Pharmaceutical Care for a Child with Refractory Stenotrophomonas maltophilia Sepsis by Clinical Pharmacist / 中国药房

ABSTRACT

OBJECTIVE：To investigate the pharmaceutical ca re for a child with refractory Stenotrophomonas maltophilia sepsis by clinical pharmacists ，and to provide reference for the treatment of children with this disease. METHODS ：Clinical pharmacist participated in drug therapy for a child with refractory S. maltophilia sepsis. Based on the pathophysiological characteristics of the child and the PK/PD characteristics of the antimicrobials ，clinical pharmacists suggested that the anti-infection regimen should be adjusted as cefoperazone sodium and sulbactam sodium 160 mg/（kg·d），every 8 hours combined with levofloxacin 10 mg/kg， every 12 hours. For clinical manifestations of severe inflammatory reaction ， the clinical pharmacist suggested receiving methylprednisolone sodium succinate 1 mg/kg additionally ，every 12 hours，for anti-inflammatory adjuvant therapy. At the same time， clinical pharmacist provided individualized pharmaceutical care （including the detection of blood concentration of cefoperazone sodium and sulbactam sodium ，the detection of ADR and medication education of oxygen atomization ）during the treatment，and followed up the child for one year. RESULTS ：The doctors adopted the suggestions of clinical pharmacists. The sepsis was controlled ，the child ’s condition were improved and then discharged. During the follow-up ，the child did not suffered from ADR ，such as cartilage and joint injury. CONCLUSIONS ：Hypoimmunity，long stay in intensive care unit ，endotracheal intubation and malignant tumor are the high risk factors of S. maltophilia infection. The monitoring of therapeutic drugs of cefoperazone sodium and sulbactam sodium is very necessary in the treatment of severe infection in children. After weighing the advantages and disadvantages and meeting certain conditions ，children can use quinolones for anti-infection ；based on the effective anti-infection treatment ，low-dose glucocorticoid can reduce the systemic inflammatory respense in patients with sepsis.