Pharmaceutical Care of Anti-infective Treatment in a Patient with Rickettsia-associated Septic Shock
Objective:To analyze the pharmaceutical care process of anti-infective treatment in a patient with Rickettsia-associated septic shock,and provide reference for the diagnosis and treatment of serious infection caused by Rickettsia in clinical practice.Methods and Results:The patient developed fever and dry cough without obvious inducement 6 days ago,and dyspnea 1 day ago.The examination at admission showed that the procalcitonin(3.23 ng/mL)and C-reactive protein(120.4 mg/L)levels increased obviously,so the clinician gave empiric anti-infective treatment with imipenem-cilastatin sodium,levofloxacin,and ribavirin;on the 2nd day,the patient showed symptoms of septic shock,and after consultation with the clinical pharmacist,it was suggested that the anti-infective treatment regimen was adjust to meropenem and azithromycin;on the 4th day,the metagenomic next-generation sequencing(mNGS)test results of the patient's blood samples showed positive for Rickettsia japonica,while the mNGS results of the sputum samples showed positive for Klebsiella pneumoniae,Streptococcus mitis,Streptococcus pneumoniae and Candida tropicalis.The clinical pharmacists believed that Rickettsia japonicum was pathogenic bacteria and the others were colonized bacteria,so it was suggested that the anti-infective treatment regimen was changed to doxycycline,but the clinician added piperacillin-tazobactam sodium for the safety purpose;3 days later,the patient's body temperature returned to normal,infection indicators and related symptoms were obviously improved,and the patient was discharged from the hospital soon.Conclusion:Septic shock caused by Rickettsia is relatively rare,so it is easily ignored in clinical practice.When carrying out the pharmaceutical care,clinical pharmacists should comprehensively analyze the patient's clinical manifestations,examination results and medication history,assist clinicians in identifying the pathogenic bacteria of infection as quickly as possible,so that the targeted anti-infective treatment is carried out to ensure rapid recovery of the patient.
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维普
