临床药师参与439例神经科感染性疾病会诊分析

Analysis of 439 Cases of Infection Diseases from Neurology Ward Consulted by Clinical Pharmacists

目的：分析神经科感染性疾病的特点,为临床治疗提供参考。方法：对某院2011-2013年神经科感染患者的临床药师会诊记录单进行回顾性分析。结果：在439例会诊病例中,65岁以上的老年人256例（58.31%）;主要为肺部感染294例（65.33%）、泌尿道感染40例（8.89%）、颅内感染37例（8.22%）;经培养共分离病原菌510株,其中革兰阴性杆菌362株（70.98%）,革兰阳性球菌127株（24.90%）,真菌21株（4.12%）,排名前5位的病原菌依次是铜绿假单胞菌125株（24.51%）、鲍曼不动杆菌93株（18.24%）、肺炎克雷伯菌88株（17.25%）、金黄色葡萄球菌68株（13.33%）、大肠埃希菌32株（6.27%）;肠杆菌科细菌中肺炎克雷伯菌、大肠埃希菌产ESBLs分别为61.36%和75.00%,铜绿假单胞菌对美罗培南、亚胺培南的敏感率分别为65.8%、70.6%,鲍曼不动杆菌耐药严重,其中泛耐药菌21株（22.58%）,革兰阳性球菌对万古霉素和替考拉宁高度敏感,金黄色葡萄球菌中耐甲氧西林耐药株（MRSA）的检出率为52.24%;会诊意见被医师全部采纳的有372例（84.74%）,部分采纳的有32例（7.28%）,未采纳的有35例（7.97%）;会诊意见全部采纳和部分采纳的病例中有效的有319例（78.96%）;将采纳情况和预后情况进行双向有序线性趋势检验,线性回归分量有统计学意义（P〈0.01）,等级相关系数为0.325（P〈0.01）,该资料说明预后随着采纳情况增加而变好。结论：临床药师在神经科参与感染性疾病治疗,特别是耐药菌的治疗中,提高了有效率,发挥着重要作用。

Objective： To analyze the characteristics of infectious diseases from neurology ward and provide reference for the treatment. Methods： The consultation record of the neurological patients who suffered infection diseases were retrospectively summarized from January 2011 to December 2013. All the consultation were performed by clinical pharmacists. SPSS 19. 0 software was used to analyze the adoption and prognosis of the outcomes. Results： In 439 consultation cases,256 patients（ 58. 31%） were older than 65 years. Most of the cases were respiratory infection（ 294 cases,65. 33%）,urinary tract infection（ 40 cases,8. 89%） and intracranial infection（ 37 cases,8. 22%）. There were 510 strains of bacteria isolated by culturing,in which 362 strains were gram-negative bacteria（ 70. 98%）,127 strains were gram-positive bacteria（ 24. 90%） and 21 strains were fungi（ 4. 12%）. The top five of pathogenic bacteria were Pseudomonas aeruginosa（ 125 stains,24. 51%）,Acinetobacter baumannii（ 93 stains,18. 24%）,Staphylococcus aureus（ 88 stains,17. 25%）,Staphylococcus aureus（ 68 stains,13. 33%） and Escherichia coli.（ 32 stains,6. 27%）. The detection rates of ESBLs of K. pneumonia and E. coli were 61. 36% and 75. 00%,respectively. Among 125 strains of P. aeruginosa,the sensitive rate to meropenem and inipenem was 65. 8% and 70. 6%,respectively. A. baumannii was highly multidrug resistant,and 21 strains（ 22. 58%） with pan-drug resistance were isolated. Gram-positive bacteria were highly sensitive to vancomycin and teicoplanin. Totally35 strains（ 52. 24%） of MRSA were isolated. The complete adoption rate of consultation opinion was 84. 74%（ 372 cases）,the partial adoption rate was 7. 28%（ 32 cases）,and 35 cases（ 7. 97%） were declined. In all the adopted cases（ 319 cases,78. 96%） showed effectiveness. In the linear correlation analysis,the consultation adoption and therapy outcomes had significant correlation（ P〈0. 01）.Conclusion： Clinical pharmacists can improve the efficiency in anti-infection therapy and play important roles in the treatment of infectious diseases in neurology ward,especially in the treatment of drug-resistant bacterial infections.