Anti-infection Treatment and Pharmaceutical Care of a Patient with Chronic Sinusitis Secondary Brain Abscess
Objective:To analyze the pharmaceutical care process of one patient with chronic sinusitis and secondary brain abscess during anti-infection treatment,and provide reference for the diagnosis and treatment of similar patients in clinical practice.Methods and Results:A patient visited the hospital for treatment due to"fever and headache for 8 days".According to the patient's head CT results and symptoms,the patient was initially diagnosed with viral meningoencephalitis,so acyclovir was given empirically.Two days later,the patient still had fever and headache,and bacterial infection could not be ruled out,so ceftriaxone was added.Later,the MRI showed that the patient's left maxillary sinus,ethmoid sinus,frontal sinus inflammations were located on the same side as the brain abscess lesions.In addition,metagenomic next-generation sequencing of cerebrospinal fluid reported Porphyromonas endodontalis and Prevotella oralis.As the patient had chronic sinusitis,the possibility of abscess originating from the paranasal sinus could not be ruled out,so ceftriaxone was discontinued and meropenem was used instead;subsequently,the patient's body temperature dropped,but the CT scan indicated the possibility of brain herniation,then the patient received surgical treatment.Considering that intracranial infection was mostly caused by Gram-positive bacteria,vancomycin was added empirically.Later,Streptococcus constellatus was detected in the intracranial purulent secretion specimens.Three days later,the plasma concentration of vancomycin was lower than the recommended value lower limit,then the dosing frequency was adjusted and ornidazole was added.After treatment for more than one month,the patient recovered well.Conclusion:For the intracranial infection in patients with chronic sinusitis,full consideration should be given to the possibility of disseminated infections of common bacteria in the mouth and nose and etiological examinations should be carried out actively.The treatment should cover possible common bacteria as much as possible to guarantee the recovery of patients.
万方数据
维普
