1025例住院患者特殊使用级抗菌药物应用分析

Analysis of Application of Antibiotics for Special Use in 1025 Inpatients

目的:评价乌鲁木齐市友谊医院(以下简称"我院")住院患者特殊使用级抗菌药物应用情况,为合理应用抗菌药物提供参考。方法:调取2015—2017年我院应用特殊使用级抗菌药物的出院病历,共1 025份;分析患者基本情况、病原学送检情况、标本分布情况、抗菌药物品种和特殊使用级抗菌药物应用情况。结果:1 025例使用特殊使用级抗菌药物的住院患者中,949例送标本进行了细菌培养,病原学送检率为92.59%,送检标本共1 677份,分离出细菌830株,检出率较高的细菌依次为大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌等。1 025例患者共使用特殊使用级抗菌药物9个品种,以美罗培南、亚胺培南和万古霉素为主;用药时间为1～39 d,平均4.98 d;碳青霉烯类抗菌药物的用药频度最高,头孢吡肟的药物利用指数最高;联合用药的患者402例,占39.22%;不规范应用特殊使用级抗菌药物主要表现为无会诊、会诊人员非我院特殊使用级抗菌药物专家组成员及由无处方权限的医师开具。结论:我院特殊使用级抗菌药物的临床应用基本合理,但仍存在不合理现象,应加强抗菌药物的使用管理。

OBJECTIVE: To evaluate the application of antibiotics for special use in inpatients in Urumqi FriendshipHospital(hereinafter referred to as "the hospital"), so as to provide reference for the rational application of antibiotics. METHODS: Totally 1 025 discharged medical records of antibiotics for special use from 2015 to 2017 were extracted, the basic conditions of patients, the status of pathogens, the distribution of specimens, the varieties of antibiotics and the application of antibiotics for special use were analyzed. RESULTS: Among the 1 025 inpatients with antibiotics for special use, 949 cases were sent for bacterial culture, and the pathogenic detection rate was 92.59%, totally 1 677 samples were sent for detection, and 830 strains of bacteria were isolated, and the bacteria with higher detection rate were Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa, etc. A total of 9 varieties of antibiotics for special use were applied in 1 025 patients, mainly meropenem, imipenem and vancomycin;the duration of medication ranged from 1 d to 39 d, with an average of 4.98 d. Carbapenems were the most frequently used antibiotics, and the drug utilization index of cefepime was the highest. There were 402 patients with drug combination, accounting for 39.22%. Non-standard application of antibiotics for special use mainly manifested as no consultation, consultation staff members of non-specialist anti-bacterial drug expert group and issued by clinicians without prescription authority. CONCLUSIONS: The clinical application of antibiotics for special use in our hospital is basically rational, but there are still some irrational phenomena, and the application management of antibiotics for special use should be strengthened.