1例替加环素致多重耐药菌感染患者重度低纤维蛋白原血症病例分析

A Case Report of Severe Hypofibrinemia in a Patient with Multi-Drug Resistant Bacteria Infection Caused by Tigecycline

摘要: 目的：为临床治疗多重耐药菌感染患者使用替加环素致重度低纤维蛋白原血症的药学监护和替加环素的安全使用提供参考，为临床对该现象的识别及处置提供借鉴和帮助。方法：通过研究1例耐碳青霉烯鲍曼不动杆菌肺部感染患者使用替加环素治疗后出现低纤维蛋白原血症，分析替加环素与低纤维蛋白原血症相关性，并结合相关文献分析替加环素致重度低纤维蛋白原血症的危险因素和可能机制。结果：报道1例卒中相关肺部感染病例，该患者耐碳青霉烯鲍曼不动杆菌、COVID-19感染，慢性肾功能不全3期。本例患者重度低纤维蛋白原血症与替加环素存在合理时间相关性，且排除其他疾病及其他药物因素，考虑该患者重度低纤维蛋白原血症为替加环素引起。医师采纳临床药师意见，患者纤维蛋白原恢复。结论：临床使用替加环素过程中，应严密监测患者的凝血指标及纤维蛋白原水平，尤其对于肾功能不全、初始纤维蛋白原水平不高及大剂量长疗程替加环素治疗患者，避免凝血障碍及出血事件等。替加环素致低纤维蛋白原血症时，临床药师及时给予停用替加环素建议，并建议在必要时输注人纤维蛋白原和血浆制品纠正，同时对低纤维蛋白原血症患者进行监药学监护，包括患者肝肾功、凝血指标、纤维蛋白原水平、合并用药及不良反应等。规范抗菌药物使用，提高治疗的安全性及有效性。

Abstract: Objective: To provide a reference for the pharmaceutical care and the safe use of tigecycline in hypofibrinogenemia caused by tigecycline, and to provide reference and help for the clinical identification and treatment of this phenomenon. Methods: By studying a case of a patient with a pulmonary infection caused by carbapenem-resistant Acinetobacter baumannii who developed hypofibrinogenemia after treatment with tigecycline, the correlation between tigecycline and hypofibrinogenemia was analyzed. Additionally, the risk factors and possible mechanisms for severe hypofibrinogenemia induced by tigecycline were explored in conjunction with relevant literature. Results: A case of pulmonary infection was reported, which was resistant to Acinetobacter baumannii and COVID-19 infection. CKD 3. There is a reasonable time correlation between the patient’s low fibrinogen and tigecycline. Excluding the disease and drug factors, it is considered that the patient’s low fibrinogen is caused by tigecycline. Doctors adopted the advice of clinical pharmacists, and patients recovered fibrinogen. Conclusion: In the process of using tigecycline, we should closely monitor the coagulation index and fibrinogen level of patients, especially those with renal insufficiency and patients treated with tigecycline in large doses and long course, so as to avoid coagulation disorders and bleeding events. The clinical pharmacist intervened in time when the hypofibrinogenemia was caused by tigecycline, and suggested that human fibrinogen should be infused when necessary, and at the same time, the patient should be supervised by the pharmacy, including liver and kidney function, coagulation index, fibrinogen level, combined medication and adverse reactions. The use of antimicrobial agents should be standardized to enhance the safety and efficacy of treatment.