住院患者抗菌药应用合理性的调查  

Investigation of rationality of antibacterial use in inpatients

作　　者：白玉国[1] 张爱琴[1] 李京明[2] 李夏明[3] 张沫[1] 焦平[1] 

机构地区：[1]首都医科大学附属北京安贞医院药剂科,北京100029 [2]首都医科大学附属北京安贞医院检验科,北京100029 [3]首都医科大学附属北京安贞医院感染科,北京100029

出　　处：《药物不良反应杂志》2009年第5期330-334,共5页Adverse Drug Reactions Journal

摘　　要：目的:调查住院患者抗菌药应用现状,为临床合理应用抗菌药提供参考。方法:回顾性随机抽取北京安贞医院2006、2007年应用抗菌药住院患者的病历各500份,调查患者住院期间预防、治疗应用抗菌药情况,以《北京地区医疗机构抗菌药物临床应用指南》为依据,分析抗菌药应用存在的不合理现象。结果:2006年500例患者中,男317例,女183例,年龄5个月～89岁,平均(55.6±15.6)岁,手术患者194例,非手术患者306例。2007年500例患者中,男236例,女264例,年龄1个月～90岁,平均(52.7±24.6)岁,手术患者209例,非手术患者291例。2006、2007年Ⅰ类手术预防用药分别为162例(87.1%)和122例(93.1%);术前用药时间超过48h者分别为154例(95.1%)和118例(96.7%);Ⅰ、Ⅱ、Ⅲ类手术术前用药超过24h者分别为49例(28.8%)和77例(38.5%)。2006和2007年无指征治疗用药分别为152例(30.4%)与97例(19.4%);用药疗程不合理分别为153例(30.6%)与115例(23.0%);联合用药不合理分别为62例(74.7%)与198例(65.8%);行细菌药物敏感试验各为35例(7%)和500例(100%),未根据药物敏感试验结果调整药物治疗方案分别为17例(48.8%)和172例(34.4%)。2006年有4例<18岁患者不合理应用氟喹诺酮类药物;2006年有3例以及2007年有9例>60岁患者和2例小儿应用万古霉素未监测肾功能及个体化给药。结论:住院患者合理应用抗菌药物情况2007年较2006年有明显进步,但按《指南》要求,合理用药水平尚待进一步提高。Objective： To investigate the current situation of antibacterial use in inpatients for reference to rational drug use in clinical practice. Methods：In a retrospective study, five hundred case records of patients receiving antibaeterials each year were randomly selected in Beijing Anzhen hospital in 2006 and 2007. The situation of prophylactic and therapeutic uses of autibacterials were investigated, and the irrational phenomenon of antibacterial use was analyzed according to Beijing Medical Institutions Antibiotic Clinical Practice Guidelines. Results： In 2006, the 500 patients comprised 317 males and 183 females aged 5 months ~ 89 years, average age was （55.6 ± 15.6） years; of them, surgical patients was 194 and non-surgical patients was 306. In 2007, the 500 patients comprised 236 males and 264 females aged one month to 90 years, average age was （52.7 ± 24.6） years; of them, surgical patients were 209 and non-surgical patients were 291. In 2006 and 2007, the patients receiving prophylactic use of antibacterials for grade I surgery were 162 cases （87.1%） and 122 cases （93.1%） , respectively; before surgery, the patients who took more than 48 hours of treatment were 154 cases （95.1%） and 118 cases （96.7%） , respectively; before grade I, Ⅱ, and Ⅲ surgery, the patients took more than 24 hours of treatment were 49 cases （28.8%） and 77 cases （38.5%）, respectively. In 2006 and 2007, the patient with no indication receiving therapeutic antibacterial use were 152 cases （30.4%） and 97 cases （ 19.4% ）, respectively; the patients receiving inappropriate treatment course were 153 cases （30.6%） and 115 cases （23.0%） , respectively; the patients receiving inappropriate combination therapy were 62 cases （74.7%） and 198 cases （65.8%） , respectively; the patients receiving antibacterial sensitivity tests were 35 cases （7%） and 500 cases （ 100% ）, respectively; the patients whose drug therapy regimen were not adjusted according to the antibacterial sensit

关 键 词：抗菌药物 合理用药 细菌耐药性 

分 类 号：R96[医药卫生—药理学]