产超广谱β-内酰胺酶肠杆菌科细菌感染患者使用抗菌药物的药物评价

  目的  评价云南省第一人民医院产超广谱β-内酰胺酶（ESBLs）肠杆菌科细菌患者应用抗菌药物使用的合理性。  方法  采用药物利用评价（DUR）和药物利用评估（ DUE）法，分析评价云南省第一人民医院2017年1月至2017年6月出院的135例 ESBLs肠杆菌科细菌感染患者的药物利用指数（DUI）、抗菌药物选用、给药方案及临床治疗结果。  结果  纳入DUR和DUE分析的抗菌药有14种，其中8种药物的药物利用指数（DUI） < 1，5种药物的药物利用指数（DUI） = 1，3种药物DUI > 1； DDDs居前5位的药物分别为头孢甲肟、头孢哌酮舒巴坦、美罗培南、左氧氟沙星和头孢曲松。DUE标准评价结果显示仅药品不良反应处理及监测为100%，而符合标准率较低的为有产ESBLs的危险因素且为轻中度感染选用的抗菌药物（28.87%）并正确降阶梯治疗（30.00%）。  结论  联合应用DUR和DUE可以更全面的对ESBLs肠杆菌科细菌患者的用药情况。仍需加强对ESBLs肠杆菌科细菌感染患者分层选择抗菌药物及选择合理的给药方案。

Evaluation of Drug Utilization in the Infected Patients with ESBLs Produced by Enterobacteriaceaein

  Objective  To evaluate the rationality of antibiotics utilization in the infected patients with ESBLs produced by Enterobacteriaceaein one hospital．   Methods  The methods of drug utilization review（DUR） and drug utilization evaluation（DUE） were used to analyze the drug utilization, drug use index（DUI） , selection of antibacterials, medicine regimen and therapeutic outcome in 135 patients with ESBLs produced by Enterobacteriaceaein in the hospital from January 2017 to June 2017.   Results  The DUR method involved 16 kinds of antibiotics． Among them, 8 kinds were with DUI below 1, 5 kinds with DUI equal to 1, and 3 kinds with DUI above 1．The drugs with top five DDDs were cefmenoxime, cefoperazone sulbactam, levofloxacin and ceftriaxone. 100%; yet monitoring of PCT, liver function and adverse drug reactions had lower qualified rate. DUE criteria showed that qualified rate adverse drug reactions was 100%; yet the right antibiotics were selected for mild and moderate infection that it produced ESBLs risk factors（28.87%）, and the de-escalation treatmen was right（30%）.   Conclusions  A more comprehensive evaluation of drug utilization in patients with ESBLs produced by Enterobacteriaceaein can be achieved using DUR combined with DUE methods. The layering use of antibiotics and rational selection medicine regimen for the patients within the infected patients with ESBLs produced by Enterobacteriaceaein in the hospital still needs to be strengthened．