妊娠脂肪肝患者并发肺炎克雷伯菌血流感染治疗过程分析

doi:10.5246/jcps.2020.08.055

中国药学(英文版) ›› 2020, Vol. 29 ›› Issue (8): 591-595.DOI: 10.5246/jcps.2020.08.055

妊娠脂肪肝患者并发肺炎克雷伯菌血流感染治疗过程分析

李莉霞¹, 陈锋², 薛晓梅³, 杨帆⁴, 何斌^3*

1. 上海交通大学医学院附属新华医院药学部, 上海 200092
2. 上海交通大学医学院附属新华医院检验科微生物室, 上海 200092
3. 上海交通大学医学院附属新华医院麻醉与外科重症监护病房, 上海 200092
4. 上海复旦大学附属华山医院抗生素研究所, 上海 200040

收稿日期:2020-03-06 修回日期:2020-04-29 出版日期:2020-08-31 发布日期:2020-05-16
通讯作者: Tel.: +86-21-25077826, E-mail: hebin@xinhuamed.com.cn
基金资助:
National Natural Science Foundation of China (Grant No. 81470390); Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant Support (Grant No. 20152218); Shanghai Sailing Program (Grant No. 19YF1431700); Clinical Trial of Xinhua Hospital (Grant No. 15LC11).

Treatment analysis of acute fatty liver of pregnancy complicated with hematogenous infection of CRKP

Lixia Li¹, Feng Chen², Xiaomei Xue³, Fan Yang⁴, Bin He^3*

1. Department of Pharmacy, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
2. Department of Clinical Laboratory, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
3. Department of Anesthesiology and SICU, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
4. Institute of Antibiotics of Huashan Hospital, Fudan University, Shanghai 200040, China

Received:2020-03-06 Revised:2020-04-29 Online:2020-08-31 Published:2020-05-16
Contact: Tel.: +86-21-25077826, E-mail: hebin@xinhuamed.com.cn
Supported by:
National Natural Science Foundation of China (Grant No. 81470390); Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant Support (Grant No. 20152218); Shanghai Sailing Program (Grant No. 19YF1431700); Clinical Trial of Xinhua Hospital (Grant No. 15LC11).

摘要/Abstract

摘要：

妊娠期急性脂肪肝, 是妊娠晚期特发性疾病, 起病急而凶险, 发病率低, 但死亡率高。妊娠期急性脂肪肝伴多器官功能衰竭(MODS)并发重症感染, 尤其是多重耐药病原菌引起的血行感染, 治疗难度明显增大, 生存几率可能更低, 目前未见相关报道。本院治疗一例重症患者, 31岁, 孕37⁺⁵周, 妊娠期急性脂肪肝伴MODS患者术后并发重症感染。血培养阳性, 快速鉴定为产KPC酶肺炎克雷伯菌(CRKP)。结合联合药敏结果, 使用亚胺培南西司他丁钠、替加环素、多粘菌素及磷霉素四联方案, 成功治愈患者。针对妊娠期急性脂肪肝合并CRKP的血行感染的特点, 快速鉴定并结合药敏结果, 采用个体化、联合的抗菌药物治疗方案, 成功救治患者。本例患者病情危重, 在治疗过程中, 需要临床医生、临床药师和微生物检验师协作, 根据患者病理生理变化特点, 共同讨论治疗方案, 是本例患者救治成功的关键因素之一。

关键词: 孕妇, 妊娠期急性脂肪肝, 肺炎克雷伯菌, 血行感染

Abstract:

Acute fatty liver of pregnancy (AFLP) is an idiopathic disease with acute and critical onset. Although the incidence of AFLP is relatively low, its mortality remains high. When AFLP is complicated with multi-organ dysfunction syndrome (MODS) and severe infection, especially hematogenous infection caused by multidrug-resistant pathogens, treatment becomes extremely difficult with an even lower survival rate. In the present work, we reported a 31-year-old primipara woman who developed AFLP complicated with MODS and severe infection at 37⁺⁵ weeks of gestation and received treatment in our hospital. The result of fast blood culture was positive for carbapenem-resistant Klebsiella pneumonia (CRKP). Based on this finding in combination with the results of drug sensitivity test, the quadruple regime using scheme imipenem cilastatin sodium, tigecycline, polymyxin and fosfomycin was implemented, and the patient was successfully cured. Successful treatment of pregnant women with AFLP complicated with MODS and/or hematogenous infection of CRKP can be achieved by using individualized combined antibiotic therapies on the basis of fast blood culture and combined drug sensitivity test. In this case, the patient was in a critical situation. In the treatment process, clinicians, clinical pharmacists and microbiologists should cooperate with each other and discuss the treatment plan together according to the pathophysiological characteristics of the patient, which was one of the key factors for successful treatment of the patient.

Key words: Pregnant woman, Acute fatty liver of pregnancy, Carbapenem-resistant Klebsiella pneumonia, Hematogenous infection

中图分类号:

Supporting:

李莉霞, 陈锋, 薛晓梅, 杨帆, 何斌. 妊娠脂肪肝患者并发肺炎克雷伯菌血流感染治疗过程分析[J]. 中国药学(英文版), 2020, 29(8): 591-595.

Lixia Li, Feng Chen, Xiaomei Xue, Fan Yang, Bin He. Treatment analysis of acute fatty liver of pregnancy complicated with hematogenous infection of CRKP[J]. Journal of Chinese Pharmaceutical Sciences, 2020, 29(8): 591-595.

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妊娠脂肪肝患者并发肺炎克雷伯菌血流感染治疗过程分析

Treatment analysis of acute fatty liver of pregnancy complicated with hematogenous infection of CRKP

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