Practice Experience of Anti-infective Treatment in an Elderly Patient with Stroke-associated Pneumonia
Objective:To analyze the anti-infective treatment process of an elderly patient with stroke-associated pneumonia,and provide reference for the anti-infective treatment in clinically similar patients.Methods and Results:The patient was admitted to the hospital due to"weakness of left limb,unconsciousness,and limb twitching for 4 days".Based on the head CT scan results,the patient was initially diagnosed with stroke,and the chest CT scan results suggested the presence of pulmonary infection,which was considered to be stroke-associated pneumonia,then the patient was empirically treated with ceftazidime;4 days later,Klebsiella pneumoniae was detected in the sputum specimen(negative for the extended-spectrum β-lactamase test);6 days later,the patient had high fever suddenly,and the infection indicators such as WBC count,neutrophil percentage,C-reactive protein increased significantly,so ceftazidime was changed to imipenem-cilastatin sodium,but the infection symptoms did not improve significantly;3 days later,Staphylococcus aureus(resistant to methicillin)was detected in the sputum specimen,so it is recommended to add vancomycin;6 days later,the infection had not subsided obviously,so vancomycin was adjusted to linezolid,but the infection still recurred from time to time;subsequently,Escherichia coli was detected in the sputum specimen(positive for the extended-spectrum β-lactamase test),so piperacillin-tazobactam sodium was administered;3 days later,the patient's infection basically subsided and he/she was discharged.Conclusion:Stroke-associated pneumonia is characterized by a complex spectrum of pathogenic bacteria and long-lasting mixed infections,and the pathogenic bacteria are often changeable in the disease process.Therefore,clinical pharmacists should actively explore the pathogenic bacteria of stroke-associated pneumonia,so as to provide targeted anti-infective treatment in a timely manner and ensure that patients recover as quickly as possible.
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