基于科研点评与信息化管控美罗培南合理用药分析

Analysis of rational drug use of meropenem based on scientific research review and information management

目的基于科研点评与信息化管控分析美罗培南合理用药情况。方法回顾性分析2018—2019年天津市北辰医院应用美罗培南的患者住院病历,并分析其药物使用情况、诊断及疗程情况、微生物培养后细菌分布情况及肾功能不全患者美罗培南用药剂量,并进一步按照特殊抗菌药物相关指南进行合理性评价。结果与2018年相比,2019年美罗培南用药总量增长60.17%、用药疗程增长3.28%、消耗数量增长60.17%、住院天数增长173.78%、用药天数增长101.76%。所有应用美罗培南的患者病例中,诊断包含肺部感染、感染性休克、腹腔感染、脓毒血症、血流感染、尿路感染、胰腺炎、皮肤感染等。2018年美罗培南平均疗程为(6.31±5.01)d,2019年美罗培南平均疗程为(5.97±3.02)d,2019年减少了5.39%。2018年132例应用美罗培南的患者中,115例行微生物送检,送检率87.12%,共培养出33株细菌。2019年237例应用美罗培南的患者中,236例行微生物送检,送检率99.58%,共培养出45例菌株。在2018年,132例应用美罗培南患者均进行肾功能检查,结果显示,58例患者血肌酐(Scr)<62μmol/L,54例患者Scr62~115μmol/L,20例患者Scr>115μmol/L。其中6例患者内生肌酐清除率(Ccr)<50 mL/min,3例未实施给药剂量及给药频次调整。按照药物说明书相关适应证及患者临床病理资料,在2018年132例应用美罗培南患者病历中,不合理应用药物的患者占12.88%(17/132),2019年237例应用美罗培南患者病历中,不合理应用药物的患者占3.80%(9/237)。结论通过科研点评与信息化管控可发现医院美罗培南使用存在不合理现象,对患者美罗培南使用情况进行分析及点评,有利于规范美罗培南使用,提高临床用药的安全性及合理性。

Objective To analyze the rational use of meropenem based on scientific research review and information management.Methods The medical records of patients with meropenem in Tianjin Beichen Hospital from 2018 to 2019 were retrospectively analyzed,and the drug use,diagnosis and course of treatment,bacteria distribution after microbial culture,and dosage of meropenem in patients with renal insufficiency were analyzed,and the rationality was further evaluated according to the relevant guidelines of special antibacterial drugs.Results Compared with 2018,the total number of meropenem medications increased by 60.17%,the duration of medication increased by 3.28%,the number of consumption increased by 60.17%,the number of hospitalization days increased by 173.78%,and the number of medication days increased by 101.76%in 2019.All patients treated with meropenem were diagnosed with pulmonary infection,sepsis,wound infection,submaxillary lymphadenitis,pancreatitis,acute tonsillitis,sepsis,urinary tract infection,etc.The average treatment course of meropenem was(6.31±5.01)d in 2018,and(5.97±3.02)d in 2019,which decreased by 5.39%in 2019.In 2018,115 of the 132 patients treated with meropenem underwent microbial examination,with a detection rate of 87.12%,and a total of 33 bacterial strains were cultured.In 2019,of 237 patients treated with meropenem,236 were submitted for microbial detection,with a detection rate of 99.58%.A total of 45 strains were cultured.In 2018,132 patients treated with meropenem underwent renal function tests,and the results showed that serum creatinine(Scr)was<62μmol/L in 58 patients,62—115μmol/L in 54 patients,and>115μmol/L in 20 patients.Among them,6 patients had endogenous creatinine clearance rate(Ccr)<50 mL/min,and 3 patients did not adjust dose and frequency of administration.According to the indications and clinicopathological data of the patients,among the 132 cases of meropenem application in 2018,12.88%(17/132)were found to be irrational use of drugs;among the 237 cases of meropenem application in 2019,3.80%(9/237)were irrational use of drugs.Conclusion The irrational use of meropenem in hospitals can be found through scientific research review and information control.The analysis and comment on the use of meropenem in patients is conducive to standardize the use of meropenem and improve the safety and rationality of clinical medication.