1580例住院患者抗菌药物临床使用的横断面分析

目的：分析医院抗菌药物临床使用的横断面情况及其合理性。方法：采用横断面调查方法,分析2013年12月13日0：00—24：00时内所有住院患者抗菌药物的使用情况。结果：1 580例住院患者中,抗菌药物横断面使用率为50.13%,其中单用率为83.71%,二联使用率为14.39%,三联使用率为1.77%;在全院各科室中ICU抗菌药物使用率为100.00%,其次为心脏外科、内科综合科、泌尿外科的使用率分别为80.95%,76.00%和71.14%;全院治疗性用药病原学送检率达49.40%,ICU送检率为最高（100.00%）;预防性用药率为36.74%,其中围术期预防性使用抗菌药物为主要原因,占81.99%;使用频率居前5位的依次为头孢菌素类、青霉素类、喹诺酮类、碳青霉烯类、以及其他β-内酰胺类。结论：该院抗菌药物横断面使用率控制在合理水平,联合用药率持续下降,但存在病原学检测率降低,围术期预防性使用抗菌药物给药时机不合理等问题,需要进一步完善监管制度与方法。     

Measurement of Adult Antimicrobial Drug Use in Tertiary Care Hospital Using Defined Daily Dose and Days of Therapy

Widespread overuse and inappropriate use of antimicrobial drugs continues to fuel an increase in antimicrobial resistance and leads to consequent treatment complications and increased healthcare costs. In the present study we aimed to describe antimicrobial drug consumption and predictors and to identify potential targets for antimicrobial stewardship. This was a prospective observational study conducted at adult medicine wards of tertiary care teaching hospital over the period of five months. Antimicrobial drug consumption was measured using days of therapy per 1000 patient days and defined daily dose per 1000 patient days. Additionally, predictors of multiple antimicrobial prescribing were also analyzed. Seven hundred thirty patients were screened and 550 enrolled, receiving 1,512 courses of antimicrobial therapy, mainly intravenously (66%). Most frequently prescribed agents were artesunate (13%), ceftriaxone (11%) and metronidazole (10.5%). Overall consumption was 1,533 days of therapy per 1000 patient days and was mainly attributed to antibiotics (98.3%) for empirical therapy (50%). Median days of antimicrobial drugs prescribing were 3 (inter quartile range 2-5). Most commonly consumed antimicrobials were ceftriaxone (31%, 248.8 g) and artesunate (26%, 29 g). Antimicrobials contributed to 72.5% expense of the total incurred. Multivariate analysis reveals that younger patients (≥45 years) (odds ratio: 1.59, 95% CI 1.14-2.21) were more likely and absence of comorbidities (odds ratio: 0.58, 95% CI 0.42-0.79) and shorter hospital stay (≥6 days)(odds ratio: 0.44, 95% CI 0.32-0.60) were associated with less likelihood of prescribing multiple antimicrobial drugs. Estimating antimicrobial drugs use by defined daily dose method will remain open to criticism because the prescribed dosage is not often in agreement with the “usual” daily dose, which depends on location of and susceptibility of pathogenic organisms and metabolic status of the patient.     

2016—2018年南阳市第一人民医院特殊使用级抗菌药物的使用情况分析

目的 对2016—2018年南阳市第一人民医院住院患者特殊使用级抗菌药物的使用情况进行分析,为规范科室合理使用提供管理思路。方法 对南阳市第一人民医院特殊使用级抗菌药物的使用率、销售金额、用药频度（DDDs）、使用强度（AUD）和科室分布等指标进行回顾性分析。结果 2016—2018年,特殊使用级抗菌药物的平均使用率为2.73%,美罗培南的销售金额始终处于首位。DDDs和AUD排名前3位的均为美罗培南、替考拉宁、盐酸头孢吡肟,呼吸内科、儿科和呼吸重症监护科的使用数量较多。结论 南阳市第一人民医院特殊使用级抗菌药物的使用频度过高,临床药师应积极参与进行针对性的管理。     

Antimicrobial prescribing at a university hospital: justified or 'just in case': testing a new scoring system as a key quality indicator

OBJECTIVE: To evaluate the quality of antimicrobial drug prescribing at a university hospital in the Department of Medicine, by using a new scoring system as a quality indicator. METHODS: Design: a prospective, longitudinal survey, during a 21-week period. The necessity of antimicrobial treatment of all in-patients at the Department of Medicine, to whom new antimicrobials were prescribed, was assessed by using a scoring system based on the presence of signs and symptoms of an infection. If the sum's total score was 3 or more, the antimicrobial treatment was deemed justifiable; if the score was less than 3, the antimicrobial treatment was regarded as questionable. Setting: Department of Medicine (279 hospital-beds) at the University Hospital Center Rijeka, a 1200-patient-bed teaching hospital in Croatia. RESULTS: Antimicrobials were prescribed to 15% of the total patients. They were given as a treatment to 89% of the patients, and in 67% of the cases, this treatment was administered empirically. According to the scoring system, 29% of the patients did not have a justified indication for antimicrobial treatment. CONCLUSION: The proposed quality indicator (scoring system) that we used is a simple method for the quality assessment of antimicrobial use. It has indicated areas that require in-depth analysis.     

Antimicrobial use at a university hospital: appropriate or misused? A qualitative study

OBJECTIVE: To evaluate the quality of antimicrobial drug use in a university hospital medical department (Department of Medicine, University Hospital Rijeka, Croatia) with 279 hospital-beds in wards containing patients from endocrinology, gastroenterology, hematology, clinical immunology, cardiology and coronary care unit, nephrology and pulmonology sections of the hospital. METHODS: The appropriateness of antimicrobial treatment for all in-patients in the Department of Medicine was assessed in a prospective, longitudinal survey carried out during a 21-week period using Kunin's criteria where Categories I and II indicate "appropriate therapy", Categories III and IV indicate major deficiency in the choice or use of antimicrobials. Category V indicates unjustified antimicrobial administration. RESULTS: During the study period, a total of 438 patients were treated with antimicrobials in the Department of Medicine. Of these, 159 (36%) received antimicrobials appropriately (Category I and II), 180 (41%) needed antimicrobials (Category III and IV) but they should have been prescribed differently. The main reason for inappropriate antimicrobial treatment was the wrong choice of antimicrobials (broad-spectrum where a narrow spectrum antibiotic would have been sufficient). In the case of 99 patients (23%) an indication for antimicrobial therapy did not exist (Category V). CONCLUSION: The main reason for suboptimal use of antimicrobials was the over-prescribing of broad-spectrum antimicrobials. This situation should be corrected e.g. by changes in the post-graduate medical teaching program.     

Factors influencing antimicrobial utilization at a university hospital during a period of 11 years

OBJECTIVE: A number of factors may influence antibiotic prescribing. The objective of this study was to identify trends in antimicrobial prescribing during a period of 1 years at the University Hospital Center Rijeka (UHC), Croatia, and to identify possible factors that might have influenced changes in prescribing patterns. This may help in establishing criteria for future intervention. METHODS: Antimicrobial utilization was evaluated retrospectively for the 11-year period from 1990-2000. It was measured in defined daily doses (DDDs) per 100 bed days using the ATC Index with DDDs 2000. RESULTS: During the investigation period, marked differences were noted in total and individual antimicrobial consumption. In the first 4 years of this study, the utilization of all groups of antimicrobials decreased, while in its second part (i.e. from 1995-1997) an increase in utilization of all antimicrobial groups occurred. Changes in utilization of groups of antimicrobials did not coincide completely with the changes in total antimicrobial utilization. The most prominent changes were a decrease in penicillin and cephalosporin utilization, and an increase of macrolides and aminoglycosides utilization from 1997-2000. Ampicillin and cefalexin were mostly prescribed as single antibiotics during a 5-year period (1990-1995) with the exception of 1 year (1994) when a marked decline in antimicrobial utilization was noted. In the following years, amoxicillin and amoxicillin with enzyme inhibitor became the most-used antimicrobials. CONCLUSION: Various factors influenced antimicrobial utilization during the investigation period. There were factors that directly influenced prescribing, e.g. the physicians' prescribing habit, guidelines, policy and formulary. Other factors directly influenced utilization, e.g. availability of a drug through purchasing, dispensing, procurement, pricing etc.     

Neutropenia in patients receiving long-term cefepime therapy for osteomyelitis.

The frequency of neutropenia in patients receiving long-term cefepime therapy for osteomyelitis compared with that in patients receiving other antimicrobials was studied. A comparative case review was conducted of home infusion patients receiving cefepime and patients receiving other antimicrobials for osteomyelitis. All courses of antimicrobial therapy for osteomyelitis between January 2001 and December 2002 were evaluated. The duration of prescribed therapy was approximately six weeks. Weekly laboratory tests included complete blood counts with differential. A total of 134 courses of antimicrobial therapy were reviewed (13 courses of cefepime therapy in 12 patients and 121 courses of therapy with other i.v. antimicrobials in 120 patients). Eight (62%) of the cefepime courses resulted in neutropenia, compared with none in the courses of other antimicrobials. Neutropenia was detected after 17-30 days of cefepime therapy. Blood counts returned to normal within one week of cefepime discontinuation. Eight of 13 courses of extended therapy with i.v. cefepime for osteomyelitis resulted in neutropenia, compared with none of 121 courses of other antimicrobials. Clinicians should exercise extreme caution when prescribing cefepime for longer than 14 days.     

11522张门诊处方中抗菌药物应用情况调查

目的指导临床合理应用抗菌药物。方法随机抽取我院门诊西药房1999年3月～5月的处方11522张,对应用的抗菌药物的品种、出现频率、给药途径及联合用药等情况进行统计分析。结果抗菌药物应用率为39.11％,应用品种有58种,主要是青霉素类、喹诺酮类、氨基糖苷类;以单种药物治疗为主（75.30％）,2种联用占21.86％,最多可达4种联用（0.     

Indications for antimicrobial prescribing in European nursing homes: results from a point prevalence survey

PURPOSE: In light of the emerging problem with multiresistant microorganisms in nursing homes (NHs), the European Surveillance of Antimicrobial Consumption NH subproject was set up to measure and describe antimicrobial use across Europe. The aim of this paper was to investigate the indications for antimicrobial use and hence identify targets for quality improvement. METHODS: Data were obtained from a point prevalence survey conducted in 323 NHs across 21 European countries. A resident questionnaire had to be completed for each resident receiving an antimicrobial, collecting data such as compound name and indication for antimicrobial prescribing. Four main indications for antimicrobial use were recorded: nasal decolonisation of methicillin-resistant Staphylococcus aureus (MRSA) carriage with mupirocin, prophylactic, empirical, and microbiologically documented treatments. The latter three treatment types were further subdivided according to the targeted infections. RESULTS: In total, 1966 residents were treated with 2046 antimicrobials. Empirical treatments were most common (54.4% of all antimicrobial therapies; prevalence: 3.39 per 100 eligible residents), followed by prophylactic (28.8%; prevalence: 1.87%) and microbiologically documented (16.1%; prevalence: 1.01%) regimes. MRSA decolonisation with nasal mupirocin (0.7%; prevalence: 0.02%) was uncommon. Antimicrobials were most frequently prescribed for the prevention or treatment of urinary (49.5%; prevalence: 3.23%) and respiratory (31.8%; prevalence: 1.81%) tract infections. A very high proportion of uroprophylaxis was reported (25.6% of all prescribed antimicrobials; prevalence: 1.67%). CONCLUSIONS: The indications for antimicrobial prescribing varied markedly between countries. We identified uroprophylaxis as a possible target for quality improvement. Copyright ? 2012 John Wiley & Sons, Ltd.     

中药配方颗粒处方分析

目的：了解北京市宣武中医医院门诊中药配方颗粒处方情况,提高处方合理用药水平。方法：调取我院2011年9月—2012年2月中药配方颗粒门诊处方信息,对其中患者性别、年龄、科别、用药金额及比例、涉及中药配方颗粒品种、药品在处方中出现次数和剂量等进行统计、分析,对中药配方颗粒处方的临床诊断也进行人工统计、分析。结果：女性用药比例高于男性;中老年用药比例高于其他年龄段;普通内科、呼吸科、皮肤科、脾胃科和专家门诊用药比例高;2011年12月的处方量和用药金额高;我院涉及配方颗粒的药品有400种,当归、陈皮、黄芩、茯苓、白芍居使用频率排序前5位;使用频率排序前20种药品的使用剂量在2010年《中华人民共和国药典》规定剂量范围内平均出现频率为56.97%,超出规定剂量平均出现频率的41.84%;处方临床诊断不规范比例为17.6%。结论：我院中药配方颗粒处方中存在用药剂量问题,处方中的临床诊断也存在不规范问题。为保证患者用药安全,要加强临床用药剂量监测和合理用药检查,切实发挥临床药师的作用。     

2016年天津市儿童医院住院患儿抗菌药物的使用情况分析

目的 调查天津市儿童医院住院患儿抗菌药物的使用情况,为临床合理应用抗菌药物提供参考。方法 随机抽取天津市儿童医院2016年1~12月住院病例中的918份病历进行统计与分析。结果 病原学检测率为90%,检测阳性率为21.80%。内科和外科的抗菌药物使用率分别为50.15%、47.76%。内科中的呼吸、新生儿、感染、重症科的抗菌药物使用率较高。头孢类（32.60%）、氧头孢烯类（29.30%）、大环内酯类（18.99%）为应用最多的3类抗菌药物。在给药途径方面,静滴给药占71.15%。抗菌药物单用、二联及二联以上的使用率分别为69.17%、26.43%、4.40%。结论 天津市儿童医院抗菌药物应用情况基本符合国家标准,以静滴给药为主,应进一步提高规范应用抗菌药物管理力度,促进抗菌药物合理应用。     

内外科患者感染病原菌对抗菌药物敏感性的对比分析

目的：了解内、外科住院患者感染主要病原菌的种类及对抗菌药物的敏感性,为临床合理使用抗菌药物以及预防和控制耐药菌的产生提供科学依据。方法收集山西医科大学第二医院2012年内、外科住院患者感染病原菌和药敏试验报告单。送检标本包括尿、血液、病变部位分泌物、痰、粪便、咽拭子、脑脊液等。应用细菌耐药性监测网提供的WHONET 5.5软件及SPSS16.0软件对原始数据进行分析,比较内、外科患者感染病原菌的分布情况以及不同来源病原菌对不同抗菌药物的敏感率。结果共分离到来源于4092例内、外科住院患者的非重复病原菌4268株,其中内科患者2182例2257株,外科患者1910例2011株。来源于内科患者的病原菌前5位依次为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、凝固酶阴性葡萄球菌和阴沟肠杆菌;来源于外科患者的病原菌前5位依次为大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌和阴沟肠杆菌。来源于内科患者的病原菌对抗菌药物的敏感率高于外科患者的有大肠埃希菌对头孢哌酮舒巴坦、头孢吡肟、头孢他啶、头孢曲松及头孢呋辛[62.7%（271/432）比58.0%（202/348）,65.5%（283/432）比55.5%（193/348）,63.8%（275/431）比53.3%（185/347）,41.8%（180/431）比34.4%（120/349）,34.0%（146/430）比26.6%（93/349）],阴沟肠杆菌对头孢吡肟[94.4%（151/160）比83.3%（140/168）],铜绿假单胞菌对阿米卡星[92.2%（190/206）比86.1%（230/267）],鲍曼不动杆菌对亚胺培南、美罗培南、头孢哌酮舒巴坦、环丙沙星及米诺环素[30.1%（31/103）比19.0%（41/216）,29.7（30/101）比17.5%（38/217）,19.4%（20/103）比10.8%（23/213）,19.2%（19/99）比9.8%（20/204）,23.2%（22/95）比11.1%（22/198）],敏感率低于外科患者的有金黄色葡萄球菌对复方新诺明、庆大霉素及克林霉素[54.8%（40/73）比78.9%（71/90）,50.0%（37/74）比71.3%（62/87）,28.8%（21/73）比46.6%（41/88）],肺炎克雷伯菌对左氧氟沙星[77.3%（269/348）比90.5%（239/264）],铜绿假单胞菌对妥布霉素[81.8%（148/181）比88.7%（235/265）]。上述差异均有统计学意义（均P﹤0.05）。结论内科与外科患者感染病原菌的种类不同,来源于内、外科患者的同一种病原菌对同一种抗菌药物的敏感性也不同,临床医生应结合药敏试验结果,合理使用抗菌药物。     

Usage of antimicrobial agents in a private primary healthcare setting in South Africa

Objective The aim of this study was to investigate the prescribing of antimicrobials in a private primary healthcare setting in South Africa. Setting A group of private primary healthcare clinics in South Africa. Method A retrospective, drug utilisation study was conducted on nine clinics that were randomly selected from 33 clinics situated in different geographical areas of South Africa, and whose data were electronically available. Data were obtained from the central database of the private primary healthcare provider and extracted for the period January 1, to December 31, 2001. Key findings The study population consisted of the total patient population (n = 83 655) who visited the clinics during this one‐year period. The total number of medicine items prescribed was 515 976 at a total cost of R1 716 319 ($17 163). Of these, antimicrobials represented 18.69% (n = 96 421) of all medicine items prescribed at a cost of R1 045 108 ($10 451) (60.89%). Antimicrobials were prescribed during 72.72% of consultations at the nine clinics during the one‐year period. The antimicrobials most frequently prescribed were penicillins (38.17%) followed by sulphonamides (22.49%), antiprotozoals (9.88%) and tetracyclines (9.34%). The most common diagnoses for which antimicrobials were prescribed were viral influenza, upper respiratory tract infections, hypertension, acute bronchitis, and common cold. Conclusions The high percentage of antimicrobial prescribing obtained in this study could indicate excessive use of antimicrobials in the private primary healthcare setting. The prescribing of antimicrobials in respiratory tract infections could indicate overuse and inappropriate use of these agents. This could have an effect on the health of the patients needing care, and the general budget for healthcare services. It is recommended that further investigations on the prescribing protocols of antimicrobial usage be done.     

Exploring pharmacists' perceptions of the feasibility and value of pharmacist prescribing of antimicrobials in secondary care in Scotland

Objectives The introduction of non‐medical prescribing in the UK has provided opportunities and challenges for pharmacists to help ensure prudent use of antimicrobials. The objective of this research was to explore pharmacists' perceptions of the feasibility and value of pharmacist prescribing of antimicrobials in secondary care in Scotland. Methods Pharmacists' perceptions were explored using focus groups in five Scottish regions representing (a) urban and rural areas and (b) district general hospitals and large teaching centres. Senior hospital pharmacists, both prescribers and non‐prescribers, working in specialities where antimicrobials are crucial to patient management, were invited to participate. A topic guide was developed to lead the discussions, which were audio‐recorded and transcribed. The framework approach to data analysis was used. Key findings Six focus groups took place and some emerging themes and issues are presented. Pharmacists believed that the feasibility of antimicrobial prescribing is dependent upon the patient's clinical condition and the area of clinical care. They identified potential roles and opportunities for pharmacist prescribing of antimicrobials. Perceived benefits included giving patients quicker access to medicines, reducing risk of resistance and better application of evidence‐based medicine. Conclusions Pharmacists feel they have a good knowledge base to prescribe and manage antimicrobial treatment, identifying possible opportunities for intervention. Roles within a multidisciplinary antimicrobial team need to be clearly defined.     

我院呼吸内科抗菌药物使用情况调查分析

目的分析我院呼吸内科抗菌药物使用情况,为临床合理用药提供依据。方法随机抽取2010年10月～2011年9月的呼吸内科出院病历360份,进行回顾性分析,调查抗菌药物使用情况,包括抗菌药物的种类、剂量、疗程、联合用药情况、药敏试验等。结果其中316例患者使用了抗菌药物,占调查病历的87.78%;共涉及13类45种,主要为喹诺酮类、头孢菌素类与β-内酰胺酶抑制剂配伍的复方制剂、头孢菌素类;使用频率排名前3的为左氧氟沙星、头孢哌酮钠-他唑巴坦、阿奇霉素;其中,二联用药居多（占71.52%）;不合理用药有28例（占8.86%）,主要为联合用药不适宜（占56.25%）。结论我院呼吸内科抗菌药物使用基本合理,基本符合安全有效的原则,但仍有一些不合理用药现象。     

200例围手术期患者预防性应用抗菌药的调查、分析

目的 :了解我院围手术期病例抗菌药应用情况 ,评价其用药合理性。方法 :随机抽查外科围手术期病历200例 ,对抗菌药品种、用药频度、联用情况、用药时间、疗效以及药物不良反应等进行分析。结果 :应用了抗菌药的有191例 ,应用率为95 5 %。本组病例共用抗菌药22个品种 ,以头孢菌素类、青霉素类、左氧氟沙星、氨基糖苷类及克林霉素为主。不合理用药主要表现为过早应用抗菌药或用药时间过长、不合理联合用药、不同病理生理状态下未按药代动力学参数调整给药剂量等。结论 :应强化医师围手术期预防应用抗菌药物的合理化意识