β-内酰胺酶抑制剂抗菌药物临床使用调查

Clinical Application of β-Lactamase Inhibitor Antibiotics

目的了解医院临床β-内酰胺酶抑制剂抗菌药物的应用情况，落实《抗菌药物临床应用指导原则》，减少不合理使用、滥用抗菌药物。方法对出院患者1184份病历进行回顾性对列研究，并根据监测结果，随机选择住院的患者98例进行前瞻性监测，根据回顾性研究发生的问题，在前瞻性调查中加以纠正。结果前瞻性监测中71例使用了抗菌药物，23例使用β-内酰胺酶抑制剂抗菌药物；手术预防20例，其中Ⅰ类手术18例，用药时间2～10d，Ⅱ类手术2例，用药时间5～6d，Ⅲ类手术2例；内科3例治疗选用β-内酰胺酶抑制剂药物用药10d，并未根据细菌种类及药敏试验结果合理选择抗菌药物，同时病程无分析记录。结论外科在清洁手术后都预防性使用了抗菌药物，用药指征不准确，并且选用级别过高的哥内酰胺酶抑制剂抗菌药物与联合抗菌药物术后预防使用；内科治疗一般感染疾病，首先选择了用于难治和耐药菌产生的抗感染药物，多数病例使用抗菌药物前未送细菌培养和药敏试验；因此，应加强口一内酰胺酶抑制剂抗菌药物管理。

OBJECTIVE To know of the application status of β-Lactamase inhibitor antibiotics in our hospital, promote the compliance of Guideline for application of antibiotics, and cut down the abusing or irrationally using of antibiotics. METHODS Retrospective cohort research was used to review the medical records of 1184 patients left our hospital. Based on the inspection results, to select following 98 inpatients to do prospective research and correct those problems found in the retrospective research. RESULTS There were 71 cases in the prospective research who had applied antibiotics, in which 23 cases had used β-lactamase inhibitor antibiotics; 20 cases with precautious application, 18 cases underwent type Ⅰ operation and used antibiotics for 2 to 10 days; 2 cases underwent type Ⅱ operation and used antibiotics for 5 to 6 days; 2 cases underwent type Ⅲ operation; 3 cases of internal medicine patients had been treated with β-lactamase inhibitor antibiotics for 10 days, not selected by the type of bacteria and the result of drug sensitivity test, and no analysis records in the progress note. CONCLUSIONS In surgical departments, use antibiotics as preventive measurements even after clean operation which lack indications and choose over estimated level of β-lactamase inhibitor antibiotics and combine medication for post-operation preventive medicine. When treating ordinary infections, Internal department had chose antibiotics which should be used for difficult diseases caused by resistant microbes. Most patients do not have undergone bacteria cultivation and drug sensitivity test before applying antibiotics. Therefore the management of antibiotics should be enhanced.