1011张门诊处方抗菌药物的应用分析

目的了解门诊西药处方中抗菌药物的使用现状。促进抗菌药物的合理使用。方法随机抽取2008年12月份门诊处方1011张，对抗菌药物应用情况进行调查分析。结果门诊抗菌药物的使用率为48％，其中89％为单用1种抗菌药物，11％为2种抗菌药物联用，未见3种抗菌药物联用。一线、二线抗菌药物的使用分别占20．5％、79．5％，未见三线抗菌药物的使用。结论抗菌药物的使用基本合理，但仍需进一步改进、提高。     

四川某骨科医院2012～2013年感染病原菌分布及耐药性分析

目的监测2012~2013年该院分离病原菌分布及药敏情况,指导临床合理用药。方法采用Micro Scan WalkAway-40全自动微生物鉴定系统进行细菌鉴定。结果从该院2012~2013年门诊及住院患者送检的各类标本中分离得到781株病原菌,其中革兰阴性菌占68.25%,革兰阳性菌占28.81%,真菌占2.95%。主要病原菌为金黄色葡萄球菌(23.05%),大肠埃希菌(18.57%),肺炎克雷伯菌(15.11%),铜绿假单胞菌(10.12%),阴沟肠杆菌(9.48%)。病原菌量在不断增加,而抗菌药物的敏感率却在不断降低。结论 2012年和2013年抗菌药物种类相符,分离病原菌种类在增加,耐药率也在不断增加,临床应合理使用抗菌药物,以降低耐药率的发生。     

重症监护病房病原菌种类及耐药性监测分析

目的调查该院重症监护病房(ICU)病原菌种类及其耐药情况。方法对2016年1月至2017年12月从该院ICU感染性疾病患者临床标本中分离的457株病原菌的种类及其耐药性进行调查分析。结果 457株细菌中,革兰阴性菌占62.3%(285/457),以铜绿假单胞菌(13.6%)、肺炎克雷伯菌(10.9%)、大肠埃希菌(7.6%)为主;革兰阳性菌占11.2%(51/457),以金黄色葡萄球菌(4.8%)为主;真菌占26.5%(121/457),以白色念珠菌为主(14.0%)。分离的病原菌对各类抗菌药物的耐药程度各不相同,但大部分菌株均呈现耐药。结论临床应加强ICU病原菌检测及耐药性监测,加强抗菌药物应用的管理和督查,合理使用抗菌药物。     

门诊抗菌药物处方专项点评结果分析

目的 分析门诊处方抗菌药物使用情况,为有效推进抗菌药物专项治理,促进抗菌药物合理使用提供参考.方法 根据抗菌药物的说明书及《处方管理办法》等判断抗菌药物应用是否合理,系统分析本溪市中心医院《抗菌药物临床应用管理办法》实施以来2011年7月至2012年12月门诊抗菌药物使用情况.结果 抽查门诊处方24 021张中共有抗菌药物处方2 812张,抗菌药物使用率为11.71％,其中不合理应用抗菌药物处方占3.63％ (102/2 812),抗菌药物使用合格率为96.37％(2 710/2 812).结论 该院《抗菌药物临床应用管理办法》实施以来门诊抗菌药物使用率＜20％,但仍存在不合理用药情况.     

呼吸科重症监护室患者下呼吸道铜绿假单胞菌感染情况及耐药性分析

目的调查近5年来湘雅二医院呼吸内科重症监护室(RICU)患者下呼吸道铜绿假单胞菌(PA)感染情况,并分析其耐药性变化趋势,为指导临床合理选用抗菌药物提供参考依据。方法分离鉴定该院RICU患者及呼吸科普通病房患者2008年7月至2013年7月送检的痰标本病原菌,分析PA感染及耐药情况,并将2病区PA感染及耐药情况进行比较分析。结果 2008~2013年RICU送检的痰液标本共检出病原菌517株,其中PA为141株,占27.3%;分析其对该院14种常用抗菌药物的耐药情况,耐药率最高的为替卡西林/克拉维酸(61.0%),最低的为多黏菌素B(9.2%)。普通病房同期送检痰标本检出病原菌378株,其中PA为125株,占33.1%,耐药率最高的药物为替卡西林/克拉维酸(28.0%),最低的药物为多黏菌素B(4.0%)。结论 PA仍然是近5年该院RICU患者下呼吸道感染的主要致病菌之一,且抗菌药物耐药情况逐年上升;RICU抗菌药物耐药情况普遍高于呼吸内科普通病房。临床尤其是RICU需采取有效措施防止院内感染,合理使用抗菌药物以减少耐药株的出现。     

1037株病原菌分布及其主要病原菌耐药情况分析

目的分析佛山市南海区第三人民医院检出的病原菌分布及其主要病原菌耐药情况,为临床合理用药和控制医院感染提供依据。方法采用法国生物梅里埃公司ATB微生物鉴定仪对2010年1月至2011年12月从该院患者的各类标本中分离的1 037株病原菌进行鉴定,药敏试验采用琼脂纸片扩散法及法国生物梅里埃ATB药敏板条。结果检出病原菌以革兰阴性杆菌为主占58.4%、革兰阳性球菌次之占27.3%,真菌占13.2%,除真菌外的其他主要病原菌的抗菌药物耐药率普遍较高。结论医院容易发生医院感染,应加强其病原菌分布及其抗菌药物耐药情况监测,以指导临床合理用药,降低医院感染率。     

佛山市三水区妇幼保健院2009年儿科抗菌药物使用状况分析

目的：了解佛山市三水区妇幼保健院抗菌药物的使用情况,评价使用的合理性,促进儿科合理化用药。方法：随机抽取2009年该院儿科门诊处方2 371份,对抗菌药物的使用情况进行分析。结果：使用抗菌药物的处方占85.6%,静脉滴注和肌内注射给药的处方占63.2%。在抗菌药物处方中,同时使用抗菌药物和抗病毒药物的处方占35.4%。单独使用一种抗菌药的处方占49.7%,使用两种抗菌药物的处方占35.8%。结论：儿科门诊用药存在不合理现象,建议规范化管理。     

我院门诊处方抗菌药物使用情况调查

目的：调查本院门诊处方抗菌药物应用情况，促进合理用药。方法：随机抽取2006年5月致2006年12月门诊部处方，对有关门诊部抗菌药物使用情况进行回忆性调查、统计和分析。结果：含抗菌药物处方为59.8％。其中儿科处方含抗菌药物占80.6％。普通感冒含抗菌药物处方达86.2％，抗菌药物注射局部使用率为2.1％，抗菌药物重复使用达0.33％。结论：门诊处方存在抗菌药物应用不合理问题，应进一步规范。     

老年科患者2013~2014年感染病原菌及耐药性分析

目的了解老年科患者感染病原菌及耐药情况,以指导临床合理使用抗菌药物。方法回顾性分析该院2013~2014年1 563例老年患者的临床标本送检资料。结果共检出非重复病原菌591株,阳性率为37.8%,主要分离自痰液标本,共299株(50.6%),其次为尿液171株(28.9%)、分泌物75株(12.7%)、血液15株(2.5%);分离病原菌以革兰阴性菌为主(72.60%),又以铜绿假单胞菌居多。鲍曼不动杆菌、大肠埃希菌及金黄色葡萄球菌对多种抗菌药物的耐药率较高,共检出多重耐药菌54株,占全院的56.3%。结论该院老年患者病原菌感染以革兰阴性菌为主,病原菌对多种抗菌药物的耐药率较高,多重耐药较严重,应根据药敏试验结果合理选用抗菌药物。     

2015年某院临床细菌耐药监测报告的分析

目的：分析新华医院2015年临床送检标本的主要病原菌种类、对常规抗菌药物的耐药率及抗菌药物临床应用中存在的问题，为临床治疗提供依据。方法2015年全年门诊及住院患者送检细菌培养标本4827份（非重复），经细菌鉴定后，分离出1433份（含51株真菌）有临床意义的阳性标本，阳性检出率为29．69％，采用K‐B法和M IC法进行耐药性检测，对分离出的主要病原菌和耐药率进行评价。结果致病菌检出率为29．69％（1433／4827），其中革兰阴性杆菌占72．43％（1038／1433），革兰阳性球菌占24．01％（344／1433），检出率由高到低依次为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌、阴沟肠杆菌和鲍曼不动杆菌。结论新华医院2015年主要检出病原菌对常规抗菌药物耐药率已呈上升趋势，临床医生应该严格控制抗菌药物的使用，改变以往的经验性用药而转为以病原菌治疗，重视实验室药敏检测，减少耐药菌株、合理使用抗菌药物，提高治疗效果。     

Drug Design and Discovery: Translational Biomedical Science Varies Among Countries

Drug design and discovery is an innovation process that translates the outcomes of fundamental biomedical research into therapeutics that are ultimately made available to people with medical disorders in many countries throughout the world. To identify which nations succeed, exceed, or fail at the drug design/discovery endeavor—more specifically, which countries, within the context of their national size and wealth, are “pulling their weight” when it comes to developing medications targeting the myriad of diseases that afflict humankind—we compiled and analyzed a comprehensive survey of all new drugs (small molecular entities and biologics) approved annually throughout the world over the 20‐year period from 1991 to 2010. Based upon this analysis, we have devised prediction algorithms to ascertain which countries are successful (or not) in contributing to the worldwide need for effective new therapeutics.     

Identifying Injection Drug Users at Risk of Nonfatal Overdose

Objectives: Drug overdose is the second leading cause of accidental deaths among U.S. adults aged 15–64 years. Emergency physicians have a unique opportunity to provide overdose prevention interventions, because habitual drug users are in frequent need of medical care. The authors evaluated associations between individual-level risk factors and experiencing an overdose in the past six months to determine which characteristics and behaviors may be most predictive of overdose.
Methods: The authors used data from a sample of street-recruited habitual drug users who participated in face-to-face interviews about overdose from November 2001 to February 2004. This analysis was restricted to 772 respondents who had been injecting for at least one year and who had injected heroin within the past two months.
Results: A total of 16.6% of participants had overdosed in the past six months. Characteristics and behaviors that were independently associated with an increased risk of a recent overdose were having had a prior overdose (odds ratio [OR], 28.58; 95% confidence interval [CI] = 14.10 to 57.96), using cocaine/crack in the past six months (OR, 2.07; 95% CI = 1.25 to 3.45), using alcohol in the past six months (OR, 1.90; 95% CI = 1.01 to 3.57), experiencing serious withdrawal symptoms in the past two months (OR, 2.70; 95% CI = 1.58 to 4.61), and younger age.
Conclusions: Drug users who have previously experienced a nonfatal overdose are at very high risk of experiencing future overdoses. Further longitudinal studies are needed to identify robust predictors of overdose risk over time in habitual drug users, but these data suggest that drug users who have overdosed warrant aggressive prevention efforts such as agonist maintenance treatment or provision of take-home naloxone.     

抗心律失常药导致室性心律失常187例临床分析

目的分析抗心律失常药导致室性心律失常的原因。方法应用动态心电图分析187例抗心律失常药致室性心律失常。结果各种抗心律失常药都有不同程度致心律失常不良反应,尤其Ic类抗心律失常药致室心律失常作用较强。结论当左室射血分数降低(LVEF40%),联合应用利尿剂及/或地高辛,和/或应用抗精神类药物,用药后QT间期离散度增加等都可出现致室性心律失常不良反应。     

Adverse events in drug administration: a literature review

Discussions between the children's services manager at an National Health Service trust, and a children's nursing lecturer from the trust's partnering university clarified that there was a need to establish a greater understanding of the local circumstances surrounding adverse events in drug administration - particularly when those events involved nurses. Indeed it is claimed that nurses spend up to 40% of their time administering drugs. It was agreed that a collaborative research study, specifically designed to explore the nature of drug administration errors, could inform future trust policies and procedures around both drug administration and error, as well as the various university curricula concerning drug administration. This study, supported by senior management in the trust, and the chair of the local research ethics committee, has commenced. The first part of this study -- an introductory literature review, is presented here. The work of O'Shea [J Clin Nurs (1999)8:496-504] is significant in structuring the review that bears a number of recurring themes. It is not the intention of this literature review to reappraise O'Shea's original critique but to expand on her work, offer a contemporaneous perspective in the light of studies and reports published since 1999, and reset the topic in the context of clinical governance. This literature review has already provided an underpinning framework for a pilot questionnaire to staff who have been involved in drug administration errors and is also the basis for curricular input to preregistration students on the subject of risk management and drug administration. In conclusion, several recommendations about the shape of future research are offered.     

Trends in carisoprodol abuse and misuse after regulatory scheduling: a retrospective review of California poison control calls from 2008 to 2015

Background: In January 2012, carisoprodol was classified as a Schedule IV substance under the controlled substances act from a previously non-controlled, non-scheduled classification. Carisoprodol is marketed as a skeletal muscle relaxant and is commonly cited for its abuse potential.

Objectives: We aimed to compare volume of calls involving carisoprodol abuse or misuse to a statewide poison control system before and after the scheduling change.

Methods: Data were extracted from poison control calls coded as “misuse/abuse” involving carisoprodol from four years before (2008 to 2011) and four years after (2012 to 2015) the scheduling change. The volume of calls from pre- and post-scheduling change was compared after adjusting for yearly California census data.

Results: The number of calls related to carisoprodol abuse or misuse was significantly decreased in the four years following the change compared to the four years before.

Conclusion: Scheduling of carisoprodol was temporally related to decreased exposures as reported to California Poison Control Centers. Governmental regulation may impact a drug’s potential for abuse.     

An analysis and comparison of commonly available United Kingdom prescribing resources

Background and objective: Safe prescribing requires accurate and practical information about drugs. Our objective was to measure the utility of current sources of prescribing guidance when used to inform practical prescribing decisions, and to compare current sources of prescribing guidance in the UK with idealized prescribing guidance. Methods: We developed 25 clinical scenarios. Two independent assessors rated and ranked the performance of five common sources of prescribing guidance in the UK when used to answer the clinical scenarios. A third adjudicator facilitated review of any disparities. An idealized list of contents for prescribing guidance was developed and sent for comments to academics and users of prescribing guidance. Following consultation an operational check was used to assess compliance with the idealized criteria. The main outcome measures were relative utility in answering the clinical scenarios and compliance with the idealized prescribing guidance. Results: Current sources of prescribing guidance used in the UK differ in their utility, when measured using clinical scenarios. The British National Formulary (BNF) and EMIS LV were the best performing sources in terms of both ranking [mean rank 1·24 and 2·20] and rating [%excellent or adequate 100% and 72%]. Current sources differed in the extent to which they fulfilled criteria for ideal prescribing guidance, but the BNF, and EMIS LV to a lesser extent, closely matched the criteria. Discussion: We have demonstrated how clinical scenarios can be used to assess prescribing guidance resources. Producers of prescribing guidance documents should consider our idealized template. Prescribers require high‐quality information to support their practice. Conclusion: Our test was helpful in distinguishing between prescribing resources. Producers of prescribing guidance should consider the utility of their products to end‐users, particularly in those more complex areas where prescribers may need most support. Existing UK prescribing guidance resources differ in their ability to provide assistance to prescribers.     

1641株临床分离病原菌的分布及耐药分析

目的了解重庆市涪陵中心医院2006～2008年临床分离病原菌的分布情况及常见细菌的耐药现状。方法对2006～2008年临床科室送检的培养标本,采用MicroScan A/s-4自动细菌鉴定及药敏测试仪进行鉴定和药敏试验,并对其结果进行统计分析。结果 4621份标本共分离出的病原菌占34.93%,其中以革兰阴性杆菌为主。检出前5位的病原菌依次为大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌、金黄色葡萄球菌、鲍曼不动杆菌。送检标本主要以痰、血液、脓、尿液为主。耐甲氧西林的金黄色葡萄球菌(MRSA)的检出率为55.74%;产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌和肺炎克雷伯菌的检出率分别为36.55%、26.38%;铜绿假单胞菌和鲍曼不动杆菌是多重耐药菌株,对多种抗菌药物耐药。结论本院分离的细菌耐药水平高且多重耐药,加强病原菌的耐药性监测,有利于合理使用抗菌药物和减缓多重耐药菌株的形成。