外科药房静脉用药集中调配中心抗菌药物医嘱分析

目的了解抗菌药物不合理用药情况,提高用药安全性、合理性、有效性。方法对外科药房静脉用药集中调配中心2013年全部抗菌药物不合理医嘱的常见问题进行审核、统计、分类和分析。结果不合理医嘱4 739条,主要不合理医嘱问题集中在给药剂量(50.66%)、药物溶媒(35.24%)、溶媒量(11.84%)、配伍禁忌(2.00%)、给药途径不适宜(0.26%)等问题。结论药师应通过医嘱审查联络信方式与临床科室沟通,为患者用药安全、合理把好关。     

2013-2014年河北北方学院附属第一医院住院抗菌药物处方的不合理用药分析

目的调查2013—2014年河北北方学院附属第一医院住院抗菌药物处方不合理用药的情况,为促进临床合理应用抗菌药物提供依据。方法抽取2013年1月—2014年12月河北北方学院附属第一医院住院抗菌药物处方20 000张,对不合理用药情况进行回顾性分析。结果抗菌药物处方存在不合理用药问题的共1 623张,占8.12%;其中存在的问题主要为溶媒种类的选择及溶媒量不当、给药剂量及给药频次不合理、疗程过长或偏短、联合用药指征不明确等;联合用抗菌药物品种数越多,不合理用药的发生率越高;头孢类和青霉素类使用率均较高,不合理用药处方率分别为7.50%、6.19%;而使用率均较低的碳青霉烯类、头霉素类以及抗真菌药处方中不合理用药处方率较高,分别为19.16%、18.36、19.17%。结论河北北方学院附属第一医院住院患者抗菌药物使用基本合理,但仍存在一些问题,需进一步加强临床医师合理应用抗菌药物的相关培训,并加大处方点评力度。     

2013-2014年荆州市第一人民医院神经外科病原菌的耐药性和抗菌药物用量的相关性分析

目的 分析荆州市第一人民医院神经外科病原菌的耐药性与抗菌药物用量的相关性,为临床合理用药提供参考。方法 统计2013年1月-2014年12月荆州市第一人民医院神经外科病原菌的分布及耐药性和抗菌药物的使用情况,并采用Pearson法对病原菌的耐药性与抗菌药物用量的相关性进行统计分析。结果 共分离出病原菌162株,主要来自痰标本(42.6%);其中革兰阴性菌以鲍曼不动杆菌、铜绿假单胞菌为主,革兰阳性菌以金黄色葡萄球菌为主;鲍曼不动杆菌对多数抗菌药物均耐药,而铜绿假单胞菌对常用抗生素仍保持较高的敏感性,金黄色葡萄球菌除对万古霉素、复方磺胺、利奈唑胺仍保持较高的敏感性外,对其余试验药物的耐药率较高。抗菌药物的使用以头孢唑啉、头孢西丁、左氧氟沙星的用药频度(DDDs)较高。鲍曼不动杆菌、铜绿假单胞菌对头孢他啶、左氧氟沙星、美罗培南的耐药率与DDDs显著相关;金黄色葡萄球菌对左氧氟沙星、头孢西丁的耐药率与DDDs显著相关。结论 荆州市第一人民医院神经外科鲍曼不动杆菌及金黄色葡萄球菌的耐药率较高,除需严格控制抗菌药物的合理应用外,全面落实医院感染防控措施至关重要。     

基层医院儿科应用抗菌素状况及葡萄球菌的耐药性调查

目的：观察儿科抗生素的应用状况以及葡萄糖球菌的耐药情况,并对儿科抗生素使用合理性进行评价。方法：选取我院儿科抗生素应用状况数据库资料作为研究对象,分析我院儿科抗生素应用状况、葡萄球菌对不同抗生素的耐药性情况。结果：儿科抗生素使用率较高,平均使用率达90．96％,而且某些单品种抗生素使用较多,微生物送检率达91．29％;葡萄球菌对常用抗生素青霉素、红霉素等的耐药性可达88．0％以上,对万古霉素尚未产生耐药性,辛内吉及呋喃坦啶耐药性较低,低于10％;抗生素二联用情况也比较常见,占35．83％,三联及以上联用情况尚未出现。结论：儿科抗生素使用率比较高,而且葡萄球菌的耐药性情况也较为普遍,临床医护人员需要对此引起重视,合理应用抗生素,保证疗效的同时,预防细菌耐药性的增强。     

Acute bone and joint infections in children: current concepts

Paediatric bone and joint infections can be associated with devastating consequences for the growing child. The diagnosis is challenging, requiring experienced clinical examination with adjunct diagnostic tests to aid the distinction between a multitude of differential diagnoses which includes transient synovitis, fracture, neoplasia, rheumatological conditions, blood disorders and infection. Emergent diagnosis is required to prevent consequences such as sepsis, chronic infection, angular deformity and disruption of longitudinal bone growth. The clinical presentation of bone and joint infections in children is varied and includes pain, erythema and swelling, fever, reduced range of movement and the inability to weight bear. Blood and tissue samples should be obtained, if possible, prior to commencing antimicrobial therapy in order to secure the best chance of identifying a causative organism and guide treatment. However, this should not delay treatment. Various imaging modalities can be helpful. Whilst there is some variation depending on the child's age, Staphylococcus aureus is the commonest causative organism in both septic arthritis and osteomyelitis. Septic arthritis and osteomyelitis in children should be treated jointly by paediatricians and orthopaedic surgeons, with input from the wider multi-disciplinary team. Trends towards reduced rates of surgical intervention and shorter antibiotic courses have been evident over recent decades. In this article we present a review of the continuously evolving concepts for the management of paediatric bone and joint infections.     

Plazomicin: an investigational therapy for the treatment of urinary tract infections

Introduction: Living in the ever-expanding era of multidrug-resistant (MDR), extensively drug-resistant (XDR), and even pandrug-resistant Gram-negative microorganisms, the medical community is facing the approaching fear of the “End of Antibiotics.” Plazomicin is a next-generation aminoglycoside designed to evade all clinically relevant aminoglycoside-modifying enzymes, the main mechanism of aminoglycoside resistance. A newer aminoglycoside active against several MDR-XDR microorganisms is herein presented and discussed.

Areas covered: Herein, the authors present the currently available information on plazomicin. This includes the current knowledge concerning plazomicin’s: mechanisms of action, in vitro activity and interactions, its pharmacokinetics, its clinical efficacy in complicated urinary tract infections (cUTIs) and acute pyelonephritis, and its toxicity issues.

Expert opinion: Plazomicin was developed to evade all clinically relevant aminoglycoside-modifying enzymes. Unfortunately, ribosomal enzymatic modification by ribosomal 16S-rRNA methyltransferases confers broad-spectrum high-level aminoglycoside resistance. Still, plazomicin demonstrates high activity against the Enterobacteriaceae including extended spectrum beta lactamase and most carbapenemase producers, as well as several of the non-fermenters. When compared to levofloxacin, the in vivo activity of plazomicin in complicated urinary tract infections (cUTIs) and in acute pyelonephritis in humans was very promising. Furthermore, regarding safety, no clinically significant effects on renal, vestibular, or cochlear function have been observed both at Phase I and II studies in humans, with mild to moderate adverse events being dose related. However, the authors believe that the real position of plazomicin in the MDR-XDR world will be revealed once pending Phase III studies are completed.     

抗菌药物使用的多变量监控

目的 建立基于多变量数据分析(multivariate data analysis,MVA)的抗菌药物监控模型,为规范临床抗菌药物的合理使用提供依据。方法 提取浙江省立同德医院住院患者2011—2013年共12个季度81种抗菌药物的用药频度(defined daily doses,DDDs)数据,建立主成分分析(principal component analysis,PCA)模型。通过构建得分图和X区块模型距离(distance to model X block,DModX)控制图,结合变量贡献图,对不同季度的抗菌药物进行监控,评价季度一致性,分析导致异常的原因。结果 2011年第4季度和2012年、2013年4个季度抗菌药物DDDs的一致性较好。2011年第1~3季度的DModX统计值超出了控制限,主要原因为3种特殊使用级抗菌药物(头孢噻利、夫西地酸、去甲万古霉素)、8种限制使用级抗菌药物(头孢米诺、哌拉西林/舒巴坦、阿莫西林/舒巴坦、呋苄西林、头孢丙烯、头孢唑肟、异帕米星、奥硝唑)和4种非限制使用级抗菌药物(氯唑西林、头孢氨苄、头孢羟氨苄、头孢噻肟)的DDDs偏高。结论 本研究证明了MVA在抗菌药物监控中的有效性,为临床抗菌药物监控提供新的方法。