某三甲医院2019年万古霉素使用调查分析

Investigation and Analysis of Vancomycin Used in a Third Class Hospital in 2019

目的:考察医院抗菌药物万古霉素的使用状况,对其用药合理性进行分析以期为临床合理用药提供借鉴和参考。方法:依据相关点评指南、指导原则、专家共识和万古霉素使用说明书等,进入某医院信息系统(HIS)筛查和收集医院2019年全部住院患者病历数据,对患者的万古霉素用药情况进行回顾性分析。结果:医院27个科室共接诊2647名患者,人群覆盖新生儿至老年患者,其中男性1617例(61.09%);万古霉素的使用目的以治疗用药为主,治疗用药患者有1823例(68.87%),且在送检1634例的微生物检验样本中检出革兰氏阳性菌217株,1658名患者(满18岁)的万古霉素治疗用药利用指数(DUI)为1.11。调查中发现的主要问题是:部分患者(52例,1.9%)可采用较低级别抗生素治疗,但实际选择万古霉素,少数病例药物起点选择偏高;用药疗程方面有14例(0.5%)患者的用药周期超过合理规定值;不良反应方面有47例(1.8%)患者出现了肾损伤反应,这些发生肾毒性患者均未对所用药物进行药物浓度或其他指标监测。结论:万古霉素在该院的总体使用状况较为合理,基本未出现药物滥用情况。

Objective:To investigate the use condition of antibacterial drug vancomycin in hospital,and to analyze the rationality of its use in order to provide reference for clinical rational drug use.Methods:According to relevant review guidelines,guiding principles,expert consensus and vancomycin instructions,the hospital information system(HIS)was used to screen and collect medical records of inpatients during 2019,and the medication status of patients with vancomycin was retrospectively analyzed.Results:A total of 2647 patients covering newborns to the elderly were treated in 27 departments of the hospital,including 1617 male patients(61.09%).Vancomycin was mainly used for therapeutic purposes,and 1823 patients(68.87%)were treated with vancomycin,and 217 strains of Gram-positive bacteria were detected in 1634 samples for microbial test.The therapeutic vancomycin utilization index(DUI)of 1658 patients(over 18 years old)was 1.11.The main problems found in the investigation were as follows:some patients(52 cases,1.9%)could be treated with a lower grade of antibiotics,but vancomycin was finally chosen,and a few patients had a higher starting point;In terms of medication duration,14 patients(0.5%)had medication duration exceeding the reasonable prescribed value.In terms of adverse reactions,47 patients(1.8%)had renal injury reactions,and none of these patients with nephrotoxicity were monitored for drug concentration or other indicators.Conclusion:The overall use of vancomycin in this hospital is reasonable,and there is basically no drug abuse.