慢性肾脏病住院患者使用抗菌药物应用特点的分析
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摘要
目的通过对慢性肾脏病(chronickidneydisease,CKD)患者使用抗菌药物进行调查,评价其用药安全性,为临床应用抗菌药物提供参考。方法回顾性分析我院2014年1月至10月慢性肾脏病住院患者抗菌药物的使用情况,包括患者基本情况,抗菌药物使用情况、药品不良反应等,录入Excel中并进行统计分析。结果 1 793例慢性肾脏病住院患者中,感染发生率为20.86%,以呼吸和泌尿系统感染为主。有495例患者使用抗菌药物,使用抗菌药物579例次,其中治疗用345例次,预防用150例次。在治疗用药中有69.52%的患者进行了病原菌检测。在抗菌药物的患者中,使用喹诺酮类和头孢菌素类抗菌药物居前两位。抗菌药物联合用药66例,不良反应22例,消化系统的不良反应居首位。结论慢性肾脏病患者使用抗菌药物的不良反应发生率正常,临床医生在抗菌药物使用过程中应注意根据肾脏情况调整给药方案。
Objective To investigate the use of antibacterials in patients with chronic kidney disease(CKD) and evaluate the drug safety for providing some clinical reference. Methods Inpatients with CKD over a 10-month period from January to October, 2014 in our hospital were analyzed retrospectively. Results In the 1 793 cases of hospitalized patients with CKD, the incidence of infection was 20.86%, mainly respiratory and urinary tract infections. 495 cases were treated with antibacterials, 345 cases for treating and 150 cases for preventing. In cases for treating, pathogenic bacteria were detected in 69.52% of the patients. Quinolones and cephalosporins were the most commonly used antibacterials.There were 66 cases with drug combinations, 22 cases with adverse drug reactions, and the adverse reactions of digestive system were the most common. Conclusion Inpatients with CKD are basically safe to use antibiotics. The dosage regimen should be adjusted by renal condition in the clinic.
Objective To investigate the use of antibacterials in patients with chronic kidney disease(CKD) and evaluate the drug safety for providing some clinical reference. Methods Inpatients with CKD over a 10-month period from January to October, 2014 in our hospital were analyzed retrospectively. Results In the 1 793 cases of hospitalized patients with CKD, the incidence of infection was 20.86%, mainly respiratory and urinary tract infections. 495 cases were treated with antibacterials, 345 cases for treating and 150 cases for preventing. In cases for treating, pathogenic bacteria were detected in 69.52% of the patients. Quinolones and cephalosporins were the most commonly used antibacterials.There were 66 cases with drug combinations, 22 cases with adverse drug reactions, and the adverse reactions of digestive system were the most common. Conclusion Inpatients with CKD are basically safe to use antibiotics. The dosage regimen should be adjusted by renal condition in the clinic.
引文
[1]张佩嘉,谭洁.互联网技术用于慢性肾脏病健康管理的研究进展[J].护理学杂志,2017,32(1):99-102.
[2]胡双翼.肾内科住院患者抗菌药物应用特点的临床分析[J].世界最新医学信息文摘,2017,17(83):152,164.
[3] Kasiske B L, Wheeler D C. KDIGO Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease Foreword[J]. Kidney International Supplements, 2013, 3(1):2.
[4]国家卫生计生委.印发抗菌药物临床应用指导原则(2015年版)[J].中国医药生物技术, 2015,10(5):477.
[5] Go A S, Chertow G M, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization[J]. N Engl J Med, 2004,351(13):1296-1305.
[6]樊佳,韩飞,王仁定,等.慢性肾脏病患者发生医院感染的临床分析[J].中华医院感染学杂志, 2012,22(22):5015-5017.
[7]李洁,朱潮涌,鲍晓红.慢性肾脏疾病患者发生医院感染的特点与危险因素分析[J].中国现代医生, 2012,50(8):52-53.
[8] Yoon J W, Gollapudi S, Pahl M V, et al. Na ve and central memory T-cell lymphopenia in end-stage renal disease[J]. Kidney Int,2006,70(2):371-376.
[9]于敏,李澜,王姣,等.狼疮性肾炎患者并发医院感染的临床特点及相关因素分析[J].中华医院感染学杂志,2010,20(17):2594-2596.
[10]潘文森,袁雅冬.慢性肾脏病合并感染的治疗[J].临床荟萃,2016,31(6):615-620.
[11]郑茜子,苏涛,王玉,等.氟喹诺酮类药物肾损害[J].中国实用内科杂志, 2011,31(3):229-231.
[12]史浩,任红.慢性肾脏病患者抗菌药物的合理应用[J].世界临床药物,2013,34(11):704-707.
[13] Loghman-Adham M, Kiu W C I, Ciorciaro C, et al. Detection and management of nephrotoxicity during drug development[J].Expert Opin Drug Saf, 2012,11(4):581-596.
[14] Khalili H, Bairami S, Kargar M. Antibiotics induced acute kidney injury:incidence, risk factors, onset time and outcome[J]. Acta Med Iran, 2013,51(12):871-878.
[15]赵靓,郭代红,朱曼,等.501例药源性肾损伤分析[J].中国药物警戒,2015,12(10):627-631.
[16] Choudhury D, Ahmed Z. Drug-associated renal dysfunction and injury[J]. Nat Clin Pract Nephrol, 2006,2(2):80-91.
[17]刘可欣,管玫,严郁,等.抗菌药物的药源性肾损害[J].中国药师,2015,18(3):476-479.
[18]徐世希.药物性肾损伤29例临床分析[J].中国药业,2017,26(15):85-87.
[19]曹菊,苏涛,李晓玫.抗感染药物导致的急性肾损伤[J].药物不良反应杂志, 2010,12(5):325-328.
[20] Jr O R, Ambrose P G. Antimicrobial safety:focus on fluoroquinolones[J]. Clinical Infectious Diseases An Official Publication of the Infectious Diseases Society of America, 2005, 41(Suppl 2):144-157.
[21]戴丽.喹诺酮类药物临床应用及不良反应[J].中华医院感染学杂志, 2012,22(1):163-164.
[22]蔺以.氟喹诺酮类药物临床应用的不良反应与用药原则[J].中国医药科学, 2012,2(1):102-103,105.
[23]谭莉莉.喹诺酮类抗菌药物的临床不良反应[J].中国药物警戒,2013,10(2):92-95.
[24]张莉蓉.氟喹诺酮类抗菌药物不良反应的流行病学及中枢神经毒性研究[D]:复旦大学,2003.
[2]胡双翼.肾内科住院患者抗菌药物应用特点的临床分析[J].世界最新医学信息文摘,2017,17(83):152,164.
[3] Kasiske B L, Wheeler D C. KDIGO Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease Foreword[J]. Kidney International Supplements, 2013, 3(1):2.
[4]国家卫生计生委.印发抗菌药物临床应用指导原则(2015年版)[J].中国医药生物技术, 2015,10(5):477.
[5] Go A S, Chertow G M, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization[J]. N Engl J Med, 2004,351(13):1296-1305.
[6]樊佳,韩飞,王仁定,等.慢性肾脏病患者发生医院感染的临床分析[J].中华医院感染学杂志, 2012,22(22):5015-5017.
[7]李洁,朱潮涌,鲍晓红.慢性肾脏疾病患者发生医院感染的特点与危险因素分析[J].中国现代医生, 2012,50(8):52-53.
[8] Yoon J W, Gollapudi S, Pahl M V, et al. Na ve and central memory T-cell lymphopenia in end-stage renal disease[J]. Kidney Int,2006,70(2):371-376.
[9]于敏,李澜,王姣,等.狼疮性肾炎患者并发医院感染的临床特点及相关因素分析[J].中华医院感染学杂志,2010,20(17):2594-2596.
[10]潘文森,袁雅冬.慢性肾脏病合并感染的治疗[J].临床荟萃,2016,31(6):615-620.
[11]郑茜子,苏涛,王玉,等.氟喹诺酮类药物肾损害[J].中国实用内科杂志, 2011,31(3):229-231.
[12]史浩,任红.慢性肾脏病患者抗菌药物的合理应用[J].世界临床药物,2013,34(11):704-707.
[13] Loghman-Adham M, Kiu W C I, Ciorciaro C, et al. Detection and management of nephrotoxicity during drug development[J].Expert Opin Drug Saf, 2012,11(4):581-596.
[14] Khalili H, Bairami S, Kargar M. Antibiotics induced acute kidney injury:incidence, risk factors, onset time and outcome[J]. Acta Med Iran, 2013,51(12):871-878.
[15]赵靓,郭代红,朱曼,等.501例药源性肾损伤分析[J].中国药物警戒,2015,12(10):627-631.
[16] Choudhury D, Ahmed Z. Drug-associated renal dysfunction and injury[J]. Nat Clin Pract Nephrol, 2006,2(2):80-91.
[17]刘可欣,管玫,严郁,等.抗菌药物的药源性肾损害[J].中国药师,2015,18(3):476-479.
[18]徐世希.药物性肾损伤29例临床分析[J].中国药业,2017,26(15):85-87.
[19]曹菊,苏涛,李晓玫.抗感染药物导致的急性肾损伤[J].药物不良反应杂志, 2010,12(5):325-328.
[20] Jr O R, Ambrose P G. Antimicrobial safety:focus on fluoroquinolones[J]. Clinical Infectious Diseases An Official Publication of the Infectious Diseases Society of America, 2005, 41(Suppl 2):144-157.
[21]戴丽.喹诺酮类药物临床应用及不良反应[J].中华医院感染学杂志, 2012,22(1):163-164.
[22]蔺以.氟喹诺酮类药物临床应用的不良反应与用药原则[J].中国医药科学, 2012,2(1):102-103,105.
[23]谭莉莉.喹诺酮类抗菌药物的临床不良反应[J].中国药物警戒,2013,10(2):92-95.
[24]张莉蓉.氟喹诺酮类抗菌药物不良反应的流行病学及中枢神经毒性研究[D]:复旦大学,2003.