138例患者替加环素应用分析  

Analysis on Application of Tigecycline in 138 Patients

作　　者：杨雪婷[1] 郑鹏程[1] 曹玮[1] YANG Xueting;ZHENG Pengcheng;CAO Wei(Dept.of Pharmacy,the First People＇s Hospital of Yunnan Province/the Affiliated Hospital of Kunming University of Science and Technology,Yunnan Kunming 650032,China)

机构地区：[1]云南省第一人民医院/昆明理工大学附属医院药学部,云南昆明650032

出　　处：《中国医院用药评价与分析》2018年第9期1243-1245,1249,共4页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：云南省卫生计生委卫生计生政策研究课题(No.2015YNHP06);云南省教育厅科学研究基金项目(No.2016ZDX022);云南省第一人民医院"昆华.奥新"科技计划项目(No.2014QN004)

摘　　要：目的:了解云南省第一人民医院(以下简称"我院")替加环素的应用情况,为临床合理用药提供依据。方法:回顾性分析2014年9月至2016年12月我院138例使用替加环素患者的临床资料,结合当前临床指南推荐级别及循证研究,将替加环素治疗地位分为一线治疗和替代治疗,证据分级为Ⅰ、Ⅱ和Ⅲ级;并从患者急性生理和慢性健康Ⅱ(acute physiology and chronic health evaluationⅡ,APACHⅡ)评分、感染分级、替加环素清除病原菌情况及其联合用药情况等多方面进行评估。结果:138例患者中,使用替加环素作为一线治疗的有11例(占7.97%),替代治疗的有127例(92.03%),而替代治疗中Ⅰ级证据分级的有34例(占总病例数的24.64%);APACHⅡ评分<15分者6例[药物利用指数(drug utilization index)为1.01],APACHⅡ评分为15~20分者45例(DUI为1.05),APACHⅡ评分>20分者87例(DUI为1.05);116例(占84.06%)患者的用药剂量为每12 h使用50 mg;剂量加倍使用者8例;替加环素用于一线治疗(复杂腹腔感染)的DUI为1.16,替代治疗的DUI平均值为1.01;替加环素清除目标病原菌226株,主要清除鲍曼不动杆菌76株(DUI为1.03)、肺炎克雷伯63株(DUI为1.03)、大肠埃希菌28株(DUI为1.06)和耐甲氧西林金黄色葡萄球菌26株(DUI为1.01);替加环素与头孢哌酮舒巴坦、美罗培南、左氧氟沙星和环丙沙星的联合应用较多。结论:我院替加环素的临床应用存在部分不合理情况,需进一步提高合理用药水平,以大大减少替加环素的使用量,减缓细菌耐药进程。OBJECTIVE： To investigate the application status of tigecycline in the First People＇s Hospital of Yunnan Province（ hereinafter referred to as ＂our hospital ＂）,so as to provide reference for the rational drug application in clinic. METHODS： Retrospective analysis was conducted on clinical data of 138 patients with tigecycline in our hospital from Sept. 2014 to Dec. 2016. Combined with current clinical guidelines and evidence-based studies,tigecycline treatment status was divided into first-line treatment and alternative treatment,and the evidence was gradedⅠ,Ⅱ,and Ⅲ. And evaluation was conducted from the aspects of acute physiology and chronic health evaluation Ⅱ（ APACH Ⅱ）,infection grading,tigecycline clearance of pathogens and the drug combination. RESULTS： Of the 138 patients,11（ 7. 97%） received tigecycline as first-line therapy,127（ 92. 03%） received replacement therapy,and 34 cases of the grade I evidence were in replacement therapy（ 24. 64%）. There were 6 cases of APACH Ⅱscore 〈15points（ drug utilization index was 1. 01）,45 cases of APACH Ⅱ score from 15 to 20 points（ DUI was 1. 05）,and 87 cases of APACH Ⅱ score 〉20 points（ DUI was 1. 05）. The dose of 116 patients（ 84. 06%） was 50 mg every 12 h.Dose was doubled in 8 cases. The average DUI for patients with first-line treatment（ complex abdominal infection） was1. 16,and the average DUI for patients with replacement therapy was 1. 01. 226 strains of pathogens were eliminated from tigecycline target,mainly 76 strains of acinetobacter baumannii（ DUI was 1. 03）,63 strains of klebsiella pneumonia（ DUI was 1. 03）,28 strains of escherichia coli（ DUI was 1. 06） and 26 strains of methicillin-resistant staphylococcus aureus（ DUI was 1. 01）. The combination of tigecycline with cefoperazone sulbactam,meropenem,levofloxacin and ciprofloxacin was widely used. CONCLUSIONS： There are some irrational situation in the clinical application of tigecycline in our hospital. It is necessary t

关 键 词：替加环素 分级优化管理 药物利用指数 合理用药 

分 类 号：R978.1[医药卫生—药品]