临床药师参与多学科会诊对多重耐药菌所致重症感染患者的影响与典型病例的药学监护分析  

Influence of Multidisciplinary Consultation Involved by Clinical Pharmacists on Patients with Severe Infection Caused by Multi-Drug Resistance Organisms and Analysis of Pharmaceutical Care of Typical Cases

作　　者：范彩霞[1,3] 李正林 宫丽 FAN Cai-xia;LI Zheng-lin;GONG Li(GCP Office,The People's Hospital of Longhua,Shenzhen Affiliated to Southern Medical University,Shenzhen Guangdong 518109,China;Department of Pharmacy,Shenzhen Bo'ai Shuguang Hospital,Shenzhen Guangdong 518109,China;Department of Pharmacy,The People's Hospital of Longhua,Shenzhen Affiliated to SouthernMedical University,Shenzhen Guangdong 518109,China)

机构地区：[1]南方医科大学附属深圳市龙华区人民医院GCP办公室,广东深圳518109 [2]深圳博爱曙光医院药剂科,广东深圳518109 [3]南方医科大学附属深圳市龙华区人民医院药学部,广东深圳518109

出　　处：《抗感染药学》2023年第4期355-360,共6页Anti-infection Pharmacy

基　　金：深圳市龙华区医疗卫生机构区级科研项目(编号:2020007);广东省医院药学研究基金(奥美基金)(编号:2021A38)。

摘　　要：目的:评价临床药师参与多学科会诊对多重耐药菌(multi-drug resistance organisms,MDROs)所致重症感染患者的影响,并分析典型病例的药学监护过程。方法:选取2019年1月—2020年12月医院收治的104例有临床药师参与多学科会诊的MDROs所致重症感染患者作为干预组,选取同期110例无临床药师参与多学科会诊的MDROs所致重症感染患者作为对照组,比较2组患者感染部位、病原菌分布、治疗结局和不良反应发生情况,并分析典型病例的药学监护过程。结果:干预组和对照组患者的感染部位均主要为呼吸系统(36例vs 40例)、泌尿系统(17例vs 16例)、中枢神经系统(13例vs 11例)和血液系统(9例vs 10例),而其病原菌均主要为产超广谱β-内酰胺酶的大肠埃希菌(84例vs 85例)、甲氧西林耐药的金黄色葡萄球菌(21例vs 24例)和产超广谱β-内酰胺酶的肺炎克雷伯菌(15例vs 19例),但经比较其差异均无统计学意义(P>0.05);治疗结局显示,干预组患者治疗后的总有效率高于对照组(89.42%vs 71.82%,P<0.05);治疗期间,干预组患者的药物不良反应发生率低于对照组(18.27%vs 30.91%,P<0.05);此外,临床药师参与重症感染患者的多学科会诊,给临床提出了很多有用的建议,同时开展药学监护,保障了患者的用药安全和治疗效果。结论:MDROs所致重症感染主要累及呼吸系统、泌尿系统、中枢神经系统和血液系统,而其病原菌主要为产超广谱β-内酰胺酶的大肠埃希菌、甲氧西林耐药的金黄色葡萄球菌和产超广谱β-内酰胺酶的肺炎克雷伯菌;临床药师参与多学科会诊并开展药学监护可以帮助临床制定出更为合理的抗感染治疗方案,从而保障患者的用药安全和治疗效果。Objective:To evaluate the influence of multidisciplinary consultation involved by clinical pharmacists on patients with severe infection caused by multi-drug resistance organisms(MDROs)and analyze pharmaceutical care of typical cases.Methods:104 patients admitted to the hospital from January 2019 to December 2020 with severe infec‐tion caused by MDROs who received multidisciplinary consultation involved by clinical pharmacists were selected as the intervention group,and 110 patients with severe infection caused by MDROs who had not received multidisci‐plinary consultation involved by clinical pharmacists were selected as the control group.The infection sites,distribution of pathogenic bacteria,treatment outcomes and adverse reactions of patients were compared between the two groups,and the pharmaceutical care process of typical cases was analyzed.Results:The infection sites of patients in the interven‐tion group and the control group were mainly respiratory system(36 cases vs 40 cases),urinary system(17 cases vs 16 cas‐es),central nervous system(13 cases vs 11 cases)and hematologic system(9 cases vs 10 cases).The pathogenic bacteria were mainly Escherichia coli producing extended-spectrum beta-lactamase(84 cases vs 85 cases),methicillin-resistant Staphylococcus aureus(21 cases vs 24 cases)and Klebsiella pneumoniae producing extended-spectrum beta-lactamase(15 cases vs 19 cases),but the differences between them were not statistically significant(P>0.05);the treatment outcomes showed that the total effective rate of treatment of patients in the intervention group was higher than that of patients in the control group(89.42%vs 71.82%,P<0.05);during the treatment,the incidence of adverse drug reactions of patients in the intervention group was lower than that of patients in the control group(18.27%vs 30.91%,P<0.05);in addition,clinical pharmacists participated in the multidisciplinary consultation of patients with severe infections,and proposed many useful suggestions for the clinic practices;meanwhile,they ca

关 键 词：临床药师 多学科会诊 多重耐药菌 重症感染 药学监护 

分 类 号：R97[医药卫生—药品] R969.3[医药卫生—药学]