碳青霉烯类药物在某院的应用现状与药学分析

Application status and Pharmaceutical Analysis of carbapenems in a hospital

目的 对碳青霉烯类药物的应用现状进行分析与评价。方法 对2019年1月~12月各季度碳青霉烯类药物的用药金额和用药频度(DDDs)进行汇总统计分析,结合某院细菌耐药性监测结果分析碳青霉烯类药物使用情况并抽取100份病历评价临床应用合理性。结果2019年碳青霉烯类药物在全院用量排名前五的科室是血液科、ICU、呼吸内科、神经外科和肾内科,各季度在排序上变化不大,美罗培南在用药金额和DDDs排序位居第一。随着碳青霉烯类药物的用量增加,鲍曼不动杆菌的耐药率也明显上升。100份病历中有47例存在用药问题,其中不符合评价细则规定适应证的就有35例。结论 某院碳青霉烯类药物的使用存在不合理之处,适应证掌握不严,品种选择不适宜、与丙戊酸钠配伍等问题,应继续加强使用管理,尤其是对美罗培南的管控,以降低细菌耐药性发生的风险。

Objective To analyze and evaluate the application status of carbapenems.Methods A summary statistical analysis of the amount and frequency of carbapenems used in each quarter from January to December 2019.Analyze the use of carbapenems and extract 100 medical records to evaluate the rationality of clinical application based on the results of bacterial resistance monitoring in a hospital.Results The top five departments of carbapenems used in the hospital were hematology,ICU,respiratory medicine,neurosurgery and nephrology.There was little change in the ranking of each quarter.Meropenem ranked first in the amount of drugs and DDDs.With the increase in the amount of carbapenems,the drug resistance rate of Acinetobacter baumannii has also increased significantly.There are 47 cases in 100 medical records had medication problems,of which 35 cases did not meet the indications specified in the evaluation rules.Conclusion The use of carbapenems in the hospital is unreasonable.Problems such as lax control of indications,inappropriate selection of varieties,compatibility with sodium valproate,etc.We should continue to strengthen the use of management to reduce the risk of bacterial resistance occurred especially meropenem.