某院住院患者碳青霉烯类抗菌药物的临床使用情况与医嘱点评分析

Analysis of the Clinical Use of Carbapenems and Comments on Medical Orders for Inpatients in a Hospital

目的:分析医院住院患者碳青霉烯类抗菌药物的临床使用情况与医嘱点评结果,为临床碳青霉烯类药物的合理使用提供参考。方法:选取医院2020年1月—5月403例使用过碳青霉烯类抗菌药物的住院患者的病历资料,统计和分析患者的碳青霉烯类药物使用情况、感染类型、病原学检查情况和标本类型等,依据相关权威资料开展医嘱点评,分析碳青霉烯类药物的合理用药情况。结果:403例患者的碳青霉烯类药物用药频度从高到低依次为比阿培南(1459)、美罗培南(1186.67)和亚胺培南(208),药品金额从高到低依次为美罗培南(64.52万元)、比阿培南(59.79万元)和亚胺培南(10.96万元);403例患者主要来自普外科(111例,占27.54%)、血液内科(74例,占18.36%)和神经外科(74例,占18.36%),患者的感染类型主要为肺部感染(215例,占53.35%)和腹腔感染(101例,占25.06%);403例患者在使用碳青霉烯类药物前开展病原学检查的有332例(占82.38%),开展特殊使用级抗菌药物使用会诊的有196例(占48.63%);医嘱点评结果显示,403患者中存在碳青霉烯类药物不合理使用的有46例(不合理发生率为11.41%),主要的不合理原因为联合用药不适宜(15例,占32.61%)和给药剂量不适宜(12例,占26.09%)。结论:医院住院患者的碳青霉烯类抗菌药物使用存在诸多不合理现象,医院管理部门应加强碳青霉烯类抗菌药物的使用管理,定期开展用药点评,以确保患者的用药安全。

Objective:To analyze the clinical use of carbapenems and the results of comments on medical orders for inpatients in the hospital,so as to provide reference for the rational use of carbapenems in clinical practice.Methods:The medical records of 403 inpatients who had used carbapenems were selected from January to May 2020,and the use of carbapenems,infection types,etiology test and specimen types of patients were counted and analyzed.According to the relevant authoritative information,medical orders were commented and the rational use of carbapenems was analyzed.Results:The medication frequency of carbapenems in 403 patients in a descending order was biapenem(1459),meropenem(1186.67)and imipenem(208),and the amount of drugs in a descending order was meropenem(RMB 645200),biapenem(RMB 597900)and imipenem(RMB 109600);403 patients were mainly from General Surgery Department(111 cases,27.54%),Hematology Department(74 cases,18.36%)and Neurosurgery Department(74 cases,18.36%).The infection types of patients were primarily pulmonary infection(215 cases,53.35%)and abdominal infection(101,25.06%).Among 403 patients,there were 332 patients(82.38%)who underwent etiological examination before using carbapenems,and 196 patients(48.63%)who underwent consultation on the use of special antibacterial drugs.The results of comments on medical orders showed that there were 46 patients with unreasonable use of carbapenems(occurrence rate of 11.41%)among 403 patients,and the main reasons included inappropriate drug combination(15 cases,32.61%)and inappropriate dosage(12 cases,26.09%).Conclusion:There are many unreasonable phenomena in the use of carbapenems for inpatients.The hospital management department should strengthen the use management of carbapenems,and carry out regular comments on medications to ensure the medication safety of patients.