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1例罕见弥散性肺微脓肿合并机化性肺炎的药学监护
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| 篇名： | 1例罕见弥散性肺微脓肿合并机化性肺炎的药学监护 |
| TITLE： | Pharmaceutical care for a rare case of diffuse pulmonary microabscesses complicated with organizing pneumonia |
| 摘要： | 目的 探讨临床药师在非免疫缺陷患者因星座链球菌所致罕见弥散性肺微脓肿合并机化性肺炎（OP）个体化治疗中的作用。方法针对1例中年、无免疫缺陷，且病程长达1年、影像学呈现弥散性微脓肿与OP双重病理特征并存的星座链球菌致肺脓肿患者，临床药师基于药动学/药效学特点，协助临床医生将既往疗效不佳的抗感染方案优化为注射用头孢曲松钠联合甲硝唑氯化钠注射液，以增强用药方案对混合厌氧菌的覆盖及病灶穿透能力；待患者咯血停止后，临床药师建议适时启动小剂量注射用甲泼尼龙琥珀酸钠干预OP；出院后序贯予口服利奈唑胺片、甲硝唑片、甲泼尼龙片、奥美拉唑肠溶片治疗。结果实施个体化治疗方案后，患者咯血症状消失，肺部病灶显著吸收，病情稳定出院；出院后3个月随访病情稳定。结论对于非免疫缺陷宿主的慢性迁延性肺部感染合并OP，临床药师通过协助临床医生优化抗感染方案，并建议在感染控制后适时启动抗炎治疗，有助于实现良好转归。此类复杂病例的个体化治疗需兼顾病原体覆盖、病理屏障及抗炎时机。 |
| ABSTRACT： | OBJECTIVE To investigate the role of clinical pharmacists in the individualized treatment of a rare case of diffuse pulmonary microabscesses caused by Streptococcus constellatus complicated with organizing pneumonia （OP） in a non-immunocompromised patient. METHODS For a middle-aged， non-immunocompromised patient with a one-year disease course， whose imaging findings showed the coexistence of diffuse microabscesses and OP caused by S. constellatus pulmonary abscess， the clinical pharmacist， based on pharmacokinetics/pharmacodynamics characteristics， assisted the physician in optimizing the previously ineffective anti-infective regimen to Ceftriaxone sodium for injection combined with Metronidazole and sodium chloride injection， so as to enhance coverage of mixed anaerobes and lesion penetration. After the patient’s hemoptysis ceased， the clinical pharmacist recommended timely initiation of low-dose Methylprednisolone sodium succinate for injection to manage OP. Upon discharge， sequential oral therapy with Linezolid tablets， Metronidazole tablets， Methylprednisolone tablets and Omeprazole enteric-coated tablets was prescribed. RESULTS After implementation of the individualized treatment regimen， the patient’s hemoptysis resolved， pulmonary lesions significantly regressed， and the patient was discharged in a stable condition. At the three-month follow-up， the patient remained stable. CONCLUSIONS For chronic persistent pulmonary infection complicated with OP in a non-immunocompromised host， clinical pharmacists assist clinicians in optimizing anti-infective regimens and recommend the timely initiation of anti-inflammatory therapy after infection control， thereby contributing to favorable clinical outcomes. Individualized treatment of such complex cases requires comprehensive consideration of pathogen coverage， pathological barriers， and the timing of anti-inflammatory intervention. |
| 期刊： | 2026年第37卷第10期 |
| 作者： | 蔡双霜；邱学文；廖钥；赵虹霞；江灏 |
| AUTHORS： | CAI Shuangshuang，QIU Xuewen，LIAO Yue，ZHAO Hongxia，JIANG Hao |
| 关键字： | 星座链球菌；弥散性肺微脓肿；机化性肺炎；非免疫缺陷；药学监护；临床药师；药代动力学；药效学 |
| KEYWORDS： | Streptococcus constellatus； diffuse pulmonary |
| 阅读数： | 7 次 |
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