围手术期抗菌药物预防性应用情况及其合理性分析

目的 探讨围手术期抗菌药物预防性应用情况,并分析其合理性.方法 回顾性分析我院2016年4月～2017年8月期间收治的外科手术患者620例临床相关资料,探讨围手术期抗菌药物合理使用情况.结果 620例患者中使用抗菌药物预防感染的占98.71％;围手术期平均预防用药时间为9.58±1.73天,其中最长预防用药时间为18天...     

阑尾炎手术患者围手术期预防性应用抗菌药物情况及合理性

目的 调查分析阑尾炎手术患者围手术期预防性应用抗菌药物情况,探讨其用药的合理性.方法 随机选取2018年4月至2020年1月在我院实施手术治疗的106例阑尾炎患者作为研究对象.统计患者围手术期预防性应用抗菌药物的情况,并了解其用药时间及联合用药情况,分析用药合理性.结果 106例阑尾炎手术患者中,97例为预防性用药,占...     

我院骨科Ⅰ类切口抗菌药物预防性使用合理性分析

目的：通过对骨科Ⅰ类切口围术期抗菌药物预防使用合理性进行统计分析,为进一步规范围术期抗菌药物合理使用提供依据。方法：回顾性分析2012年3月—2013年3月出院的434例Ⅰ类切口手术患者病历资料,对其抗菌药物使用情况从预防使用率、预防使用时机、预防时间时长、抗菌药物种类选择及构成比等方面进行统计分析。结果：434例Ⅰ类切口手术患者中,围术期抗菌药物预防使用率为68.43%,术前0.5~2 h使用率为77.10%,预防时长不超过24 h者仅为5.05%,抗菌药物选择方面以二代头孢（头孢呋辛）为主,占预防使用率的70.37%。结论：晋城市人民医院骨科Ⅰ类切口手术预防性抗菌药物使用指证基本能符合要求,但品种选择、给药时机、预防时长均明显高于卫生部标准。应继续加强骨科乃至全院医师抗菌药物合理使用培训,加大抗菌药物使用监管、考核力度,以期尽快使抗菌药物合理使用率达卫生部标准。     

我院Ⅰ类切口手术围手术期预防性抗菌药物使用情况调查分析

目的 调查景德镇市第一人民医院Ⅰ类切口手术围手术期预防性抗菌药物临床使用情况并进行分析,以提高合理用药水平.方法 随机抽取2010年1-12月Ⅰ类切口手术出院患者的病历140份,根据<抗菌药物临床应用指导原则>对围手术期预防性抗菌药物临床应用进行评价.结果 Ⅰ类切口手术围手术期预防性抗菌药物使用率为72.9%(102/140).在预防性抗菌药物使用的102例中,有91例存在不合理现象,占89.2%;不合理类型主要为药物选择不合理(52.9%)、用药时机不合理(52.9%)、无指征用药(35.3%)等.使用频率较高的抗菌药物是头孢替唑、头孢呋辛钠、头孢哌酮他唑巴坦.结论 景德镇市第一人民医院Ⅰ类切口手术围手术期预防性抗菌药物的临床应用存在不合理现象,应强化临床医师合理应用抗菌药物的意识,加强围手术期抗菌药物临床应用的管理,提高合理用药水平.     

围术期预防性使用抗菌药物临床分析

目的分析围术期预防性抗菌药物不合理使用的临床效果。方法随机抽取2011年1∽12月在该院接受手术治疗的住院患者120例,对病例中不合理抗菌药物使用情况进行分析。结果 120例住院患者出现围术期预防性抗菌药物不合理使用现象245例次,平均2.99次/例;围术期抗菌药物的预防性使用率最高的是第2代头孢菌素,占60.83%（73/120）;药物联合应用不当65例次,其中2联用药22例,应用不当17例次;3联用药32例次,应用不当26例次;4联用药11例次,均不合理。结论围术期预防性使用抗菌药物不仅可以加强临床工作人员对抗菌药物合理使用知识的了解,还可降低由抗菌药物不合理使用引发的不良反应。     

抗菌药物使用合理性分析

目前,我国抗菌药物滥用的现象十分严重.广谱抗菌药的大量使用,极易造成细菌耐药性的增加,其使用的合理性与患者的健康和生命安全密切相关.为了解本院抗菌药物的应用状况,作者对本院2008至2009年病区抗菌药物的使用进行回顾性统计,分析并评价其使用的合理性,为临床合理用药提供参考.     

我院普通外科抗菌药物使用情况分析

目的 了解我院普通外科应用抗菌药物的合理性。方法 抽取普通外科2005年11月～2006年10月的所有处方,统计普通外科消耗抗菌药物的品种、数量、金额,结合病历分析应用抗菌药物的合理性。结果 我院普通外科抗感染用药以疗效可靠、不良反应小、价廉的抗菌药物为主。从病例上分析抗菌药物使用存在65.42%的不合理性。结论 应加强管理,严格执行《医院感染管理规定》,合理使用抗菌药物。     

我院508例患者抗菌药物使用情况分析

近年来，抗菌药物发展迅速，新药不断涌现，对治疗感染性疾病作出了卓越的贡献。但是，因滥用和不合理应用给患者和社会造成了极大的危害。为了解我院抗菌药物的合理使用情况，现对我院2006年7月至2007年7月使用抗茵药物的种类及品种进行抽样调查和分析，以期为临床合理用药提供参考。     

480份住院病历抗菌药物治疗及预防使用情况分析

抗菌药物是临床应用最广泛的药物之一，其临床应用涉及到每一个科室和各专业医生。我国抗菌药物使用频率非常高，远远高于30％的国际水平。随着抗菌药物日益广泛应用。因其药物滥用而导致的药物毒副作用问题也越来越突出。不规范的使用抗菌药物、不合理的预防性用药、耐药菌的增加以及患者经济负担的加重，使得合理应用抗菌药物已成为社会的呼声，     

我院2005年妇产科抗菌药物使用情况调查分析

目的：了解我院妇产科应用抗菌药物的合理性。方法：通过计算机提取我院2005全年妇产科住院病人的所有电子处方，统计妇产科消耗抗菌药物的种类、数量、金额，结合病历分析妇产科应用抗菌药物的合理性。结果：我院妇产科抗菌药物使用最多的是抗厌氧菌的克林霉素以及硝基咪唑类药物，其次是β-内酰胺类抗生素。结论：我院妇产科抗感染药物的使用着重于疗效可靠，不良反应少。但从药物经济学的角度考虑仍欠佳，在今后工作中有待进一步改进。     

Surgical antimicrobial prophylaxis in transurethral ureterolithotripsy

The aim of this study was to establish a standard protocol for surgical antimicrobial agents for patients who received transurethral ureterolithotripsy (TUL). We retrospectively reviewed the medical charts of patients who received TUL. From October 2002 to December 2003, 2 days (total, four times) of antimicrobial prophylaxis (AMP) was done, and from January 2004 to December 2004, single prophylaxis was done. We analyzed the incidence of postoperative fever and other factors associated with TUL and compared these factors between the 2-day-AMP and single-AMP groups. Of 135 patients with TUL, 66 patients were in the single-AMP group and 69 in the 2-day-AMP group. The incidences of postoperative fever were 4.5% in the single-AMP group and 11.6% in the 2-day-AMP group. No statistically significant difference was found in the incidence of postoperative fever between the two groups. Our study showed that single AMP was effective for patients receiving a TUL operation. In the future, a prospective randomized study will be needed for a large series, with various types of lithotripters being included.     

Effective antimicrobial regimens for use in humans for therapy of Bacillus anthracis infections and postexposure prophylaxis

Expanded options for treatments directed against pathogens that can be used for bioterrorism are urgently needed. Treatment regimens directed against such pathogens can be identified only by using data derived from in vitro and animal studies. It is crucial that these studies reliably predict the efficacy of proposed treatments in humans. The objective of this study was to identify a levofloxacin treatment regimen that will serve as an effective therapy for Bacillus anthracis infections and postexposure prophylaxis. An in vitro hollow-fiber infection model that replicates the pharmacokinetic profile of levofloxacin observed in humans (half-life [t(1/2)], 7.5 h) or in animals, such as the mouse or the rhesus monkey (t(1/2), approximately 2 h), was used to evaluate a proposed indication for levofloxacin (500 mg once daily) for the treatment of Bacillus anthracis infections. The results obtained with the in vitro model served as the basis for the doses and the dose schedules that were evaluated in the mouse inhalational anthrax model. The effects of levofloxacin and ciprofloxacin treatment were compared to those of no treatment (untreated controls). The main outcome measure in the in vitro hollow-fiber infection model was a persistent reduction of culture density (> or = 4 log10 reduction) and prevention of the emergence of levofloxacin-resistant organisms. In the mouse inhalational anthrax model the main outcome measure was survival. The results indicated that levofloxacin given once daily with simulated human pharmacokinetics effectively sterilized Bacillus anthracis cultures. By using a simulated animal pharmacokinetic profile, a once-daily dosing regimen that provided a human-equivalent exposure failed to sterilize the cultures. Dosing regimens that "partially humanized" levofloxacin exposures within the constraints of animal pharmacokinetics reproduced the antimicrobial efficacy seen with human pharmacokinetics. In a mouse inhalational anthrax model, once-daily dosing was significantly inferior (survival end point) to regimens of dosing every 12 h or every 6 h with identical total daily levofloxacin doses. These results demonstrate the predictive value of the in vitro hollow-fiber infection model with respect to the success or the failure of treatment regimens in animals. Furthermore, the model permits the evaluation of treatment regimens that "humanize" antibiotic exposures in animal models, enhancing the confidence with which animal models may be used to reliably predict the efficacies of proposed antibiotic treatments in humans in situations (e.g., the release of pathogens as agents of bioterrorism or emerging infectious diseases) where human trials cannot be performed. A treatment regimen effective in rhesus monkeys was identified.     

抗感染药物在外科领域的预防性应用指南(美国)

为了帮助医师正确时间使用正确剂量的正确抗生素，以降低术后医院感染的发生率，美国医疗保险与医疗补助服务中心(CMMS)与疾病控制中心(CDC)组织外科感染预防、医院感染控制以及流行病学专家制订了外科手术感染预防指南。现将其主要内容编译供临床参考。需要指出的是制定该指南依据均为国外研究资料，而病原菌分布及药物敏感性在不同国家、不同地区和不同时间存在差异，因此，该指南并不一定完全适用于国内情况，仅供临床参考，临床医师需结合当地医院的病原菌分布及药敏情况选用药物。     

加强老年人用药的合理性

进入21世纪，随着科技的发展，社会的进步，人民的生活水平更是不断地提高，人类寿命也正在延长，但人口老龄化这个问题也日益突现出来。老年人在生理、心理等方面均处于衰老与退化状态。许多老年人同时患有多种疾病，用药的机会和种类增多，如果不合理用药，造成的损害就会增大。因此，老年人的合理用药日益成为人们关注的重点。分析老年人这一特殊人群用药使用情况，使老年人用药趋于安全、有效、合理，对提高老年人生命质量具有重要的意义。     

Pharmaceutical cost comparison analysis of antimicrobial use for surgical prophylaxis on gastrectomy patients in a tertiary care hospital

The present study investigated the clinical effects and therapeutic cost of cefazolin (CEZ) and ampicillin/sulbactam (SBT/ABPC) compared to analyze cost-effectiveness for surgical prophylaxis in gastric cancer patients. 157 inpatients who underwent surgery for gastric cancer were investigated. There was no difference between the two groups with regard to sex, age, incidence of complication, stage of cancer, operative time and blood loss, length of hospitalization, the appearance of systematic inflammatory responses syndrome and the prophylactic effect of infection. Meanwhile, decision analysis indicated that the anticipated therapeutic cost per patient in CEZ group was less than that of SBT/ABPC group (USD 142.72 and USD 187.17, respectively). In this case, CEZ use was more cost-effective, insofar as only drug cost was considered.     

An evaluation of antimicrobial prophylaxis in paediatric surgery and its financial implication

OBJECTIVE: To assess the appropriateness of use of antimicrobial prophylaxis in paediatric surgery in Singapore. METHODS: A prospective evaluation of the use of antimicrobial prophylaxis in paediatric patients undergoing surgery in KK Hospital, Singapore was carried out from September and December 2001. Process measures for the study included adherence to local or international guidelines, choice and dose of antimicrobial agent and timing and duration of prophylaxis. Outcome measures included surgical site and other related infections. A cost analysis was also performed to look at the extra expenditure due to any excessive use of antimicrobials. RESULTS: A total of 171 patients with a mean age of 5.7 years (SD=4.5) were included in the study. Among the 117 (68.4%) elective and 54 (31.6%) emergency procedures, 22 cases (12.8%) were fully compliant with the guidelines. The most frequently encountered non-compliance types were unnecessary prolongation of prophylaxis (54.4%), inappropriate choice of antibiotics (42.7%) and overdose of antibiotics (26.3%). The estimated extra cost to patients for the study period was Sing$13,879.41 (US 8164.36). CONCLUSION: The results showed a significantly high level of inappropriate use of antimicrobial prophylaxis in paediatric surgery in Singapore. However, when the individual factors such as appropriate choice of antibiotics, appropriate timing and duration were considered, the situation was very similar to the results obtained from overseas studies.     

The guideline how to use the antimicrobial agents--the guidance how to use the antimicrobial agents

In regard to reconsider the way of antimicrobial agent, it has given the guideline which is how to use the antimicrobial agent to be protected the occurrence of drug resistant bacteria and how to use it safety. This writing omit the way of thinking about the proper use, the safety use, and the prevention for hospital acquired infections by this reference. What the proper use for antimicrobial agent is. The basic idea as the proper use for antimicrobial agent is 1. to heal a patient(individual-defense), 2. not to increase drug resistant bacteria(group-defense), 3. to be utilizable for a medical resource mostly. In the choice of antimicrobial agent for the individual situation, we have to think about 1. (to heal a patient) seriously first, and then, of course, we recognize the point of view for 2. and 3. has a good balance in this way.     

抗微生物药物临床应用进展

近年来，抗病毒及抗真菌药物研发活跃，上市的新药多。抗病毒药主要为抗HIV药物包括2或3个药物的复方制剂，自2002年以来已有2个抗HBV药物上市。近5年来已有多个第二代三唑类及棘白菌素类抗真菌药物上市或进入Ⅲ期临床试验。尽管全球范围内细菌耐药性上升迅速，多重耐药菌感染治疗困难，但与20世纪90年代比较，进入21世纪以来新抗菌药物的研发及上市速度明显减缓，而且近年来上市或进入Ⅲ期临床试验的新抗菌药多为抗耐药革兰阳性菌的药物，新的广谱抗菌药或抗革兰阴性菌药物较少，比如21世纪以来在全球无新的头孢菌素类上市。本文对近年来上市或已进入Ⅲ期临床试验的抗微生物药物包括抗病毒药物、抗真菌药物及抗菌药物作一综述。