GAN Ju-wen, SUN Wei, DENG Xiao-lan, LIU Hua, LIAO Xiao-fei
Objective: To analyze the anti-infective treatment process and pharmaceutical care key points of one patient with pulmonary infection complicated with intracranial infection, and provide reference for rational use and medication safety of clinical antibacterial drugs. Methods and Results: The patient with lung cancer was treated at a local hospital due to fever (39℃) and headache. Based on the procalcitonin level and lung CT examination results, it was initially considered as pulmonary infection, so azithromycin+piperacillin-tazobactam sodium were administrated. However, on the next day, there were symptoms such as unconsciousness and not waking up, so the patient was admitted to Department of Neurology of our hospital for further treatment. Based on the clinical combination of fever, confusion, neck resistance and other symptoms of the patient, as well as the hemogram and cerebrospinal fluid examination results, it was determined that the patient still had intracranial infection, so vancomycin+meropenem were empirically administrated. After 3 days, the patient's infection symptoms and related indicators were significantly improved, and the cerebrospinal fluid metagenomic next-generation sequencing indicated Streptococcus pneumoniae. Clinically considering that meropenem had a strong antibacterial effect on Streptococcus pneumoniae, vancomycin was discontinued. After 6 days, intracranial infection recurred in the patient. Considering that Streptococcus pneumoniae was resistant to meropenem, vancomycin was added. Later, the infection was controlled, but the patient developed severe tinnitus and hearing loss, which might be related to vancomycin in clinical consideration, so vancomycin was discontinued again and linezolid was used instead, and symptomatic treatment was given. However, after 1 week of treatment, the intracranial infection worsened, so the treatment regimen was adjusted to moxifloxacin+ceftriaxone. After that, the patient's infection symptoms and related indicators were gradually improved, and the discharge follow-up showed that the hearing was also partially recovered. Conclusion: Intracranial infection is a relatively complex and serious infection. In the clinical anti-infective treatment regimen, the antibacterial spectrum of antibacterial drugs and the passage of the blood-brain barrier should be fully considered, and the pharmaceutical care and disposal of adverse drug reactions should be prepared to ensure the treatment effect and medication safety of patients.
