某院万古霉素的临床用药情况及合理性分析

Clinical Use and Rationality of Vancomycin in a Hospital

目的:调查我院使用万古霉素患者的临床用药情况,并分析其用药的合理性,以促进临床合理使用万古霉素。方法:抽取我院2017~2018年560例使用万古霉素的患者作为研究对象,收集患者病历资料,统计其临床用药的具体情况;根据万古霉素的药品说明书、《抗菌药物临床应用指导原则》(2015年版)以及《万古霉素临床应用中国专家共识》(2011版)等文件对万古霉素的用药合理性进行分析总结。结果:560例患者中,512例为治疗性用药(91.43%),48例为预防性用药(8.57%);给药剂量以<2 g/d为主,占比60.18%;给药疗程多在1周以内,占比56.96%;给药途径绝大多数为静脉滴注给药,占比99.29%;83.75%的患者进行了血药浓度监测,71.25%的患者进行了肾功能监测,82.50%的患者进行了病原微生物学检测;423例(75.54%)患者联用了其他抗菌药,其中以联用1种抗菌药为主,占比59.11%;508例(90.71%)患者最终治愈/好转;33例患者出现了不良反应,总发生率为5.89%,其中肝功能损伤和肾功能损伤发生率较高。存在万古霉素不合理用药的患者共计113例(20.18%),主要包括用法用量不适宜(5.71%)、疗程不适宜(4. 82%)、溶媒选择不适宜(3.75%)、适应证不明确(3.21%)以及联合用药不适宜(2.68%)。结论:我院应用万古霉素的科室分布广泛,整体临床用药情况基本合理,不良反应率较低,不过仍存在一定比例的不合理用药情况,在微生物病原学送检、用药监测以及专项处方点评等方面还需要进一步加强,以保障临床用药安全。

Objective:To investigate the clinical use of vancomycin in our hospital and analyze the rationality of vancomycin use in order to promote the rational use of vancomycin in clinic.Methods:From 2017 to2018,560 patients prescribed with vancomycin in our hospital were included in the current study.The medical records and the clinic performance of the drug use were collected.The rationality of vancomycin was analyzed and summarized according to the drug instructions of vancomycin,Guidelines For Clinical Use Of Antibacterials(Edition 2015),and the Consensus of Clinical Application of Vancomycin of Chinese Experts(Editon 2011),etc.Results:Among the 560 patients,512 cases were given therapeutic drugs(91.43%),and 48 cases with preventive drugs(8.57%).Most prescriptive dosage was less than 2 g/d(60.18%),and the course of administration was less than 1 week(56.96%).The major routes of administration were intravenous drip(99.29%).83.75%of the patients were monitored for serum concentration during the course of treatment,and 71.25%of the patients were monitored for renal function,and 82.50%of the patients were detected with pathogen microbiology.In addition,423 patients(75.54%)were treated with other antibiotics,of which 59.11%were treated with one antibiotic.508 patients(90.71%)were cured/improved,and 33 patients had adverse reactions(5.89%),among which the incidences of liver damage and renal damage were higher.irrational use of vancomycin was found in 113 patients(20.18%),including inappropriate dosage(5.71%),unsuitable course of treatment(4.82%),unsuitable solvent selection(3.75%),unclear indication(3.21%)and unsuitable combination of drugs(2.68%).Conclusion:Vancomycin is commonly used in lots of departments in our hospital.The overall clinical drug use is basically rational and the adverse reaction rate is low.But there is still considerable proportion of irrational drug use in our clinic.It is necessary to strengthen the microbial etiological examination,drug use monitoring and special prescription evaluation in order to ensure the safety use of vancomycin in clinic use.