clearance rate was 50%, mortality was 25%. No adverse drug reaction appeared. CONCLUSION The participation of clinical pharmacists in the consultations of CRKP infection treatment optimizes clinical drug treatment, improves the therapeutic effects and ensures the safety of medical quality. Keyword clinical pharmacist; infection; carbapenem resistant Klebsiella pneumoniae (CRKP) ; pharmaceutical care; (neurosurgical intensive care unit / SICU) SICU , , (carbapenem-resistant Klebsiella pneumonia, CRKP) , NSICU [1] , , 2016 1~12 NSICU 8 CRKP , 1 1.1 2016 1 1 12 31 NSICU CRKP , 8 , , Excel , 1.2 , : NSICU ; , 2014 [3] / WHO 2 2.1 8 , 7 , 1 , , (APACHE II) 20~34 , , 1 , 6 , 6 , 6 1 1 8 Tab 1 Clinical characteristics of the 8 patients 2.2 CRKP 8 6 CRKP , 9~31 , CRKP , 2.3 8 , 4~21 , 6 (75%) , 4 (50%) , 2 (25%) , 1 , , 1 3 3.1 CRKP 2015 , 6.8%, NSICU CRKP [2-3] , CRKP : , , , , , [4] ICU, , , , , 16 , , , , , ICU , [5] 3.2 CRKP , CRKP , , - , , CRKP , , , , CRKP , : (1) , , [6-8]; (2) , 2~3 h, , CRKP , , [9]; (3) , , , , [10-18] CRKP : (1) 1 g ivgtt q8h , 3 h; (2) , , (15 5~7 , , , CRKP , , : (1) , , ; (2) , , ; (3) , ; (4) , , , , , ; (5) , , , CRKP , (HICPAC) : (1) ; (2) CRKP , CRKP ; (3) ; (4) , , , CRKP [4,19-20]; (5) 2% 3.3 , , 48 , , , , , , , , , C- , : , , G ++; :CRKP++++, , ++; : , 70%, , : CRKP, CT: , , , MIC , 1.0 g ivgtt q8h ( 3 h) 1.44 g 3 7 , , , , , , , , , 3 3 CRKP ; 0.6 g ivgtt qd , , 7 , , , , , , 3 , , , 200 mg ivgtt qd ( ) , 100 mg ivgtt q12h, 4.0 g ivgtt q8h, , 21 , , , , , , , 2 Tab 2 Partial laboratory detection indexes of the patients , CRKP , , , , , , , 4 CRKP , , , , CRKP , , , [1]Da R, Wang W, Lei JE, et al.Analysis on pathogens distribution and antibacterial susceptibility of bacteria isolated in neurosurgery[J].Int J Lab Med ( ) , 2015, 36 (18) :2617-2619. [2]LIU Y, LI DH, HONG T, et al.Clinical distribution and multiple drug-resistance of drug resistant strains in neurosurgery ICUdepartment[J].Exper Laborat Med ( ) , 2015, 33 (6) :717-720. [3]LI Q, WU YX, TANG MZ, et al.Distribution and antimicrobial-resistance of bacteria isolated in nosocomial infection in NSICU within20 years[J].J Clin Neurosurg ( ) , 2016, 13 (1) :49-59. [4]Borer A1, Saidel-Odes L, Eskira S, et al.Risk factors for developing clinical infection with carbapenem-resistant Klebsiella pneumoniae in hospital patients initially only colonized with carbapenem-resistant K pneumoniae[J].Am J Infect Control, 2012, 40 (5) :421-425. [5]Anderson KF, Lonsway DR, Rasheed JK, et al.Evaluation of methods to identify the Klebsiella pneumoniae carbapenemase in Enterobacteriaceae.[J].J Clin Microbiol, 2007, 45 (8) :2723-2725. [6]Zubair AQ, David LP, Brian AP, et al.Treatment Outcome of Bacteremia Due to KPC-Producing Klebsiella pneumoniae:Superiority of Combination Antimicrobial Regimens[J].Antimicrob Agent Chemother, 2012, 56 (4) :2108-2113. [7]Falagas ME, Lourida P, Poulikakos P, et al.Antibiotic Treatment of Infections Due to Carbapenem-Resistant Enterobacteriaceae:Systematic Evaluation of the Available Evidence[J].Antimicrob Agent Chemother, 2014, 58 (2) :654-663. [8]GD Pascale, L Montini, MA Pennisi, et al.High dose tigecycline in critically ill patients with severe infections due to multidrug-resistant bacteria[J].Crit Care, 2014, 18 (3) :1-9. [9]Chinese XDR Consensus Working Group, Guan XD, He LX, et al.Laboratory diagnosis, clinical management and infection control of the infections caused by extensively drug-resistant Gram-negative bacilli:a Chinese consensus statement[J].Clin Microbiol Infect, 2016, 22 (Suppl 1) :S15-S25. [10]G.Samonis, S.Maraki, D.E.Kara, et al.Synergy of fosfomycin with carbapenems, colistin, netilmicin, and tigecycline against multidrug-resistant Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa clinical isolates[J].Eur J Clin Microbiol Infect Dis, 2012, 3 (1) :695-701. [11]Tseng YC, Kan LP, Huang LY, et al.Successful treatment of a patient with ventriculoperitoneal shunt-associated meningitis caused by extended- -lactamase-producing Klebsiella pneumoniae[J].Tohoku J Exp Med 2014, 233 (4) :301-305. [12]LI L, ZHANG XF, ZENG YZ, et al.The efficacy of fosfomycin for the treatment of nosocomial infections caused by carbapenem-resistant Klebsiella pneumoniae[J].Med J West China ( ) , 2015, 27 (4) :611-613. [13]HU CW, CAI ZL, ZHANG Z.Analysis of mutations of the par C gene of Klebsiella pneumoniae infecting Neurology patients and the rational selection of antibiotics[J].J Pathogen Biol ( ) , 2015, 10 (7) :644-647. 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