YAO Kai-yun, WEI Yi, LIN Yi-ju
Objective: To analyze the pharmaceutical care process in anti-infective therapy of a patient with upper urinary tract infection caused by multidrug-resistant Preudomonas aeruginos (MDR-PA), and provide a reference for clinical anti-infective therapy of MDR-PA induced infections. Methods and Results: The patient visited the hospital due to "left flank pain for 7 days". Based on clinical symptoms and CT findings, renal ureteral calculi with concurrent infection was suspected. Empirical therapy with cefotiam was initiated. Two days later, urine culture identified Preudomonas aeruginos (PA), and susceptibility testing showed sensitivity to amikacin and piperacillin-tazobactam sodium, but resistance to ceftazidime, meropenem, and levofloxacin, confirming MDR-PA infection. The clinical pharmacist suggested adjusting to amikacin plus piperacillin-tazobactam sodium; however, a skin test for piperacillin-tazobactam sodium was positive, so amikacin monotherapy was used. After 10 days, the anti-infective therapeutic effect was not very satisfactory. Cefoperazone-sulbactam sodium, to which the isolate was intermediately susceptible, was added. Four days later, infection indicators improved significantly, and percutaneous nephrolithotripsy was performed, although some stones remained. On postoperative days 3 and 4, the patient developed fever, worsening infection indicators, and right ear pain, the latter was suspected to be amikacin-induced. The anti-infective therapeutic regimen was adjusted to cefepime plus ciprofloxacin. Seven days later, the patient's condition improved, and a second percutaneous nephrolithotripsy was performed to remove residual stones. On postoperative day 5, the infection was essentially controlled, and the patient was discharged with a sequential therapy by oral administration of cefixime and ciprofloxacin. Conclusion: For patients with renal ureteral calculi with concurrent infection, it is essential to control infection positively prior to stone removal surgery. During this period, clinical pharmacists should actively assist physicians in quickly identifying the types and drug susceptibility characteristics of pathogenic bacteria, enabling the development of more precise anti-infective therapeutic regimens and creating conditions for removing infectious stone lesions during the surgery.
