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1例49岁男性患者,因呼吸机相关性肺炎给予依替米星、美罗培南治疗。3d后痰培养结果显示耐甲氧西林金黄色葡萄球菌生长。停用依替米星,改用去甲万古霉素400mg加入0.9%氯化钠注射液250mL静脉泵入,1次/12h,并继续应用美罗培南。治疗13d后患者出现发热,T39.9℃,颈、胸、腹、背等部位出现片状红色皮疹,随后皮疹逐渐融合,自颈部至双侧腹股沟皮肤发红。血常规检查:WBC1.39×109/L,N0.06×109/L。停用去甲万古霉素,改为静脉泵入头孢哌酮钠-舒巴坦钠,继续使用美罗培南,同时给予西咪替丁及非格司亭。4d后皮疹基本消失,11d后白细胞及中性粒细胞计数恢复正常。以后未再应用去甲万古霉素,上述症状未再发生,随诊查血常规均在正常范围。
A 49-year-old male patient was given etimicin and meropenem for ventilator-associated pneumonia. The results of sputum culture after 3 days show that methicillin-resistant Staphylococcus aureus grows. Disable etimicin, instead of vancomycin 400mg 0.9% sodium chloride injection 250mL intravenous infusion, 1 / 12h, and continue the application of meropenem. After treatment for 13 days, the patient developed fever and T39.9 ℃. A flaky red rash appeared on the neck, chest, abdomen and back. Subsequently, the rash gradually fused and the skin became reddish from the neck to the bilateral groin. Blood tests: WBC1.39 × 109 / L, N0.06 × 109 / L. Stop using norvancomycin, replaced by intravenous cefoperazone sodium - sulbactam sodium, continue to use meropenem, given cimetidine and filgrammeting. The rash disappeared after 4 days, and the count of leucocytes and neutrophils returned to normal after 11 days. After no further application of norvancomycin, the above symptoms did not recur, follow-up examination of blood are in the normal range.