临床药师参与1例浅黄假单胞菌血流感染合并终末期肾病患者的药学实践

目的 探讨临床药师在抗感染药物治疗中发挥的作用。方法 临床药师通过参与1例浅黄假单胞菌血流感染合并终末期肾病患者的药学实践，探讨如何为感染合并肾病患者制定合理的抗感染治疗方案。结果 临床药师积极参与药物治疗，依据指南评价抗感染治疗方案，根据药敏结果和患者既往史，给予合理的抗感染治疗方案的修改建议，最终感染得到有效控制。结论 感染严重影响生活质量。临床药师协助医师选择适宜的抗菌药物、用法用量、正确联合用药，关注药物不良反应，制定个体化给药方案，保障感染合并肾病患者有效并合理应用抗菌药物。

Clinical Pharmacists Involved in A Case of Pharmaceutical Practice of Chryseomonas Luteola Bloodstream Infection with End Stage Renal Disease

OBJECTIVE To explore the role of clinical pharmacists in anti-infective pharmacotherapy. METHODS The pharmaceutical practice of a patient with Chryseomonas luteola bloodstream infection and end stage renal disease was analyzed to explore how to make rational anti-infective schedule for infection patients with renal disease. RESULTS Clinical pharmacists actively participated in drug treatment, evaluated anti-infective treatment plans according to the guidelines, and gave recommendations for revision of reasonable anti-infective treatment plans based on drug susceptibility results and past patient history, and finally the infection was effectively controlled. CONCLUSION Infection can affect the quality of life seriously. Clinical pharmacists can help physicians to select rational antimicrobial drugs, usage and dosage, rational drug comnination, pay attention to the side effection, thus to make individual therapeutic schedule and ensure the rational use of antimicrobial drugs for infection patients with renal disease.