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Pharmaceutical Care and Research: 2017; 17(5):347-351
DOI: 10.5428/pcar20170508
Discussion of the therapeutic strategy in the treatment of a patient with pyogenic osteomyelitis combined with bloodstream infection
1. FANG Jie1(1.Department of Pharmacy,Ruijin Hospital Affiliated to School of Medicine,Shanghai Jiaotong University,Shanghai 200025,China
2. HUANG Jie2( 2.Department of Critical Care Medicine,Ruijin Hospital Affiliated to School of Medicine,Shanghai Jiaotong University,Shanghai 200025,China )
3. YANG WanHua1(1.Department of Pharmacy,Ruijin Hospital Affiliated to School of Medicine,Shanghai Jiaotong University,Shanghai 200025,China
ABSTRACT  Objective:To discuss the anti-infection strategy for the treatment of a case of pyogenic osteomyelitis combined with persistent bloodstream infection with methicillin-susceptible Staphylococcus aureus (MSSA) and to accumulate clinical experience in the treatment of complicated infection cases.Methods: Clinical pharmacists participated in the treatment by reading related reference and checking with the actual conditions of the patient.Clinical pharmacists assisted clinicians to further optimize the anti-infective therapy.Results: Before admission into the hospital,the patient had been treated empirically with vancomycin for 2 weeks (1 g,q 12 h for 1 week,and then added with 1 g,q 8 h for 1 week),but failed to control infection and symptoms deteriorated.After admission to Ruijin Hospital Affiliated to School of Medicine,Shanghai Jiaotong University,monotherapy with daptomycin (0.5 g,qd) was empirically given,and temperature and infection indicators were improved.As blood culture showed MSSA,clindamycin 0.6 g,q 12 h was added for anti-infection treatment.One week later,the result of blood culture was negative,and the patient was given surgical debridement and nerve function was reserved.During treatment with clindamycin,urine protein and urine occult blood levels of the patient were significantly abnormal,and the creatinine level increased gradually.In view of this situation,clindamycin was abandomed,and cefazolin sodium (1 g,q 8 h) was selected for maintenance therapy.Conclusion: As a member of the clinical treatment team,clinical pharmacists should have the thinking of evidence-based medicine and assist clinicians to develop individualized medication profile by taking full advantage of their pharmaceutical knowledge.
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FANG Jie1,HUANG Jie2,YANG WanHua1,. Discussion of the therapeutic strategy in the treatment of a patient with pyogenic osteomyelitis combined with bloodstream infection[J]. Pharmaceutical Care and Research / yao xue fu wu yu yan jiu. 2017; 17(5): 347-351.
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