四川省三级综合医院碳青霉烯类抗菌药物临床应用调查及用药合理性评价

Clinical Utilization Investigation and Rationality Evaluation of Carbapenems in Tertiary General Hospitals of Sichuan Province

目的:了解四川省三级综合医院碳青霉烯类抗菌药物的临床应用情况,分析和评价其用药合理性。方法:抽取四川省15家三级综合医院碳青霉烯类抗菌药物病历,每家医院至少10份,分析各品种的临床应用情况,根据相关文献设计评分细则对病历进行评分,并分析不合理用药的原因。结果:15家三级综合医院实际抽取病历175份,涉及亚胺培南/西司他丁、美罗培南及比阿培南3个品种,其中,亚胺培南/西司他丁的用药频度(DDDs)最高(811.8),且药物利用指数(DUI)大于1.1。病历总体得分中位数为9.0(IQR:7.0,10.0;范围:010.0)。临床应用不合理病历101份(57.71%),其中73份(47.71%)存在用药不适宜问题,36份(20.57%)未进行疗效动态评估及病原学、会诊不符合要求。结论:碳青霉烯类抗菌药物临床不合理应用情况较为突出,应关注碳青霉烯类抗菌药物临床应用各个环节的管理,促进碳青霉烯类抗菌药物的合理使用。

Objective:To know the clinical utilization of carbapenems in tertiary general hospitals of Sichuan province,and then analyze and evaluate the medication rationality.Methods:The medical records containing carbapenem antibiotics from 15 tertiary general hospitals in Sichuan province were selected with at least 10 ones from each hospital to analyze the clinical application of each variety.According to the scoring rules of relevant document,the medical records were scored and the reasons for unreasonable drug use were analyzed.Results:Totally 175 medical records containing imipenem,meropenem or biapenem were collected from 15 tertiary general hospitals.Among them,imipenem had the highest DDDs(811.8),and DUI was greater than 1.1.The median overall score of medical records was 9.0(IQR:7.0,10.0;range:0-10.0).There were 101 cases(57.71%)with unreasonable clinical application,of which 73 cases(47.71%)were with unsuitable medication,and 36 cases(20.57%)were related to the failure of dynamic evaluation of curative effect,etiology and consultation.Conclusion:The status of irrational use of carbapenems is prominent.Every step in the clinical application of carbapenems should be paid attention and the rational use should be promoted further.