内镜切除肠道息肉抗菌药物预防性应用分析

目的:调查和分析我院消化内科内镜切除肠道息肉预防性应用抗菌药物的情况,为临床合理用药提供参考。方法:采用回顾性研究的方法,提取我院2018年10月1日至12月31日内镜切除肠道息肉的出院患者信息,对围术期预防性应用抗菌药物的指征、选用药物、用法用量、给药时机、用药疗程、预防用药效果与费用等指标进行统计分析。结果:338例患者中有用药指征的127例(37.6%);预防用抗菌药物品种以硫酸依替米星注射液为主(58.0%),其次为注射用头孢呋辛钠(31.0%);所有预防用药均在术后给药;预防用抗菌药物平均疗程为(2.96±1.55)d。术后因感染指标升高接受治疗的构成比为2.07%。结论:我院肠道息肉内镜切除预防性使用抗菌药物的有效性较好,但在用药指征、用药品种、给药时机与疗程等方面存在不合理之处,仍有待改进。     

423例Ⅰ类切口手术预防性应用抗菌药物分析

目的:调查我院Ⅰ类切口手术围术期预防性应用抗菌药物情况,以提高我院抗菌药物的合理应用水平。方法:采用回顾性方法,随机抽取我院2011年1—12月423份Ⅰ类切口手术患者的出院病历,对预防性应用抗菌药物的合理性进行分析。结果:抗菌药物预防应用率达59.8%(253/423),无指征预防用药为4.7%(12/253);主要使用的抗菌药物是头孢西丁钠和头孢呋辛钠;人均预防用药天数为2.98 d,人均药品金额为414.97元;药物选择的合理率为32.4%(82/253),用法与用量合理率为88.1%(223/253),给药时间合理率为39.5%(100/253),溶剂体积的合理率为87.4%(221/253),用药疗程的合理率为64.0%(162/253)。结论:我院Ⅰ类切口手术预防性应用抗菌药物还存在不合理使用现象,应该制定规范的围术期预防性应用抗菌药物干预措施,以提高医院合理用药水平。     

解放军第175医院3种Ⅰ类切口手术预防性应用抗菌药物分析

目的:评价我院3种Ⅰ类切口(甲状腺、乳腺、疝)手术预防性应用抗菌药物的合理性。方法:采用回顾性调查方法,对我院2010年出院的302例(甲状腺、乳腺、疝)Ⅰ类切口手术病历资料进行统计分析。结果:我院3种Ⅰ类切口手术围术期抗菌药物预防性应用率达100%,单一、二联、三联用药率分别为91.39%(276/302)、6.95%(21/302)和1.66%(5/302);预防用抗菌药物共9类,按使用频次排序居前4位的抗菌药物依次为头霉素类、头孢菌素类、β-内酰胺+β-内酰胺酶抑制剂复方制剂、氨基糖苷类;术前0.5～2 h给药仅1例,术前>2 h给药50例,术后继续使用率为100%;用药时间≤24 h者8例,24～48 h者25例,用药持续时间最长达17 d。结论:该院清洁手术围术期预防性应用抗菌药物存在指征掌握不严、品种选择欠妥、给药时间不恰当、术后用药时间过长等不合理现象,应进一步规范使用并加大监管力度。     

某院145例围手术期预防应用抗菌药物调查分析

目的:评价我院围手术期预防应用抗菌药物情况,促进临床合理用药。方法:对我院2012年7-9月份所抽查的145例患者抗菌药物专项点评资料进行回顾性分析,从抗菌药物的品种选择、用药时机、用药疗程、联合用药等指标进行分类统计。结果:所抽查145病例中抗菌药物使用率为79.3%,Ⅰ类切口手术抗菌药物使用率为72.5%,术前0.5h~2h用药病例为57例,术前2h用药病例为7例,术后用药病例为51例;预防用药疗程≤1d的有2例;≤2d的21例;3~7d的64例;>7d的8例。Ⅰ类切口和Ⅱ类切口的平均用药天数分别为4.2d和5.6d。结论:我院围手术期抗菌药物的使用仍存在不合理之处,应加强管理,规范用药。     

Variation in prophylactic antibiotic use in pediatric orthopedic surgery

Fifty-two pediatric patients undergoing orthopedic surgery were evaluated to determine the pattern of prophylactic antibiotic use. Of the 50 patients receiving antibiotics, 43 patients were given the antibiotic prior to surgery; 38 patients received the drug within two hours prior to surgery. All patients received the postoperative antibiotic for a duration ranging from 2 to 14 days. Thirty-one patients received the postoperative antibiotic for longer than 48 hours without documentation of infection. Cephapirin and/or cefazolin were the most common antibiotics used. Due to fixed postoperative doses (0.5-2 g), the dose/kg/d exceeded the maximum recommended therapeutic doses in one-third of the patients. The results of this study illustrate that the use of prophylactic antibiotics in pediatric orthopedic surgery can be improved to maximize benefits and minimize costs and the potential for adverse effects. Until data from controlled studies become available, it seems appropriate to follow the Centers for Disease Control guidelines in establishing hospital policy for surgical prophylaxis.     

A single preoperative dose of cefazolin versus postoperative amoxicillin and gentamycin combination in prophylaxis of orthopaedic and traumatologic surgery.

The use of antibiotic prophylaxis was evaluated in 228 surgical patients. The patients were given either cefazolin preoperatively or amoxicillin + gentamycin postoperatively in a randomized fashion to determine whether cefazolin would demonstrate an advantage over amoxicillin + gentamycin with respect to protection against postoperative wound infection, systemic infection and cost. We also tried to find out if the inflation of a tourniquet would interfere in the incidence of wound infection. Major postoperative wound infections were reduced in the cefazolin treated group (2.56 per cent versus 4.50 per cent). There also was a reduction in minor postoperative wound infections in the cefazolin group when it was compared with the amoxicillin + gentamycin group (6.83 per cent, 13.51 per cent, respectively). No systemic infection was seen in either group. There was no difference between the patients on whom were used tourniquets or not. Analysis of patients' charges suggested that 68.75% of the cost of preoperative antibiotic prophylaxis might be saved by limiting the duration of prophylactic drug administration by cefazolin.     

Are local clinical guidelines useful in promoting rational use of antibiotic prophylaxis in Caesarean delivery?

Objectives To identify changes in prescribing patterns of antibiotic prophylaxis in Caesarean delivery after introduction of local clinical guidelines. To identify changes in outcomes of prescribing antibiotics following the implementation of local clinical guidelines on antibiotic prophylaxis. Setting University of Belgrade, Medical School, Clinic of Gynaecology and Obstetrics “Narodni front” Belgrade, Serbia. Method A quantitative retrospective analysis of antibiotic use before (January–June 2005), and following (January–June 2006) implementation of guidelines on antibiotic prophylaxis in two wards. Patients who underwent Caesarean section prior to (261) and following (281) introduction of local guidelines, participated in this study. Main outcome measures Drug utilization cost presented as the number of DDD/100 bed days/eur, the average duration of hospital stay, number of wound infections. Results There was a significant change in prescribing patterns of antibiotic prophylaxis in Caesarean section following introduction of local guidelines. The use of ceftriaxone, amikacin and metronidazole decreased (57.47% vs. 11.74%; 9.19% vs. 4.27%; 61.69% vs. 46.26%, respectively). On the other hand, the use of “older” antibiotics such as gentamicin, cefuroxime, cefazolin and ampicillin increased (14.56% vs. 29.18%; 9.2% vs. 17.44%; 9.58% vs. 45.2% and 0% vs. 3.9%, respectively). DDD/100 bed days/eur analysis revealed a 47% decrease of total cost for prophylactic antibiotic treatment in Caesarean section following local guideline implementation. In contrast, rate of wound infections and duration of hospital stay were not significantly different in both groups. Conclusion In an attempt to ensure cost-effective prophylactic use of antibiotics in Caesarean delivery, local clinical guidelines were introduced. They resulted in changes in prescribing patterns of antibiotics. There was a significant decrease in use of ‘third’ generation of cephalosporin’s whereas the use of “older” antibiotics with proven efficacy and safety increased. In contrast, there was no significant change in treatment outcomes such as wound infection and average hospital stay.     

我院小儿清洁手术围术期预防性应用抗菌药物调查分析

目的:了解我院外科小儿清洁手术围术期预防性应用抗菌药物情况,评价其用药的合理性.方法:回顾性调查我院外科2009年11月至2010年11月577例清洁手术病例预防性应用抗菌药物情况.结果:577例病例中,抗菌药物预防性应用率达100％;采用术前0.5～2h给药者577例次,占100％,其中累计应用抗菌药物时间最短者为24h,最长者达7d.预防性应用抗菌药物涉及3类7种,其中青霉素类350例次(60.66％),头孢菌素类222例次(38.48％).结论:我院小儿清洁手术围术期 抗菌药物使用存在使用率高、用药时间过长、抗菌药物选择档次偏高等问题,清洁手术围术期抗菌药物的合理使用有待规范.     

3种清洁手术抗菌药物预防使用情况调查

目的了解本院腹外疝、甲状腺和乳房3种清洁手术抗菌药物预防使用情况。方法回顾性调查手术科室2010年5至12月住院患者的病历,包括患者的基本情况、手术类型、抗菌药物的品种、给药途径、疗程和费用等,并与指南比较和分析。结果共266份病历,病人年龄2～88岁(中位数:52岁)。头孢呋辛是最常预防使用的抗菌药物。不合理用药主要为给药时机不当、术后用药时间过长、药物选择、用药频度及溶媒不当等。结论医院应该建立和完善清洁手术围手术期抗菌药物预防使用的管理制度,加强对医务人员的培训,促使临床合理用药。     

Effect of pharmacist intervention on antibiotic prophylaxis in orthopedic internal fixation: A retrospective study

BackgroundDespite the availability of guidelines and official policies, antibiotic prophylaxis in clean surgery remains suboptimal.ObjectiveThe aim of this study was to evaluate the clinical effects and cost-effectiveness of pharmacist-led intervention in the perioperative anti-infection prophylaxis of patients undergoing orthopedic internal fixation.MethodsWe performed a retrospective analysis based on the medical records of internal fixation surgery in a tertiary hospital from July 2019 to June 2020. Data were divided into two groups based on whether a full-time pharmacist participated in the treatment. The research parameters included use of antibiotics, rationality of medication, postoperative complications, and related cost. To deal with selection bias, propensity score matching method was employed at a ratio of 1:1. Meanwhile, a cost-effectiveness analysis was used to evaluate the impact of pharmacist intervention on antibiotic prevention in internal fixation surgery.ResultsA total of 537 participants were included in this study. After matching, 236 patients were comparable in each group. During the pharmacist intervention period, less pharmacologic prophylaxis (96.6% vs 100.0%, p = 0.007) and shorter prophylaxis duration (1.60 vs 2.28 days, p < 0.001) were observed. The reasonable rate increased dramatically in usage and dosage (96.6% vs 83.9%, p < 0.001), timing of administration (94.5% vs 78.4%, p < 0.001) and medication duration (64.4% vs 37.7%, p < 0.001). In addition, pharmacist intervention yielded net economic benefits. A remarkable reduction was observed in average length of stay (10.43 vs 11.14 days, p = 0.012), drug cost ($610.57 vs $706.60, p = 0.001) and defined daily doses (2.31 vs 3.27, p < 0.001). The cost-effectiveness ratios, divided drug cost savings by cost of pharmacist time, were 28:1 for drug and 2:1 for antibiotics, respectively.ConclusionPharmacist-driven antibiotic stewardship for orthopedic internal fixation patients improved compliance with peri-procedure antibiotic prophylaxis, and reduced the cost and utilization of antibiotics. This helped to bring significant clinical and economic benefits.     

Utilization of antibiotics in caesarean section: A multicentre study

This is a prospective multicentre study on patients undergoing Caesarean section, to compare the use of antibiotics in surgery, in four selected countries. Patients admitted within a 6-month period in each centre were included. Study days were 6 days a month and were taken randomly from all working days in a month. Antibiotic use was recorded pre- and post-operatively. The most commonly used antibiotic in all countries was ampicillin, except in China. Mode of the number of antibiotics used as prophylactic was 1 in India and Nepal, 2 in China and 3 in Indonesia. Duration of antibiotic(s) use was 7–8 days in all countries. Antibiotic prophylaxis for Caesarean section was used improperly, especially in respect to the number, duration and kind of antibiotic given.     

Surveillance of reasonable period of antibiotic administration to compromised hosts

For the purpose of prevention of hospital-acquired infection caused by antibiotic-resistant bacteria, we examined a method to establish an appropriate time period for the administration of antibiotics to compromised hosts. Using these antibiotics we monitored patients who received instruction about the drug regimen in the Blood and Respiratory Diseases Department ward. We monitored a) third-generation cephalospolins, b) Imipenem/Cilastatin, and c) antibiotics used against methicillin-resistant Staphylococcus aureus. When the antibiotics were administered over 14 days, pharmacists notified physicians of the current duration of administration using a confirmation form, and confirmed their future administration schedule. We examined the antibiotic usage regimen of all the patients in this ward before and after the confirmation form was adopted. Patients given the same antibiotics within 14 days significantly increased in percentage from 82% to 91% after the confirmation form was adopted (p < 0.05). The median duration of antibiotic administration decreased from 7 days to 5 days. The case with antibiotic administration for the longest duration was a patient with leukemia who received vancomycin for 116 days after adoption of the confirmation form. This patient died 4 days after his antibiotic was changed. Only 16% of the patients administered antibiotics in this ward were monitored for the duration of antibiotic administration after adoption of the confirmation form. When the pharmacists positively provided physicians with information on some patients concerning the prolongation of antibiotics administration, the number of patients administered antibiotics for less than 14 days significantly increased throughout this ward without interfering with the treatment of patients who required long-term administration of antibiotics.     

临床药师干预外科围术期预防性应用抗菌药物对比分析

目的:评价临床药师干预外科围术期抗菌药预防性应用的效果。方法:分别抽取我院2008年9月288份出院病历(干预前)及2009年9月284份出院病历(干预后),对围术期预防性应用抗菌药物的合理性进行比较。结果:经临床药师干预,围术期患者预防用药在适应证、药物选择、用法用量、超权限应用抗菌药物、溶媒选择、给药途径、联合用药、给药时机、不良反应的发生和禁忌证方面较干预前均明显得到改善;住院药品总费用占总住院费用的比例由53.86%降至34.89%,抗菌药物总费用占总住院费用的比例由12.43%降至8.79%;总住院时间和抗菌药物应用时间分别下降1.24 d和1.11 d。结论:通过临床药师对围术期预防应用抗菌药物恰当的干预是有效、可行的,对围术期安全、有效、合理、经济地预防应用抗菌药物起到了积极的促进作用。     

人工流产围术期抗菌药物用药分析

目的提高人工流产围术期抗菌药物预防使用的合理性。方法对医院门诊2010年3月和2011年3月人工流产手术患者300例进行用药调查,比较其围术期预防性使用抗菌药物情况。结果 2011年3月较2010年3月术前预防用药率、术中预防用药率明显升高,但术后预防用药率明显下降（P〈0.05）。联合用药种类逐渐减少,单—用药逐渐增加;基本趋向于口服给药;但预防性用药种类趋向广谱抗菌药物,头孢菌素类药物比例增高。结论应更进一步严格掌握各类手术预防用药的指征;加强围术期预防性应用抗生素的管理;选择适当抗菌药物行围术期预防;定期对手术患者用药进行监测。     

普外科I类切口围手术期预防性抗菌药物使用调查分析

目的了解普外科I类切口手术围手术期预防性抗菌药物使用现状,提高临床合理用药水平。方法采用回顾性调查方法,随机抽取2010年1月～2月份普外科I类切口手术出院病历52份,对围手术期用药指征、抗菌药物品种选择、用药时间和药物利用指数等方面进行分析。结果 52例I类切口手术病历全部使用抗菌药物,使用频度较高的药物为依替米星、头孢米诺钠和氨苄西林/舒巴坦,42.31%的患者用药时间≤3 d,32.69%的患者二联用药,使用频度较高的氨苄西林/舒巴坦和头孢唑啉的药物利用指数(DUI)>1。结论普外科I类切口手术围手术期抗菌药物的使用尚需进一步规范。     

Ⅰ类切口手术围术期预防性应用抗菌药物分析

目的：了解我院Ⅰ类切口手术围术期预防性应用抗菌药物情况,为加强抗菌药物临床使用管理工作提供参考。方法：采用回顾性调查方法,对2012年2月—2013年4月我院出院的451例Ⅰ类切口手术围术期预防性应用抗菌药物情况进行统计、分析。结果：我院Ⅰ类切口手术围术期抗菌药物预防性使用病历有144例,其中有用药指征的有138例,占95.83%;术前0.5～2 h内给药的有130例,占94.20%;用药疗程〈24 h的有110例,占79.71%;抗菌药物选择合理的有127例,占92.02%。结论：通过抗菌药物专项整治工作的开展,我院Ⅰ类切口手术预防性应用抗菌药物的规范性有了很大的提高,但仍存在一些不合理之处,主要表现在无指征用药、抗菌药物品种选择不适宜、预防性应用抗菌药物的给药时间不适宜、用药疗程不适宜等。应进一步加强对抗菌药物合理使用的培训与规范化管理工作,规范围术期抗菌药物的预防性应用。     

某医院常见清洁手术围术期抗菌药物预防应用的调查与分析

目的：调查某医院常见清洁手术围术期抗菌药物预防应用的情况,从而促进合理用药。方法：随机抽取2008年1～12月240例6类常见的清洁手术（白内障手术、乳腺手术、骨科手术、斜疝修补术、甲状腺手术及心脏手术）的病历,调查抗菌药物预防应用的情况。结果：240例患者抗菌药物预防性使用率100%;使用率最高的3类抗菌药物分别是第1代头孢菌素（43.48%）,第3代头孢菌素（14.91%）和林可霉素类（8.08%）;无针对性药物选择使用率高达75%;给药剂量及给药次数合理的比例分别是55%和40%;联合用药的比例是29.99%;仅仅43.33%的患者抗菌药物使用时机是在术前2小时内;抗菌药物平均使用时间是5.75天,抗菌药物使用时间最长者达12天。结论：该医院手术期抗菌药物预防应用不合理情况很普遍,应引起足够重视。     

465例剖宫产术预防性应用抗菌药物分析

目的：了解剖宫产术围术期预防性应用抗菌药物现状,为提高,临床抗菌药物使用的合理性提供参考。方法：回顾性分析2012年6～12月我院465例行剖宫产术的病例,对患者的一般情况、手术情况,抗菌药物给药时间、剂量、品种、用药疗程以及用药频度（DDDs）和药物利用指数（DUI）等进行汇总分析。结果：465例剖宫产术患者中,预防性应用抗菌药物者464例（占99．8％）,其中单一用药者391例（占84．3％）,联合用药者73例（占15．8％）。383例患者（占82．7％）在断脐后给药;用药疗程≥72h者314例（占67．7％）、≤48h者10例（占2．3％）、≤24h者140例（占30％）。用药频度（DDDs）排序居前3位的抗菌药物分别为头孢呋辛钠、头孢替安钠和奥硝唑。结论：我院剖宫产术预防性应用抗菌药物在给药时间、品种选择、联合用药等方面比较合理,但存在抗菌药物用药疗程过长、药物利用指数偏高的问题。     

玉林市红十字会医院Ⅰ类切口手术预防性应用抗菌药物合理性分析

目的:了解我院Ⅰ类切口手术预防性应用抗菌药物情况,促进临床合理用药。方法:回顾性调查我院2010年Ⅰ类切口手术患者有关抗菌药物的预防性应用情况。结果:533例Ⅰ类切口手术患者中255例预防性使用抗菌药物,百分比为47.80%,平均用药时间5.21 d,术前0.5～2 h用药238例(93.33%)、术前≥2 h用药者3例(1.18%)、术后用药14例(5.49%),不合理用药203例(79.61%)。结论:我院外科Ⅰ类切口手术抗菌药物预防性应用在用药指征、用药时间、术后用药时间等方面存在不合理现象,需加强管理。