抗菌药物相关血小板减少症的自动监测与评价研究

Automatic monitoring and assessment of antibiotics-related thrombocytopenia

目的了解住院人群中抗菌药物相关血小板减少症的临床特征和严重程度的危险因素。方法利用临床药物不良事件主动监测与智能评估警示系统-Ⅱ(ADE-ASAS-Ⅱ)回顾性监测2020年6月1日至2021年5月31日住院患者电子医疗数据,自动识别符合标准患者并报警,对报警患者人工评判后,分析抗菌药物相关血小板减少症的临床特征、药品分布和严重程度的危险因素。结果共纳入监测住院患者共计86452例,系统报警1606例,经判定阳性病例204例,平均年龄为(62.8±15.46)岁,血小板减少发生时间主要集中在7 d内,共189例(92.65%)。涉及药物11类22种,以头孢菌素类致血小板减少症最多,135例(66.20%);位居前3位药物分别是头孢哌酮舒巴坦39例(19.12%)、头孢呋辛32例(15.69%)、氟氧头孢21例(10.29%)。30例可能引起重度血小板减少的药物以美罗培南最多(20%)。合并肝功能异常(OR=3.17,95%CI:1.07~9.38)、入住ICU(OR=3.17,95%CI:1.19~8.46)、联用抗菌药物(OR=3.28,95%CI:1.38~7.79)和联用抗血栓形成药(OR=2.80,95%CI:1.11~7.07)的患者发生重度血小板减少的风险较高。针对血小板减少,临床上仅停药处理有145例,其余给予治疗药物以地塞米松(28例)和重组人血小板生成素(25例)较多。结论导致血小板减少的抗菌药物较多,临床在应用这些药物时,要密切关注患者临床表现和监测血小板计数,加强对高危人群及联用高危药物的预警防范。

Objective To find out about the clinical characteristics and risk factors for severity of antibiotics-related thrombocytopenia among inpatients.Methods Using the“ADE active surveillance and assessment system-Ⅱ”(ADEASAS-Ⅱ),the electronic medical data on inpatients treated in our hospital between June 1,2020 and May 31,2021 was retrospectively monitored.Patients who met the standards were automatically identified before alarm was given.After the alarm,patients were manually assessed,and the clinical characteristics,drug distribution and risk factors for severity of antibiotics-related thrombocytopenia were analyzed.Results A total of 86452 inpatients were included in the surveillance,with 1606 system alerts.After screening,The age of the 204 positive cases averaged(62.8±15.46)years,and thrombocytopenia mostly occurred within 7 days of medication,involving a total of 189 cases(92.65%).The drugs involved were of 11 categories and 22 types.Most of the cases of thrombocytopenia were caused by cephalosporins(135 cases,66.20%).The top three drugs were cefoperazone sulbactam(39 cases,19.12%),cefuroxime(32 cases,15.69%)and flomoxef(21 cases,10.29%).Meropenem was the most likely drug responsible for severe thrombocytopenia(30 cases,20%).Complications with abnormal liver function(OR=3.17,95%CI:1.07~9.38),admissions to ICU(OR=3.17,95%CI:1.19~8.46),co-administration with antibiotics(OR=3.28,95%CI:1.38~7.79)and combination of antithrombotic agents(OR=2.80,95%CI:1.11~7.07)could increase the risk of severe thrombocytopenia.Among these cases,145 had their drugs withdrawn,while the rest were mostly treated with dexamethasone(28 cases)and recombinant human thrombopoietin(25 cases).Conclusion There are many antibacterial drugs that cause thrombocytopenia.In clinical use of these drugs,the clinical manifestations of patients and the platelet count need to be monitored.Early warning and precautions are critical to high-risk groups and the combination of high-risk drugs.