Practice of Perioperative Rational Use of Antibacterial Drugs Based on Drug Pathway

[Objectives]To establish a new management model for rational use of perioperative antibacterial drugs in surgical departments.[Methods]Based on evidence-based medicine,the department s drug pathway was formulated,and the new mode of rational drug use control was established by using fine pharmaceutical technology intervention,and the intervention effect was evaluated by the intensity of antibacterial drug use,per capita drug costs and the proportion of drugs.[Results]After adopting drug pathway in departments,the intensity of antibacterial drug use,per capita drug costs and the proportion of drugs decreased significantly,and the effect of rational drug use control was remarkable.[Conclusions]The drug pathway provides a new management and control mode for the rational use of perioperative antibacterial drugs in surgical departments of hospitals.Thus,it is worthy of popularization and application.

Effects of intervention measures on irrational antibiotics/antibacterial drug use in developing countries: A systematic review

Irrational antibiotics/antibacterial (AB) drug use is a global problem, especially in developing countries. This results in an increased emergence of resistance to most common bacteria, higher cost of treatment, prolonged hospitalization and adverse drug reactions. Interventions measures have been instituted to avert the problem but it still persists. A systematic review was conducted to determine the effect of different interventions (education, managerial, diagnostic tests, regulatory, economic and multifaceted) on misuse of AB drugs in developing countries. A total of 722 articles were retrieved and 55 were reviewed. About 10.9% of the studies were from Africa, 63.6% from Asia, 9.1% from Latin America, and 16.4% from Southeastern Europe. A total of 52.7% of the studies were from hospital settings, 5.5% from outpatient departments, 21.8% were from public health care facilities, 12.7% from private pharmacies/drug stores, and 7.3% from the communities. Education intervention had 27.3% studies, managerial had 20%, managerial/education had 3.6%, regulatory had 9.1%, education/regulation had 9.1% and diagnostic had 3.6% studies. Multifaceted intervention had 27.3% studies, with 63% improvement in appropriate AB doses prescribed, 2.6% mean number of AB encounter reduction, 23% AB prescription reduction, 18.3% generic AB prescription improvement, 32.1% reduction in AB use, 89% reduction in AB use in acute respiratory infection, 82% in surgery, 62.7% mean reduction in deliveries, 39% in STDs, 36.3% mean reduction in diarrhea, 14.6% mean reduction AB use in malaria, and 6%-11% in the cost of treating bacteria-resistant organisms. Also noted was 6.3% reductions in mean AB encounters after 1 month of intervention, and then increased to 7.7% after 3 months thus lacking sustainability. Multifaceted interventions were effective in reducing irrational AB drug use in the various health facilities and communities as well as reduction in the emergence of resistance to the commonest bacteria in the developing countries though there was lack of sustainability or continuity of rational drug use over the time.

Antibacterial effect of Allium sativum cloves and Zingiber officinale rhizomes against multiple-drug resistant clinical pathogens

Objective:To evaluate the antibacterial properties ot Allium sativum(garlic) cloves and Zingiber officinale(ginger) rhizomes against multi-drug resistant clinical pathogens causing nosocomial infection.Methods:The cloves of garlic and rhizomes of ginger were extracted with 95%(v/v) ethanol.The ethanolic extracts were subjected to antibacterial sensitivity test against clinical pathogens.Results:Anti-bacterial potentials of the extracts of two crude garlic cloves and ginger rhizomes were tested against five gram negative and two gram positive multi-drug resistant bacteria isolates.All the bacterial isolates were susceptible to crude extracts of both plants extracts.Except Enterobacter sp.and Klebsiella sp.,all other isolates were susceptible when subjected to ethanolic extracts of garlic and ginger.The highest inhibition zone was observed with garlic(19.4S mm) against Pseudomonas aeruginosa(P.aeruginosa).The minimal inhibitory concentration was as low as 67.00 μg/mL against P.aeruginosa.Conclusions:Natural spices of garlic and ginger possess effective anti-bacterial activity against multi-drug clinical pathogens and can be used for prevention of drug resistant microbial diseases and further evaluation is necessary.

<i>In Vitro</i>Antibacterial Activity of Flavonoid Extracts of Two Selected Libyan Algae against Multi-Drug Resistant Bacteria Isolated from Food Products

This study aimed to evaluate the antibacterial activity of flavonoids extracted from two Libyan brown algae namely Cystoseira compressa and Padina pavonica using microwave-assisted extraction method against pathogenic bacteria isolated from meat, meat products, milk and dairy products (Staphylococcus aureus subsp. aureus (5 isolates), Bacillus cereus (3 isolates), Bacillus pumilus (1 isolate), Salmonella enterica subsp. enteric (4 isolates) and Enterohaemor-rhagic Escherichia coli O157 (EHEC O157) (4 isolates)). All of these isolates were muti-drug resistant with high MAR index. The results showed that C. compressa extract exhibited better and stronger antibacterial activities against the seventeen tested isolates with inhibition zones diameter ranged from 14 - 22 mm compared to P. pavonica extract which showed positive effect against 9 isolates with low inhibition zone ranged from 11 - 16.5 mm. Flavonoids extracted from C. compressa also displayed the best spectrum of bactericidal effect with a ratio MBC/MIC ≤ 4 obtained on all susceptible tested bacterial strains. Flavonoids and proanthocyanidins significantly contributed to the antibacterial properties. The mode of action of these active extracts is under investigation.

A drug-loaded flexible substrate improves the performance of conformal cortical electrodes

Cortical electrodes are a powerful tool for the stimulation and/or recording of electrical activity in the nervous system.However,the inevitable wound caused by surgical implantation of electrodes presents bacterial infection and inflammatory reaction risks associated with foreign body exposure.Moreover,inflammation of the wound area can dramatically worsen in response to bacterial infection.These consequences can not only lead to the failure of cortical electrode implantation but also threaten the lives of patients.Herein,we prepared a hydrogel made of bacterial cellulose(BC),a flexible substrate for cortical electrodes,and further loaded antibiotic tetracycline(TC)and the anti-inflammatory drug dexamethasone(DEX)onto it.The encapsulated drugs can be released from the BC hydrogel and effectively inhibit the growth of Gram-negative and Gram-positive bacteria.Next,therapeutic cortical electrodes were developed by integrating the drug-loaded BC hydrogel and nine-channel serpentine arrays;these were used to record electrocorticography(ECoG)signals in a rat model.Due to the controlled release of TC and DEX from the BC hydrogel substrate,therapeutic cortical electrodes can alleviate or prevent symptoms associated with the bacterial infection and inflammation of brain tissue.This approach facilitates the development of drug delivery electrodes for resolving complications caused by implantable electrodes.

Study on Anti-diarrhea Effect of the Prescription of 4 Tibetan Veterinary Drugs

This study was conducted to investigate the effects of extracts of 4 Tibetan veterinary drugs on bacterial diarrhea, and to guide the clinical treatment of the disease. The inhibitory effects of the extracts of the 4 Tibetan veterinary drugs, Veronica ciliate Fisch, Usnea diffracta Vain, Sophoraflavescens var. flavescens, Lamiophlomis rotata （ Benth. ） Kudo on 14 common diarrheagenic bacteria were detected by K-B diffusion method and micro-broth dilution method. Optimization was performed on prescriptions of the 4 Tibetan veterinary drugs using orthogonal design software, and a mouse bacterial diarrhea model was established with a clinical isolate, Salmonella blegdam. According to the LD50 value of the optimal prescription of the 4 Tibetan veterinary drugs, the established mouse bacterial diarrhea model was treated in 3 dose groups, i. e. , the high, middle and low dose groups （0. 060, 0. 030 and 0. 020 g/ml, respectively）. The results showed that the 4 Tibetan veterinary drugs had very good inhibitory effects on most of the tested diarrheagenic bacteria, and among them, U. diffracta had better inhibitory effects on all the tested bacteria. The optimal prescription of the d Tibetan veterinary drugs （high dose, 0.06 g/ml） exhibited very good inhibitory effect on mouse diarrhea, indicating that the prescription has very good anti-diarrhea effect, which is beneficial to the clinical treatment of such disease and the development of Tibetan veterinary drugs.

Antibacterial activity of Rosmarinus officinalis L.alone and in combination with cefuroxime against methicillin-resistant Staphylococcus aureus

Objective:To determine the antimicrobial activity of rosemary(Rosmarinus of ficinalis L.) and to investigate the synergistic effects of this extract combined with ceforuxime against methicillinresistant Staphylococcus aureus(MRSA).Methods:The inhibitory and bactericidal activities of rosemary ethanol extract,alone and in combination with cefuroxime,were studied.Results:The minimum inhibitory concentrations(MICs) of the ethanol extract of rosemary were in the range of 0.39-3.13 mg/mL.The minimum bactericidal concentrations(MBCs) were usually equal to or double that MICs.The antimicrobial activity of combinations of the ethanol extract of rosemary and cefuroxime indicated their synergistic effects against all MRSAs.Conclusions:The present work clearly demonstrates that rosemary has a key role in the elevation of susceptibility toβ-lactams.

Advances in Study of Natural Antibacterial Medicines

This paper introduce the advances in study of antibacterial effects of natural medicines in the past ten years.The antibacterial components of natural medicines mainly include flavonoids,terpenoids,alkaloids,lignans,phenols,etc..This paper is intended to provide data reference for the research and development of new natural antibacterial medicines.

Design, Synthesis and Antibacterial Activity Evaluation of 4,5-Diphenyl-1<i>H</i>-Imidazoles Derivatives

Due to the continuous emergence and rapid spread of drug-resistant strains of bacteria, there is an urgent need for the development of novel antimicrobials. Along this line, the synthesis and antibacterial activity of 4,5-diphenylimidazol-2-thiol derivatives 2a-g and 6a-e are reported. The structures of the synthesized compounds were confirmed by Nuclear Magnetic Resonance (NMR) and High Resolution Mass Spectrometry (HRMS). All compounds were screened in vitro for their antibacterial activity against Pseudomonas aeruginosa and Escherichia coli (Gram-negative bacteria) and also against Staphyloccocus aureus and Enterococcus faecalis (Gram-positive bacteria). The results showed most of the synthesized compounds have no antibacterial activity. However compound 6d was two-fold potent than ciprofloxacin against Staphylococcus aureus with Minimum Inhibitory Concentration (MIC) of 4 μg/mL and 6c showed moderate biological activity against Staphylococcus aureus (16 μg/mL) and Enterococcus faecalis (16 μg/mL).

Study on Antibacterial Effect of Single Chinese Herbs on Staphylococcus aureus

[Objectives] This study was conducted to determine in-vitro antibacterial effect of 58 Chinese herbs on Staphylococcus aureus,and screen single Chinese herbs with better in-vitro antibacterial effect for formulation of prescription. [Methods]Effective components in Chinese herbs were extracted with water,and inhibition zone diameters and minimal inhibitory concentrations of the 58 Chinese herbs against S. aureus were determined by agar plate punching method and micro two-fold method,respectively. [Results] Twenty two kinds of Chinese herbs including Terminalia chebula Retz.,Anemarrhena asphodeloides Bunge.,Prunella vulgaris L,Rheum palmatum L. and Mosla chinensis Maxim. had better antibacterial effect,among which T. chebula Retz.,A. asphodeloides Bunge.,P. vulgaris L,R. palmatum L. and C. sappan Linn showed the best antibacterial effect,with average inhibition zone over 20 mm and MIC lower than 15. 6 mg/ml.[Conclusions]Traditional Chinese herbs have certain antibacterial effect,and this study will provide important theoretical reference for clinical medication and development of prescription.

国内兽用抗菌药减量化使用措施

兽用抗菌药物的过度使用在中国等许多国家引发抗菌药物耐药性和卫生风险的问题。为了有效应对该挑战,国内兽用抗菌药减量化使用策略应运而生。本文论述改善兽用抗菌药物使用实践和维护公共卫生方面的重要性,并提出政策和实践建议。通过采取综合措施,可以更好地管理兽用抗菌药物的使用,降低抗菌药物滥用的风险,维护公共卫生,同时确保养殖业的可持续发展。

人工神经网络在治疗药物监测中的应用

人工神经网络(ANN)是对生物神经网络的一种模拟,通过相互连接而构成的自适应非线性动态网络系统,ANN的优势在于优化容易、建模简便、结果准确。该文根据文献资料对ANN在免疫抑制剂、抗菌药物、抗癫痫药物等治疗药物监测中的应用进展进行阐述,阐明ANN模型的优缺点以及未来的发展方向,希望为未来的研究者提供有价值的参考信息。ANN用于治疗药物监测有着巨大的潜在前景,有希望成为实现患者个体化用药的有效手段。

临床药师参与会诊在特殊使用级抗菌药物规范管理中的作用

目的 规范特殊使用级抗菌药物的合理使用。方法 比较特殊使用级抗菌药物会诊系统上线前后特殊使用级抗菌药物的用药频度(DDDs)、抗菌药物使用强度(AUD)、使用量占比、销售额、多重耐药菌检出率。结果 会诊系统上线后,临床药师参与特殊使用级抗菌药物会诊率达80.28%,临床医师采纳率为90.99%。与2021年相比,2022年特殊使用级抗菌药物的DDDs、AUD、使用量占比及销售额均显著下降(P <0.05);多重耐药菌检出率下降,以耐甲氧西林金黄色葡萄球菌最显著(P <0.05)。结论 临床药师参与特殊使用级抗菌药物的会诊,可促进特殊使用级抗菌药物的合理使用,延缓细菌耐药。

抗菌药物集采对妇产科及小儿骨科围手术期预防用药的影响——以某三甲医院为例

目的:评价抗菌药物集采对妇产科和小儿骨科围手术期预防用药的影响,为推进和完善抗菌药物药品集中采购提供参考。方法:以临沂市某三甲医院为例,采用回顾性方法收集第五批国家药品集中采购中选药品(注射用头孢呋辛钠)集采前半年(2021年1月1日至2021年6月30日)和集采后半年(2022年1月1日至2022年6月30日)药品消耗量、销售金额、用药频度(DDDs)、日均费用(DDDc)、可负担性等数据,并进行对比分析。结果:集采政策实施后,妇产科平均住院日由6.98天降至6.21天,降幅为14.29%,例均药品费用、例均药占比、头孢呋辛钠例均费用、DDDc分别降幅30.70%、19.26%、7.5%和12.43%;小儿骨科平均住院日由9.76天降至8.50天,降幅为12.91%,头孢呋辛钠例均费用、DDDc降幅分别为1.17%和13.69%。结论:集采政策的有效实施降低了注射用头孢呋辛钠的价格,提高了患者的可负担性、医保基金的使用效率,降低了医院运营成本。

儿科住院患儿多重耐药菌耐药性分析

目的探讨儿科住院患儿多重耐药菌感染的情况及对抗菌药的耐药性,为临床合理应用抗菌药提供理论依据。方法对2019年1月至2022年12月在海口市妇幼保健院儿科住院多重耐药菌感染的175例患儿临床资料进行回顾性分析。结果9376例患儿共分离病原菌1846株,检出多重耐药菌175株。175例患儿中,男102例,女73例,年龄1个月至5岁,<1岁56例,1~3岁107例,>3岁12例。175株多重耐药菌中,革兰氏阳性菌107株,占61.14%,革兰氏阳性菌中耐甲氧西林金黄色葡萄球菌97株(55.43%),其次是产超广谱β-内酰胺类酶(ESBLs)肺炎克雷伯菌和产ESBLs大肠埃希菌,分别为35株(20.00%)和27株(15.43%)。在标本的类型中,以痰液为主,为163株(93.15%),其次为大便9株(5.14%),药敏结果示耐甲氧西林金黄色葡萄球菌对青霉素、红霉素、头孢西丁、替加环素、苯唑西林、克林霉素耐药率100%,对万古霉素、利福平、利奈唑胺敏感率90%以上;表皮葡萄球菌对青霉素、红霉素、头孢西丁、苯唑西林、替加环素耐药率100%,对万古霉素、利福平、利奈唑胺敏感率80%以上。肺炎克雷伯菌对氨苄西林、氨苄西林/舒巴坦、头孢唑啉、头孢替坦、头孢他啶耐药率80%及以上,对亚胺培南和厄他培南敏感率70%以上;大肠埃希菌对氨苄西林、氨苄西林/舒巴坦、头孢曲松、头孢唑啉耐药率80%以上,对亚胺培南和厄他培南敏感。结论住院患儿多重耐药菌主要发生在1~3岁呼吸道感染的患儿,检测出的多重耐药菌耐药现象严重,应加强对此类患儿的管理及加强对多重耐药菌的检测和耐药性监测,合理使用抗菌药,预防多重耐药菌的产生。

某医院2019~2021年特殊使用级抗菌药物应用分析

目的为减缓超级细菌的产生速度,更经济合理地用药,笔者拟对某医院2019~2021年特殊使用级抗菌药物应用情况进行分析,为临床实践的改进提供参考信息。方法利用电子病历系统调阅2019~2021年该院应用特殊使用级抗菌药物的情况,用WPS Office的WPS表格制表。内容包括2019~2021年特殊使用级抗菌药物的用药频度(DDDs)、限定日费用(DDC)、药品销售金额排序(B)/DDDs排序(A)、病原学检出情况。结果该院2019~2021年注射用比阿培南、注射用美罗培南的DDDs始终处于前两位;注射用伏立康唑、注射用替加环素的DDC较高,该院应用的特殊使用级抗菌药物的B/A大都趋近于1,药物总体经济效益与社会效益较为一致;该院革兰氏阴性菌检出率大于革兰氏阳性菌,且每年革兰氏阳性菌检出最高的均为金黄色葡萄球菌。结论该院特殊使用级抗菌药物应用基本合理,但仍存在部分问题,需加大特殊使用级抗菌药物管理力度,加强相关医务人员培训,更合理用药的同时减轻患者的医疗经济负担。

医院和科室上下联动事前-事中-事后闭环服务抗菌药物管理模式构建与实践

目的 促进抗菌药物的合理应用。方法 基于循证证据建立医院和科室上下联动事前-事中-事后闭环服务的抗菌药物管理模式。分析闭环服务的关键节点和服务内容,落实网络化服务体系,完善特殊患者和限制级抗菌药物专项服务等闭环服务的网络干预系统,并比较实施前(2020年)和实施后(2021年至2023年)医院抗菌药物使用强度(AUD)及不合理医嘱类型。结果 2021年、2022年、2023年医院AUD分别为39.40 DDDs、32.10 DDDs、38.09 DDDs,均较2020年的57.80 DDDs低,且符合我国综合医院AUD的限定标准(40 DDDs)。2021年,抗菌药物不合理医嘱类型排名前3的分别为抗菌药物预防/治疗方案不合理、药物选择不合理、联合用药不合理;2022年,抗菌药物不合理医嘱类型排名前3的分别为抗菌药物预防/治疗方案不合理、用药疗程不合理、给药途径和剂量不合理;2023年,抗菌药物不合理医嘱类型排名前3的分别为给药途径和剂量不合理、用药疗程不合理、抗菌药物预防/治疗方案不合理。结论 医院和科室上下联动事前-事中-事后闭环服务的抗菌药物管理模式可有效降低医院AUD,促进抗菌药物不合理医嘱类型的转变,从药物治疗方案优化逐步过渡到抗菌药物剂量和疗程精细化。

某院碳青霉烯类抗菌药物的合理用药分析

目的:分析医院碳青霉烯类抗菌药物的合理用药情况,为促进临床碳青霉烯类药物的合理使用提供参考。方法:选取2022年7月—12月郑州市第二人民医院住院患者的碳青霉烯类药物医嘱作为研究资料,采集患者的临床诊断、检查结果,以及所用碳青霉烯类药物的品种、用法用量、疗程、联用药物等信息,依据《碳青霉烯类抗菌药物临床应用评价细则》对碳青霉烯类药物医嘱进行合理用药评价并进行分析。结果:2022年7月—12月医院共有84例次患者使用了碳青霉烯类药物,其涉及的临床科室主要有重症医学科(33例次,占39.29%)、呼吸与危重症医学科(12例次,占14.29%)和消化内科二(10例次,占11.90%);合理用药点评结果显示,84例次患者中共发现41条不合理用药情况,其中主要为适应证不适宜(16条,占39.02%)和用药前未进行病原学送检(14条,占34.15%)。结论:当前医院住院患者碳青霉烯类抗菌药物的使用仍存在较多的不合理现象,管理部门应当加强对临床的培训和管理,以提高其合理用药水平,最终保障患者用药的安全和有效。

2018年-2021年南阳市医院抗菌药物使用情况与常见细菌耐药性相关性分析

目的:探讨南阳市第一人民医院抗菌药物的使用情况及与常见的细菌耐药的相关性。方法:收集南阳市第一人民医院2018年1月至2021年12月临床患者送检的阳性标本,统计临床标本分离病原菌检出情况、常见抗菌药物消耗情况以及常见的革兰氏阴性杆菌、阳性球菌对抗菌药物产生的耐药率(%)与抗菌药物用药频度(Frequency of defined daily doses,DDDs)的相关性。结果:我院2018年至2021年抗菌药物DDDs较高的抗菌药物依次为美洛西林、头孢他啶、哌拉西林他唑巴坦,检出率较高的病原菌分别为大肠埃希氏菌、肺炎克雷伯菌、金黄色葡萄球菌等。大肠埃希菌产生的耐药率与哌拉西林他唑巴坦、头孢呋辛钠DDDs均有相关性(r=-0.107、0.432);肺炎克雷伯菌产生的耐药率与哌拉西林他唑巴坦、左氧氟沙星氯化钠、头孢呋辛钠DDDs呈正相关(r=0.410、0.720、0.420);铜绿假单胞菌与哌拉西林他唑巴坦、头孢哌酮舒巴坦钠DDDs呈正相关(r=0.716、0.933);金黄色葡萄球菌的耐药率与左氧氟沙星DDDs呈正相关(r=0.661);肺炎链球菌产生的耐药率与左氧氟沙星、头孢呋辛钠DDDs均存在正相关关系(r=0.416和0.482)。结论:抗菌药物的DDDs与常见细菌产生的耐药性具有一定的相关性,我院应严格控制抗菌药物的DDDs,根据感染性病种及药敏试验结果选择适当的抗菌药,加强常见病原菌的耐药监测。

临床药师介入对老年结直肠癌患者围术期使用抗菌药物合理性的影响

目的探究临床药师介入对老年结直肠癌患者围术期使用抗菌药物合理性的影响。方法选取2023年1月1日~2023年12月31日我院收治的老年结直肠癌手术患者110例,按照随机数字表法分为对照组和观察组,各55例。其中,对照组采用常规抗菌药物治疗;观察组在常规抗菌药物治疗的基础上由临床药师介入用药干预。对比两组患者抗菌药物的用药品种、抗菌药物使用的合理性、术后切口疼痛程度、用药指标及术后感染发生率。结果观察组氨基糖苷类、β-内酰胺酶抑制剂、β-内酰胺酶抑制剂+硝基咪唑类抗菌药物的使用率明显低于对照组(P<0.05),第2代头孢类、第3代头孢类、氨基糖苷类+硝基咪唑类、第2代头孢类+硝基咪唑类、第3代头孢类+硝基咪唑类抗菌药物的使用率明显高于对照组(P<0.05);观察组发生抗菌药物不合理用药的情况少于对照组(P<0.05);观察组的视觉模拟评分法(VAS)评分及抗菌药物花费低于对照组,抗菌药物用药疗程及住院时间短于对照组(P<0.05);观察组术后切口感染、尿路感染及呼吸道感染的发生率均低于对照组(P<0.05)。结论临床药师干预可提高围术期老年结直肠癌患者抗菌药物使用的合理性,减少临床不合理用药,降低术后感染率和疼痛感,有利于患者康复。