2025 年第 2 期 第 20 卷

慢性阻塞性肺疾病急性加重伴多重耐药菌感染患者1例用药分析

A case analysis about drug use of acute exacerbation of chronic obstructive pulmonary disease with multidrug resistant bacterial infection

作者：张丽1任黔玲1周溯1杨萍1董永超2

英文作者：Zhang Li1 Ren Qianling1 Zhou Su1 Yang Ping1 Dong Yongchao2

单位：1四川宝石花医院药学部，成都610213；2四川宝石花医院泌尿外科，成都610213

英文单位：1Department of Pharmacy Sichuan GEM Flower Hospital Chengdu 610213 China； 2Department of Urology Sichuan GEM Flower Hospital Chengdu 610213 China

关键词：慢性阻塞性肺疾病；多重耐药；铜绿假单胞菌

英文关键词：Chronicobstructivepulmonarydisease;Multidrugresistant;Pseudomonasaeruginosa

• 摘要：

• 本文报道1例慢性阻塞性肺疾病急性加重伴多重耐药铜绿假单胞菌感染的患者。先后给予拉氧头孢、头孢他啶及硫酸依替米星注射液抗感染治疗，症状未见好转；结合痰培养结果提示铜绿假单胞菌（黏液型），临床药师建议调整抗菌药物为美罗培南，并将丙戊酸钠缓释片替换为左乙拉西坦片，治疗3 d后因患者感染指标虽有下降，但仍然偏高，加用阿奇霉素片，经治疗后患者症状及阳性体征消失，痊愈出院。临床药师结合患者病情及病原学特点，根据抗菌药物药理作用、药代动力学/药效学特点以及辅助用药注意事项等，积极与临床医师沟通，为患者制定个性化精准的给药方案，指导临床合理用药。

• This case report is of a patient with acute exacerbation of chronic obstructive pulmonary disease and multidrug resistant Pseudomonas aeruginosa infection. Moxalactam, ceftazidime and etimicin sulfate injection were given successively for anti-infective treatment, but the symptoms were not improved. Combined with the results of sputum culture suggesting Pseudomonas aeruginosa (mucoid type), the clinical pharmacist suggested adjusting the antibacterial drug to meropenem, and replacing sodium valproate sustained-release tablets with levetiracetam tablets. Azithromycin tablets were added because the infection index of the patient was still high, although the infection index decreased after 3 d of treatment. After treatment, the symptoms and positive signs of the patient disappeared, and the patient was cured and discharged. Clinical pharmacists should actively communicate with clinicians according to the pharmacological effects, pharmacokinetics/pharmacodynamic characteristics of antibiotics, and auxiliary medication precautions in combination with the patient′s condition and pathogenic characteristics, so as to develop personalized and accurate dosing regimens for patients and guide clinical rational drug use.