Pharmaceutical Care for Anti-infective Treatment of Secondary Pulmonary Infection Caused by Extensively Drug-resistant Enterobacteriaceae in Patients with Intracranial Infection Caused by Enterococci
Pharmaceutical Care for Anti-infective Treatment of Secondary Pulmonary Infection Caused by Extensively Drug-resistant Enterobacteriaceae in Patients with Intracranial Infection Caused by Enterococci
Objective:To analyze the anti-infective treatment process of a patient with intracranial infection caused by enterococci and secondary pulmonary infection caused by extensively drug-resistant Enterobacteriaceae and provide a reference for the anti-infective treatment of similar patients in clinical practice.Methods and Results:The patient was admitted to the hospital for treatment because of headache and dizziness caused by a fall for more than one month without improvement.Considering that the patient had fever for nearly 2 weeks and the protein and chloride in cerebrospinal fluid were abnormal,it was believed to be intracranial infection;so moxifloxacin was given empirically for anti-infective treatment.Later,MRI examination prompted that the patient might have subdural abscess,and the high-throughput gene testing of PMseq-DNA pathogens indicated Enterococcus casselifavus and Enterococcus faecium,so subdural abscess drainage and decompressive craniectomy were performed.During the operation,a large amount of yellow-white pus and extensive pus mosses covering the surface of the cerebral cortex were seen,so the anti-infective treatment regimen was adjusted to linezolid plus meropenem.After 10 days of anti-infective treatment,the patient's body temperature dropped significantly,and the results of cerebrospinal fluid culture were negative for many times.But one week later,the patient's chest CT scan showed that the exudative changes in both lungs had progressed compared with before,and the sputum culture had detected extensively drug-resistant Klebsiella pneumoniae and Pseudomonas aeruginosa.Therefore,meropenem was discontinued and replaced with ceftazidime-avibactam sodium+ornidazole.After 7 days of treatment,the patient's infection indicators were significantly improved,and meropenem was downgraded to use,but the infusion time was extended to consolidate the anti-infection effect.Conclusion:Many patients with severe infections such as intracranial infection are prone to secondary pulmonary infection.Clinical pharmacists should actively work with doctors to strength the relevant monitoring and adjust anti-infective treatment regimens in a timely manner,so as to promote the improvement of patients'prognosis.
关键词
肠球菌/颅内感染/硬膜下脓肿/广泛耐药肠杆菌科细菌/肺部感染/药学监护
Key words
enterococcus/intracranial infection/subdural abscess/extensively drug-resistant Enterobacteriaceae/pulmonary infection/pharmaceutical care
维普
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