住院患者多糖肽类抗生素临床应用分析与评价

Clinical application of glycopeptide antibiotics in hospitalized patients

目的探讨多糖肽类抗生素在住院患者中的临床应用情况,评价其用药合理性,为临床合理用药提供参考依据。方法采用回顾性调查方法调查某院2014年1—12月使用多糖肽类抗生素的住院患者,记录其相关临床资料。结果共纳入病例727例,其中感染患者471例(占64.79%)。社区感染与医院感染均以呼吸道为主(分别占39.17%、45.98%)。多糖肽类抗生素用药天数平均6.06 d(4 403/727)。重症监护病房(ICU)、肿瘤科及神经外科患者使用例数最多,分别为148例(20.36%)、88例(12.10%)、81例(11.14%)。单用糖肽类患者338例(46.49%),联用种类平均达4.43种,三联及以上达99例(13.62%),联用频率最高的为第二代头孢菌素类(20.48%)。多糖肽类抗生素中使用万古霉素450例(61.90%),使用替考拉宁260例(35.76%),万古霉素与替考拉宁同用17例(2.34%)。共分离病原体847株,主要为鲍曼不动杆菌(111株,13.10%)、肺炎克雷伯菌(80株,9.45%)、铜绿假单胞菌(68株,8.03%)及金黄色葡萄球菌(54株,6.37%),其中耐甲氧西林金黄色葡萄球菌50株。经多糖肽类抗生素治疗后有效490例,有效率为67.40%。727例患者中,用药合理86例(11.83%),基本合理315例(43.33%),不合理326例(44.84%)。结论该院多糖肽类抗生素使用情况基本合理,但对适应证的把握有待加强。

ObjectiveTo survey the clinical application of glycopeptide antibiotics in hospitalized patients, and evaluate the rationality of drug use, so as to provide reference for rational clinical drug use. MethodsA retrospective study was conducted to investigate the application of glycopeptide antibiotics among inpatients in a hospital from January to December in 2014, relevant clinical data were recorded. ResultsA total of 727 cases were included , 471 （64.79%） of which were infected cases. Respiratory tract infection was the main site of both healthcareassociated infection and communityassociated infection （39.17% and 45.98%, respectively）. The average days of glycopeptide antibiotic use were 6.06 day （4 403/727）. Patients who used glycopeptide antibiotics were mainly from intensive care unit, department of oncology, and department of neurosurgery, accounting for 20.36%（n=148） , 12.10%（n=88）, and 11.14%（n=81） respectively. Glycopeptide was used in 338 patients（46.49%）,the average types of combined use was 4.43, triple and above was used in 99 patients（13.62%）,combination of the second generation cephalosporins was the highest（20.48%）. 450（61.90%） patients used vancomycin, 260（35.76%）used teicoplanin,17（2.34%）used both vancomycin and teicoplanin. A total of 847 pathogenic strains were isolated, the major were Acinetobacter baumannii （n=111, 13.10%）, Klebsiella pneumoniae （n=80, 9.45%）, Pseudomonas aeruginosa （n=68, 8.03%）, and Staphylococcus aureus （n=54 , 6.37%）, methicillinresistant Staphylococcus aureus was 50 strains. 490 （67.40%） patients treated with glycopeptide antibiotics were effective. Of 727 patients, 86 （11.83%） used antibiotics rationally, 315（43.33%） basically rational,and 326 （44.84%） irrationally. ConclusionApplication of glycopeptide antibiotics in this hospital is basically rational, but indications should be paid attention.