术后感染患者特点及药学会诊治疗分析

Analysis of characteristics and pharmaceutical consultation of postoperative infection patients

目的 分析术后感染患者的特点及药学会诊治疗情况.方法 回顾性分析2009年1月至2012年12月上海交通大学医学院附属新华医院292例术后感染患者药学会诊相关数据,包括肝肾功能状况、感染程度和感染部位、病原菌类别、抗菌药物使用率及患者转归和会诊建议的采纳率,并进行统计学分析.结果 在292例患者中,270例（92.5％）为中重度感染,121例（41.4％）有不同程度的肝肾功能损害,237例（81.2％）能明确感染部位,以肺部、尿路、血液及腹腔感染为主.病原菌检出率以革兰阴性菌最高,鲍曼不动杆菌为20.5％（60/292）,大肠埃希菌14.4％（42/292）,铜绿假单胞菌12.3％（36/292）.临床药师会诊病例中,神经外科、泌尿外科和普外科会诊量居前3位.抗菌药物使用率以哌拉西林钠他唑巴坦钠最高,为76.4％（223/292）,头孢哌酮钠舒巴坦钠次之,为56.8％（166/292）,亚胺培南西司他丁钠为44.9％（131/292）.药学会诊共计454次,会诊方案采纳率98.6％,89.7％患者病情好转.结论 术后感染患者多重耐药病原菌感染发生率较高,抗感染治疗难度大,临床药师在术后感染的防治中发挥了一定的作用.

Objective To explore the characteristics and the pharmaceutical consultation result of postoperative infection patients.Methods Data of 292 patients of postoperative infection from January 2009 to December 2012,including the liver and kidney function,infection sites,pathogenic bacteria,use rate of antimicrobial drug,prognosis and adoption rate of consultation advise were analyzed.Results Among 292 cases,92.5％ （270/292） were severe infection,41.4％ （121/292） had different degrees of liver and kidney function damage,81.2％ （237/292） showed definite infection sites,mainly including lung,urinary tract,blood and abdominal cavity.The detection rate of Gram-negative bacteria was the highest,in which acinetobacter baumannii was 20.5％ （60/292）,followed by e.coli [14.4％ （42/292）] and pseudomonas aeruginosa [12.3％ （36/292）].The top three departments of consultation rate were brain surgery,urology and general surgery.Using rate of piperacillintazobactam was the highest 76.4％ （223/292）,followed by cefperazone-sulbactam [56.8％ （166/292）] and imipenem-cilastatin [44.9％ （131/292）].There were totally 454 times consultation,98.6％ of the consultation suggestions was adopted and 89.7％ of patients got better.Conclusions In postoperative infection,the incidence of infection induced by multiple antimicrobial resistance bacteria is high,leading to difficulties treatment.The Clinical pharmacists is important for prevention and treatment of postoperative infection.