100例患者碳青霉烯类抗菌药物应用调查与合理性分析
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摘要
目的:了解某医院碳青霉烯类抗菌药物的临床应用情况,探讨用药合理性。方法:回顾性选取2017年1月至2018年1月该院使用碳青霉烯类抗菌药物的患者100例,对其用药情况与病原学检查结果进行比较,对用药合理性进行评估与分析,以便找出存在的问题并采取解决措施。结果:100例患者所使用的碳青霉烯类抗菌药物包括注射用美罗培南、注射用亚胺培南西司他丁钠,其中用药合理79例,用药合理率为79%。不合理用药21例,其中违反《抗菌药物临床应用管理办法》,越级使用碳青霉烯类抗菌药物的有6例;临床使用碳青霉烯类抗菌药物时,未及时进行病原微生物送检的有8例;未对病原菌致病性进行分析,未区分致病菌、定植菌与污染菌,盲目使用碳青霉烯类抗菌药物的有2例;未根据相关疾病指南经验性选用抗菌药物,药物选择不合理的有1例;未根据特殊人群病理生理特点及时调整给药剂量的有2例;未充分考虑碳青霉烯类抗菌药物药动学/药效学特点制订合理治疗方案,用法与用量不合理的有2例。结论:碳青霉烯类抗菌药物的临床应用过程中存在多种问题,必须对其临床应用效果进行调查,提高用药合理性,以提高其治疗效果。
OBJECTIVE: To investigate the clinical application and rationality of carbapenem antibiotics in a hospital(hereinafter referred to as "the hospital"), so as to probe into the medication rationality. METHODS: 100 patients with application of carbapenem antibiotics admitted into the hospital from Jan. 2017 to Jan. 2018 were retrospectively extracted. The drug application and the results of the pathogen examination were compared, the rationality of the drugs were evaluated and analyzed, and then the problems were fund out and corrective measures were took. RESULTS: The carbapenem antibiotics used in 100 patients included meropenem for injection and imipenem cilastatin sodium for injection, of which 79 cases were rational, and the rational rate was 79%. There were 21 cases of irrational application of drugs, among which 6 cases was off-grade application of carbapenems as antibiotics in violation of the "Administrative Measures for the Clinical Application of Antimicrobial Drugs". In clinical use of carbapenems antibiotics, 8 cases were not timely tested for pathogenic microorganisms. The pathogenicity of pathogenic bacteria was not analyzed, pathogenic bacteria, colonizing bacteria and contaminated bacteria were not distinguished, and 2 cases of carbapenems antibiotics were blindly used. The antibiotics were not selected empirically according to the relevant disease guidelines, and there was 1 case of irrational drug selection; 2 cases did not timely adjust the dosage according to the pathological and physiological characteristics of the special population. The pharmacokinetic/pharmacodynamic characteristics of carbapenems antibiotics were not fully considered in the formulation of rational treatment schemes, and there were 2 cases with irrational usage and dosage. CONCLUSIONS: There are many problems in the clinical application of carbapenems antibiotics, it is necessary to investigate the clinical application effects of carbapenems, so as to improve the rationality of drug application and promote the therapeutic effects.
OBJECTIVE: To investigate the clinical application and rationality of carbapenem antibiotics in a hospital(hereinafter referred to as "the hospital"), so as to probe into the medication rationality. METHODS: 100 patients with application of carbapenem antibiotics admitted into the hospital from Jan. 2017 to Jan. 2018 were retrospectively extracted. The drug application and the results of the pathogen examination were compared, the rationality of the drugs were evaluated and analyzed, and then the problems were fund out and corrective measures were took. RESULTS: The carbapenem antibiotics used in 100 patients included meropenem for injection and imipenem cilastatin sodium for injection, of which 79 cases were rational, and the rational rate was 79%. There were 21 cases of irrational application of drugs, among which 6 cases was off-grade application of carbapenems as antibiotics in violation of the "Administrative Measures for the Clinical Application of Antimicrobial Drugs". In clinical use of carbapenems antibiotics, 8 cases were not timely tested for pathogenic microorganisms. The pathogenicity of pathogenic bacteria was not analyzed, pathogenic bacteria, colonizing bacteria and contaminated bacteria were not distinguished, and 2 cases of carbapenems antibiotics were blindly used. The antibiotics were not selected empirically according to the relevant disease guidelines, and there was 1 case of irrational drug selection; 2 cases did not timely adjust the dosage according to the pathological and physiological characteristics of the special population. The pharmacokinetic/pharmacodynamic characteristics of carbapenems antibiotics were not fully considered in the formulation of rational treatment schemes, and there were 2 cases with irrational usage and dosage. CONCLUSIONS: There are many problems in the clinical application of carbapenems antibiotics, it is necessary to investigate the clinical application effects of carbapenems, so as to improve the rationality of drug application and promote the therapeutic effects.
引文
[1] 张楠,陆红柳,杨慧鹃,等.某院碳青霉烯类抗菌药物的临床应用调查与用药合理性评估[J].中国药房,2016,27(29):4047-4050.
[2] 李建华,王玉明,戴路明,等.碳青霉烯类抗菌药物对大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌的防突变浓度研究[J].中国医院药学杂志,2016,36(2):130-135.
[3] 杨帆. 《抗菌药物临床应用指导原则(2015年版)》解读[J]. 中华临床感染病杂志, 2016, 9(5):390-393.
[4] 马红映,汪丽,虞亦鸣,等.院内获得耐碳青霉烯类抗菌药物肺炎克雷伯菌感染的危险因素分析[J].中华医院感染学杂志,2017,27(7):1456-1458.
[5] 白艳,许芳,王天琳,等.碳青霉烯耐药肺炎克雷伯菌的分子特征与抗菌药物活性相关性的研究进展[J].中国药学杂志,2016,51(5):346-352.
[6] 徐永祥,刘治安,黄惠英,等.我院耐碳青霉烯类革兰氏阴性杆菌检出率与药物消耗量的相关性分析[J].中国药房,2017,28(20):2771-2774.
[7] 周旺.我院2012年1—6月份碳青霉烯类抗菌药物临床应用情况分析[J].临床合理用药杂志,2013,6(14):88-89.
[8] 王姝,李青.我院碳青霉烯类抗菌药物临床使用情况分析[J].临床合理用药杂志,2014,7(14):54-55.
[9] 梁艳粉.呼吸内科碳青霉烯类抗生素的应用情况及用药合理性分析[J].河北医药,2017,39(21):3336-3339.
[10] 陈文瑛,叶丹,李常安,等.1543例住院患者抗菌药物临床应用横断面调查[J].中国药房,2014,25(38):3575-3579.
[11] 史天陆,孙言才,姜玲,等.比阿培南临床合理使用评价标准的建立与应用[J].中华医院感染学杂志,2012,22(23):5367-5369.
[12] 王芳,卢旺,祝芳,等.住院患者抗菌药物临床应用横断面调查[J].山西医科大学学报,2012,43(5):353-356.
[13] 郑光敏,庞菲,李玮,等.我院耐碳青霉烯类抗菌药物革兰氏阴性杆菌的分离及其产金属β-内酰胺酶情况分析[J].中国药房,2017,28(11):1482-1485.
[14] 徐德铎,陈险峰,张莉,等.2012—2016年我院碳青霉烯类抗菌药物应用及与细菌耐药的相关性分析[J].中国药物应用与监测,2017,14(6):361-364.
[15] 裴保方,李燕,陶兴茹,等.某院耐甲氧西林葡萄球菌耐药性及抗菌药物应用分析[J].中国合理用药探索,2017,14(4):5-8.
[16] 叶丹,李常安,陈文瑛,等.1580例住院患者抗菌药物临床使用的横断面分析[J].抗感染药学,2014(5):427-432.
[17] 张功武,钱惠,蔡和平,等.我院肠杆菌科细菌对碳青霉烯类抗菌药物的耐药性分析[J].中国药房,2017,28(5):614-617.
[18] 丁楠,朱青芳,马运芳,等.新疆某三甲医院2014—2016年住院患者特殊使用级抗菌药物应用分析[J].中国医药导报,2017,14(32):124-127,132.
[19] 石莹,刘亚男,李锐,等.大肠埃希菌对碳青霉烯类及喹诺酮类抗菌药物的耐药性分析[J].中华医院感染学杂志,2017,27(21):4808-4810,4814.
[2] 李建华,王玉明,戴路明,等.碳青霉烯类抗菌药物对大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌的防突变浓度研究[J].中国医院药学杂志,2016,36(2):130-135.
[3] 杨帆. 《抗菌药物临床应用指导原则(2015年版)》解读[J]. 中华临床感染病杂志, 2016, 9(5):390-393.
[4] 马红映,汪丽,虞亦鸣,等.院内获得耐碳青霉烯类抗菌药物肺炎克雷伯菌感染的危险因素分析[J].中华医院感染学杂志,2017,27(7):1456-1458.
[5] 白艳,许芳,王天琳,等.碳青霉烯耐药肺炎克雷伯菌的分子特征与抗菌药物活性相关性的研究进展[J].中国药学杂志,2016,51(5):346-352.
[6] 徐永祥,刘治安,黄惠英,等.我院耐碳青霉烯类革兰氏阴性杆菌检出率与药物消耗量的相关性分析[J].中国药房,2017,28(20):2771-2774.
[7] 周旺.我院2012年1—6月份碳青霉烯类抗菌药物临床应用情况分析[J].临床合理用药杂志,2013,6(14):88-89.
[8] 王姝,李青.我院碳青霉烯类抗菌药物临床使用情况分析[J].临床合理用药杂志,2014,7(14):54-55.
[9] 梁艳粉.呼吸内科碳青霉烯类抗生素的应用情况及用药合理性分析[J].河北医药,2017,39(21):3336-3339.
[10] 陈文瑛,叶丹,李常安,等.1543例住院患者抗菌药物临床应用横断面调查[J].中国药房,2014,25(38):3575-3579.
[11] 史天陆,孙言才,姜玲,等.比阿培南临床合理使用评价标准的建立与应用[J].中华医院感染学杂志,2012,22(23):5367-5369.
[12] 王芳,卢旺,祝芳,等.住院患者抗菌药物临床应用横断面调查[J].山西医科大学学报,2012,43(5):353-356.
[13] 郑光敏,庞菲,李玮,等.我院耐碳青霉烯类抗菌药物革兰氏阴性杆菌的分离及其产金属β-内酰胺酶情况分析[J].中国药房,2017,28(11):1482-1485.
[14] 徐德铎,陈险峰,张莉,等.2012—2016年我院碳青霉烯类抗菌药物应用及与细菌耐药的相关性分析[J].中国药物应用与监测,2017,14(6):361-364.
[15] 裴保方,李燕,陶兴茹,等.某院耐甲氧西林葡萄球菌耐药性及抗菌药物应用分析[J].中国合理用药探索,2017,14(4):5-8.
[16] 叶丹,李常安,陈文瑛,等.1580例住院患者抗菌药物临床使用的横断面分析[J].抗感染药学,2014(5):427-432.
[17] 张功武,钱惠,蔡和平,等.我院肠杆菌科细菌对碳青霉烯类抗菌药物的耐药性分析[J].中国药房,2017,28(5):614-617.
[18] 丁楠,朱青芳,马运芳,等.新疆某三甲医院2014—2016年住院患者特殊使用级抗菌药物应用分析[J].中国医药导报,2017,14(32):124-127,132.
[19] 石莹,刘亚男,李锐,等.大肠埃希菌对碳青霉烯类及喹诺酮类抗菌药物的耐药性分析[J].中华医院感染学杂志,2017,27(21):4808-4810,4814.