糖尿病并感染患者抗菌药物合理用药评价

Rational Use of Antimicrobial Drugs in Patients with Diabetes Mellitus Complicated with Infection

目的促进糖尿病并感染患者抗菌药物的合理使用。方法收集医院内分泌科2019年收治的216例糖尿病并感染成年(≥18岁)患者的临床资料,整理抗菌药物使用的药物相关问题(DRPs);采用Granada-Ⅱ分类法,建立《糖尿病合并感染患者抗菌药物临床应用DRPs分类和评判标准》;分析并评价抗菌药物使用的必要性、有效性及安全性;采用多因子降维法分析抗菌药物使用的DRPs影响因素。结果216例患者中,使用1种、2种、3种、4种及以上抗菌药物的分别有119例(55.09%)、57例(26.39%)、25例(11.57%)、15例(6.94%);单一用药、联用2种药物、联用3种药物的分别有155例(71.76%)、59例(27.31%)、2例(0.93%);单个药物使用频次较高的抗菌药物为头孢他啶(87例,24.10%)和哌拉西林他唑巴坦(82例,22.71%)。71例(32.87%)患者使用抗菌药物发生DRPs 106次,其中DRP 2,3,4,5,6类分别发生5,13,31,30,27次。DRPs的发生与病程>10年、联合用药显著相关。结论该医院糖尿病并感染患者抗菌药物使用欠合理,其DRPs主要表现在用药的有效性和安全性方面。应依据患者病情选择抗菌药物品种并调整剂量,以保证临床安全、有效、合理用药。

Objective To promote the rational use of antimicrobial drugs in patients with diabetes mellitus(DM)complicated with infection.Methods The clinical data of 216 patients with DM and infection(≥18 years old)admitted to the endocrinology department in the hospital in 2019 were collected,and the drug-related problems(DRPs)in the use of antimicrobial drugs were sorted out.Granada-Ⅱclassification method was used to establish the Classification and Evaluation Criteria of DRPs for Clinical Application of Antimicrobial Drugs in Patients with Diabetes Mellitus Complicated with Infection.The necessity,effectiveness and safety of antimicrobial drugs were analyzed and evaluated.The influencing factors of DRPs in the use of antimicrobial drugs were analyzed by the multi-factor dimension reduction method.Results Among 216 patients,119 cases(55.09%),57 cases(26.39%),25 cases(11.57%)and 15 cases(6.94%)were treated with one,two,three and four kinds(including more than four kinds)of antimicrobial drugs respectively,155 cases(71.76%),59 cases(27.31%)and 2 cases(0.93%)were treated with one drug,two drugs and three drugs respectively.The most frequently used antimicrobial drugs were ceftazidime(87 cases,24.10%)and piperacillin-tazobactam(82 cases,22.71%).DRPs occurred 106 times in 71 patients(32.87%)using antimicrobial drugs,including 5,13,31,30 and 27 times in DRP2,DRP3,DRP4,DRP5 and DRP6,respectively.The occurrence of DRPs was significantly correlated with the course of disease over 10 years and combined medication.Conclusion The use of antimicrobial drugs in patients with DM complicated with infection in this study is not reasonable,and its DRPs are mainly manifested in the effectiveness and safety of the medication.The varieties of antimicrobial drugs should be selected and the dose should be adjusted according to the patients′condition,so as to ensure clinical safe,effective and rational use of antimicrobial drugs.