标题：我院碳青霉烯类抗菌药物临床应用情况分析

      作者：曹绍华，王庆庆，张金冉    延安大学附属医院临床药学科，陕西 延安 716000

      卷次： 2020年31卷19期

      【摘要】 目的 调查我院碳青霉烯类抗菌药物的临床应用情况，并分析用药患者的感染状况及用药合理性。方法 选取延安大学附属医院于2018年1月至2019年12月间应用碳青霉烯类抗菌药物治疗的350例患者作为调查对象，对患者的病历资料、抗菌药物应用情况、实际感染类型及病原学感染情况进行统计分析，评估院内碳青霉烯类药物的应用情况，总结用药中存在的问题。结果 经统计，使用碳青霉烯类抗菌药物治疗的患者的主要感染类型为肺部感染和腹腔感染，占总感染患者的39.71% (139/350)和34.57% (121/350)；350例应用碳青霉烯类抗菌药物的患者中，共346例患者进行病理样本取样并送检，样本类型含血液、胆汁及腹腔液等，送检率为98.86%；在送检的样本中，共274例为阳性，阳性率为78.29%，选药前进行药敏试验者共235例；经病原学检查，前5位的菌种为肺炎克雷伯菌 21.39% (74/346)、大肠埃希菌 18.21% (63/346)、鲍曼不动杆菌 8.67% (30/346)、铜绿假单胞菌 7.51%(26/346)和阴沟肠杆菌3.18% (11/346)；从药物的应用指标来看，亚胺培南西司他丁钠和美罗培南的临床药物利用指数均>1.0，而比阿培南的药物利用指数<1.0；350份患者病历资料均完成用药合理性点评，共发现56份不合理用药病历，其中亚胺培南西司他丁钠的用药问题主要为用法用量不当(6.7%)，美罗培南主要为用法用量不当(12.5%)，比阿培南主要为药物选择不当(10.0%)。结论 本院在碳青霉烯类抗菌药物的临床运用中仍存在一定不合理情况。在临床诊疗中适当开展抗菌药物应用的专项评估工作，有利于总结临床用药中的不当之处，提升用药合理性以持续改进临床用药方案。
      【关键词】 碳青霉烯类；抗菌药物；处方点评；合理用药；微生物敏感性实验
      【中图分类号】 R978.5 【文献标识码】 A 【文章编号】 1003—6350（2020）19—2518—04

Clinical application of carbapenems in Affiliated Hospital of Yan'an University.
CAO Shao-hua, WANG Qing-qing,ZHANG Jin-ran. Department of Clinical Medicine, Affiliated Hospital of Yan'an University, Yan'an 716000, Shaanxi,CHINA
【Abstract】 Objective To investigate the clinical application of carbapenems in our hospital, and to analyze theinfection status of the patients and rationality of drug use. Methods A total of 350 patients who were treated with car-bapenems in Affiliated Hospital of Yan'an University from January 2018 to December 2019 were selected as the researchsubjects. The patient's medical records, application of antibacterial drugs, actual infection types, and pathogenic infec-tions were analyzed and summarized, the application of carbapenems in the hospital was evaluated, and the existing prob-lems in medication were summarized. Results According to statistics, the main infection types of patients treated withcarbapenem antibacterial drugs are lung infections and abdominal infections, accounting for 39.71% (139/350) and34.57% (121/350) of the total infected patients, respectively. Of the 350 patients treated with carbapenems, a total of 346patients (98.86%) had samples collected for pathological examination, including blood samples, bile samples, and ab-dominal fluid samples. Among the 346 patients suffered pathological examination, 274 (78.29%) were tested positive,and 235 were tested for drug sensitivity before drug selection. Etiological examination showed that the top 5 strains de-tected were Klebsiella pneumonia (21.39%,74/346), Escherichia coli (18.21%, 63/346), Acinetobacter baumannii (8.67%,30/346), Pseudomonas aeruginosa (7.51%, 26/346), and Enterobacter cloacae (3.18%, 11/346). From the point of view ofdrug application indicators, the clinical drug utilization index of imipenem and cilastatin sodium, and meropenem wereboth greater than 1.0, while the drug utilization index of biapenem was less than 1.0. All the 350 patients' medical re-cords were reviewed for rational use of medicines, and 56 cases of unreasonable medications were found; among them,the problems of imipenem and cilastatin sodium, meropenem, and biapenem were mainly improper usage (6.7%), im-proper usage (12.5%), and improper drug selection (10.0%), respectively. Conclusion There are still some unreason-able circumstances in the clinical application of carbapenems in our hospital. Properly carrying out special evaluation ofantibacterial drug application in clinical diagnosis and treatment is helpful to summarize the inappropriateness in clinicalmedication, improve the rationality of medication, and continuously improve the clinical medication plan.
      【Key words】 Carbapenems; Antibacterial drugs; Prescription reviews; Rational drug use; Microbial sensitivitytest