1025例住院患者特殊使用级抗菌药物应用分析
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摘要
目的:评价乌鲁木齐市友谊医院(以下简称"我院")住院患者特殊使用级抗菌药物应用情况,为合理应用抗菌药物提供参考。方法:调取2015—2017年我院应用特殊使用级抗菌药物的出院病历,共1 025份;分析患者基本情况、病原学送检情况、标本分布情况、抗菌药物品种和特殊使用级抗菌药物应用情况。结果:1 025例使用特殊使用级抗菌药物的住院患者中,949例送标本进行了细菌培养,病原学送检率为92.59%,送检标本共1 677份,分离出细菌830株,检出率较高的细菌依次为大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌等。1 025例患者共使用特殊使用级抗菌药物9个品种,以美罗培南、亚胺培南和万古霉素为主;用药时间为1～39 d,平均4.98 d;碳青霉烯类抗菌药物的用药频度最高,头孢吡肟的药物利用指数最高;联合用药的患者402例,占39.22%;不规范应用特殊使用级抗菌药物主要表现为无会诊、会诊人员非我院特殊使用级抗菌药物专家组成员及由无处方权限的医师开具。结论:我院特殊使用级抗菌药物的临床应用基本合理,但仍存在不合理现象,应加强抗菌药物的使用管理。
OBJECTIVE: To evaluate the application of antibiotics for special use in inpatients in Urumqi FriendshipHospital(hereinafter referred to as "the hospital"), so as to provide reference for the rational application of antibiotics. METHODS: Totally 1 025 discharged medical records of antibiotics for special use from 2015 to 2017 were extracted, the basic conditions of patients, the status of pathogens, the distribution of specimens, the varieties of antibiotics and the application of antibiotics for special use were analyzed. RESULTS: Among the 1 025 inpatients with antibiotics for special use, 949 cases were sent for bacterial culture, and the pathogenic detection rate was 92.59%, totally 1 677 samples were sent for detection, and 830 strains of bacteria were isolated, and the bacteria with higher detection rate were Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa, etc. A total of 9 varieties of antibiotics for special use were applied in 1 025 patients, mainly meropenem, imipenem and vancomycin; the duration of medication ranged from 1 d to 39 d, with an average of 4.98 d. Carbapenems were the most frequently used antibiotics, and the drug utilization index of cefepime was the highest. There were 402 patients with drug combination, accounting for 39.22%. Non-standard application of antibiotics for special use mainly manifested as no consultation, consultation staff members of non-specialist anti-bacterial drug expert group and issued by clinicians without prescription authority. CONCLUSIONS: The clinical application of antibiotics for special use in our hospital is basically rational, but there are still some irrational phenomena, and the application management of antibiotics for special use should be strengthened.
OBJECTIVE: To evaluate the application of antibiotics for special use in inpatients in Urumqi FriendshipHospital(hereinafter referred to as "the hospital"), so as to provide reference for the rational application of antibiotics. METHODS: Totally 1 025 discharged medical records of antibiotics for special use from 2015 to 2017 were extracted, the basic conditions of patients, the status of pathogens, the distribution of specimens, the varieties of antibiotics and the application of antibiotics for special use were analyzed. RESULTS: Among the 1 025 inpatients with antibiotics for special use, 949 cases were sent for bacterial culture, and the pathogenic detection rate was 92.59%, totally 1 677 samples were sent for detection, and 830 strains of bacteria were isolated, and the bacteria with higher detection rate were Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa, etc. A total of 9 varieties of antibiotics for special use were applied in 1 025 patients, mainly meropenem, imipenem and vancomycin; the duration of medication ranged from 1 d to 39 d, with an average of 4.98 d. Carbapenems were the most frequently used antibiotics, and the drug utilization index of cefepime was the highest. There were 402 patients with drug combination, accounting for 39.22%. Non-standard application of antibiotics for special use mainly manifested as no consultation, consultation staff members of non-specialist anti-bacterial drug expert group and issued by clinicians without prescription authority. CONCLUSIONS: The clinical application of antibiotics for special use in our hospital is basically rational, but there are still some irrational phenomena, and the application management of antibiotics for special use should be strengthened.
引文
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[2] 国家卫生计生委办公厅.关于进一步加强抗菌药物临床应用管理遏制细菌耐药的通知[S].国卫办医发[2017]10号.2017-02-27.
[3] 国家卫生计生委办公厅.关于持续做好抗菌药物临床应用管理有关工作的通知[S].国卫办医发[2018]9号.2018-05-09.
[4] 国家卫生计生委办公室,国家中医药管理局办公室,总后卫生部药品器材局.关于印发《抗菌药物临床应用指导原则(2015年版)》的通知[S].国卫办医发[2015]43号.2015-07-24.
[5] 王辉,任健康,王明贵.临床微生物学检验[M].北京:人民卫生出版社,2015:211,275.
[6] 杨旸,田宗梅,金锐,等.我院2013—2015年特殊使用级抗菌药物应用分析[J].中国药房,2016,27(35):4906-4909.
[7] 桑得福.热病·桑福德抗微生物治疗指南[M].新译46版.范洪伟,等译.北京:中国协和医科大学出版社,2016:88.
[8] 黄勋,邓子德,倪语星,等.多重耐药菌医院感染预防与控制中国专家共识[J].中国感染控制杂志,2015,14(1):1-9.
[9] 王明贵,译.广泛耐药革兰阴性菌感染的实验诊断、抗菌治疗及医院感染控制:中国专家共识[J].中国感染与化疗杂志,2017,17(1):82-92.
[10] Tsai D,Lipman J,Roberts JA.Pharmacokinetic/pharmacodynamic considerations for the optimization of antimicrobial delivery in the critically ill[J].Curr Opin Crit Care,2015,21(5):412-420.
[11] 姚欣凯,李苌清,吴亚陵,等.应用PK/PD模型和蒙特卡洛模拟优化ICU中铜绿假单胞菌感染的初始给药方案[J].中国药房,2015,26(8):1060-1603.
[12] 国家卫生计生委办公厅.关于印发碳青霉烯类抗菌药物临床应用专家共识等3个技术文件的通知[S].国卫办医函[2018]822号.2018-09-18.