Objective:To analyze the clinical characteristics of serious immune-related adverse events(irAEs)such as Stevens-Johnson syndrome(SJS)and toxic epidermal necrolysis(TEN)occurring in patients caused by tislelizumab(BGB-A317),and provide reference for the safe and rational use of BGB-A317.Methods:The case reports and literature related to SJS/TEN caused by BGB-A317 as of November 2022 were searched from domestic and foreign databases such as Embase,PubMed,CNKI,SinoMed using"tislelizumab","Stevens-Johnson syndrome","toxic epidermal necrolysis","adverse drug reaction","immune-related adverse events"and"case report"as the search terms,to analyze the clinical characteristics of SJS/TEN caused by BGB-A317.Results:Five high-quality case reports were searched from relevant databases,involving 5 medical cases,including 4 TEN cases and 1 SJS case;5 patients(3 males and 2 females)were aged from 55 to 93 years,and the dosage and administration of BGB-A317 was"200 mg,q3w".The period from the first use of BGB-A317 to the onset of SJS/TEN was 54 to 127 days(median:63 days).Among the 5 patients,the skin toxic reactions of SJS/TEN caused by BGB-A317 were manifested as mucosal involvement(all oral mucosa)and prodromal rash;among them,patients who developed SJS had mucosal involvement and prodromal rash;while 1 of the 4 patients who developed TEN had no skin toxic reaction and 3 of them developed prodromal rash,but only 1 patient had mucosal involvement.All of the 5 patients who developed SJS/TEN improved or recovered after symptomatic treatment.Conclusion:The irAEs such as SJS/TEN occurring in cancer patients during treatment with BGB-A317 shall be highly concerned;once manifestations such as mucosal involvement or prodromal rash have occurred,clinical investigation and diagnosis shall be performed actively to ensure the medication safety of patients.
Objective:To analyze and evaluate the clinical medication risks of zileuton based on the US FDA adverse event reporting system(FAERS),and provide reference for the clinical medication safety of zileuton.Methods:With the OpenVigil tool,adverse events related to zileuton reported from January 1,2004 to September 30,2022 were retrieved from the Open-FDA database of FAERS,and the characteristics and risks of adverse events related to zileuton were analyzed using the reporting odds ratio method and Beyesian confidence propagation neural network method.Results:A total of 215 adverse event reports related to zileuton were discovered in the Open-FDA database,of which 158 were females(73.49%),including a total of 58 cases(26.98%)of serious adverse events such as hospitalization or severe hospitalization and disability of patients;215 reports involved a total of 26 signals,mapped to 8 SOC,with the main SOC of"respiratory,thoracic,and mediastinal diseases"(87 cases,40.66%),"skin and subcutaneous tissue diseases"(43 cases,20.00%),and"abnormal laboratory indicators"(46 cases,21.40%,all related to liver function damage);the signal intensity detection showed that there were 13 strong warning signals(including 5 related to liver function damage and 4 related to respiratory function abnormalities),and 11 moderate warning signals.Conclusion:Based on FAERS data,the main risks of zileuton are liver function damage and respiratory system abnormalities.Monitoring should be strengthened during clinical treatment to ensure the medication safety of patients.
目的:分析医院碳青霉烯耐药的肠杆菌科细菌(carbapenem-resistant Enterobacteriaceae,CRE)的感染特征及其耐药情况,为临床CRE感染患者的抗感染治疗提供参考.方法:选取 2019 年 5 月—2022 年 10 月临川区人民医院收治的 88 例CRE感染患者作为研究对象,采集患者的科室分布、标本类型和微生物检查结果等信息,分析CRE的感染特征及其耐药情况.结果:88 株CRE中主要菌株为肺炎克雷伯菌(41 株,占 46.59%)、大肠埃希菌(24 株,占 27.27%)、阴沟肠杆菌(13 株,占 14.77%);88 株CRE主要来自于痰液(56 株,占 63.64%),其次为尿液(15 株,占 17.05%)和胆汁(9 株,占 10.23%);88 株CRE主要来自ICU(54 株,占 61.36%),其次为神经外科(14 株,占 15.91%)和呼吸内科(11 株,占 12.50%);药敏结果显示,肺炎克雷伯菌、大肠埃希菌和阴沟肠杆菌对氨苄西林、头孢唑林、头孢呋辛、亚胺培南、氨苄西林-舒巴坦钠、厄他培南、头孢曲松的耐药率较高(＞75.00%),对替加环素、头孢替坦、妥布霉素的耐药率较低(＜15.00%).结论:医院CRE感染的主要致病菌为肺炎克雷伯菌,主要分布于ICU,多在痰液中检出,且对多种常用抗菌药物存在较高的耐药率,对少数抗菌药物如美罗培南、妥布霉素的耐药率较低,临床医师用药前应参考病原菌分布与药敏试验结果,合理选用疗效好的药物进行治疗.
目的:运用《2019 AGS老年人潜在不当用药Beers标准(更新版)》(以下简称《Beers标准(2019 更新版)》),分析与评价社区老年 2 型糖尿病患者的潜在不适当用药(potentially inappropriate medication,PIM)情况,为社区老年患者的用药安全提供参考.方法:选取 2020 年 10 月—2021 年 12 月社区药学门诊服务的＞60～65 岁老年 2 型糖尿病患者作为研究对象,采集患者的年龄、多病共存、服药状况、药物不良反应(adverse drug reactions,ADRs)等信息,分析患者的PIM情况及其与ADRs的关系.结果:此次符合纳入标准的老年糖尿病患者共 80 例,其平均患病种数为 5 种,平均用药种数为 9 种;调查发现,80 例患者中有 58 例存在PIM的情况,其中与药物相关的PIM 44例、与疾病相关的PIM 6例、与老年患者相关的PIM 6例、与药物相互作用相关的PIM 7例、与肾功能不全相关的PIM 5例和《Beers标准(2019 更新版)》未包括的PIM 25 例;80 例患者中真正发生ADRs的有 25 例,发生率为 31.25%;Spearman相关性分析结果显示,用药数量与ADRs的发生呈正相关(r=0.493,P＜0.05),PIM与ADRs的发生具有显著相关(r=0.715,P＜0.01).结论:社区老年 2 型糖尿病患者确实存在较多的PIM情况,且其与ADRs的发生存在较为密切的关系,临床在为此类老年患者开展诊疗的过程中,应多关注患者的多病共存和服药状况,尽量避免PIM的产生,以确保患者的用药安全.
目的:分析 2021 年周口市上报的新的药物不良反应(adverse drug reactions,ADRs)的流行病学特点,为保障患者用药安全提供参考.方法:调取 2021 年 1 月—12 月周口市属各医疗机构、药品经营企业和个人上报至国家药品不良反应监测中心的ADRs的病例报告相关数据,统计、分析患者的基本信息、新的ADRs上报机构和报告人职业、关联性和患者转归、给药途径、药品类别、累及的器官/系统及其临床表现和怀疑药品.结果:筛选出新的ADRs 报告 2 064 例,占全部ADRs 的 13.93%,其中新的一般的ADRs 有 1 952 例,新的严重的ADRs有 112 例;上报的新的ADRs的上报机构以医疗机构为主占 93.27%,报告人职业以医师为主占 56.40%;新的ADRs 患者中女性(1 115 例)多于男性(948 例),45 岁及以上人群为新的ADRs多发人群占 63.66%;新的ADRs的主要给药途径为口服给药;怀疑药品类别例数排名前 3 位依次为中药制剂(1 071 例,占 51.89%)、抗微生物用药(267 例,占 12.94%)和心脑血管系统用药(240 例,占 11.63%),其中中药制剂排名前 10 位药品以感冒治疗用中成药居多,抗菌药物静脉滴注例数最多;累及器官/系统主要为胃肠系统、皮肤黏膜、中枢与外周神经系统等.结论:临床应加强对中药制剂尤其是感冒治疗用中成药和注射剂尤其是静脉滴注抗菌药物的ADRs监测,以保障患者的临床用药安全.
Objective:To analyze the clinical use of carbapenem antibacterial drugs in the hospital,and provide reference for the standardized management and clinical rational use of carbapenem drugs.Methods:221 hospitalized patients treated with carbapenem drugs at Jiangsu Shengze Hospital from January to December 2020 were selected as the research subjects.The information such as age,gender,diagnosis,department,type of medication,and treatment outcomes was collected to analyze the clinical use characteristics and medication evaluation of carbapenem drugs.Results:The main carbapenem drugs used in 221 patients were biapenem(137 cases,61.99%)and meropenem(80 cases,36.20%);in terms of department distribution,the patients were mainly from Respiratory Medicine Department(105 cases,47.51%),followed by ICU(36 cases,16.29%);in terms of diagnosis,the patients were mainly diagnosed as pulmonary infection(152 cases,68.78%),followed by sepsis(16 cases,7.23%)and urinary tract infection(12 cases,5.43%);during the treatment process,184 cases(83.26%)underwent microbiological tests,of which 76 cases also underwent susceptibility tests,while 46 cases were treated according to susceptibility test results;according to the treatment results,142 out of 221 patients(64.25%)improved or recovered,but there were also many cases that did not improve(31 cases,14.03%),and that spontaneously left the hospital(41 cases,18.55%),and even 7 cases(3.17%)died;the medication evaluation of carbapenem drugs showed that 65 patients(29.41%)did not meet the medication indications,but the vast majority(more than 90.00%)of patients met the relevant requirements in terms of medication monitoring,approval and management.Conclusion:Most of carbapenem drugs used in the hospital are used by patients with pulmonary infection,sepsis,and urinary tract infection in Respiratory Medicine Department and ICU.The relevant monitoring,approval and management during the medication period basically comply with regulations,but there are still many unreasonable conditions for medication indications.In clinical practice,corresponding training should be strengthened to improve the level of rational medication.
目的:分析医院外科手术患者并发术后切口感染的病原菌分布与耐药特点,为临床手术患者的感染防治提供参考.方法:选取 2020 年 5 月—2022 年 5 月会昌县人民医院收治的 245 例行外科手术治疗的患者作为研究对象,记录其术后切口感染发生情况,收集切口感染患者的切口分泌物行病原菌培养与药敏试验,探究病原菌的分布特征和主要病原菌的耐药情况.结果:245 例行外科手术治疗的患者中,68 例(占 27.76%)发生术后切口感染,术后切口感染患者的切口分泌物中共分离出 79 株病原菌,其中革兰阴性菌 46 株(占 58.23%,以大肠埃希菌、铜绿假单胞菌为主)、革兰阳性菌 30 株(占 37.97%,主要为金黄色葡萄球菌)和真菌 3 株(占 3.80%);切口感染患者标本中的主要革兰阴性菌大肠埃希菌、铜绿假单胞菌对氨苄西林、复方磺胺甲噁唑、环丙沙星、头孢唑林、头孢他啶、左氧氟沙星的耐药率较高,对亚胺培南的耐药率为 0.00%;切口感染患者标本中的主要革兰阳性菌金黄色葡萄球菌对青霉素G、红霉素、四环素、莫西沙星、氨苄西林、庆大霉素、环丙沙星的耐药率较高,对利福平的耐药率为 0.00%.结论:医院外科手术患者术后切口感染发生率较高,其常见病原菌为革兰阴性菌;主要病原菌对临床常用抗菌药物呈多重耐药,临床需予以高度重视.
目的:分析急性胰腺炎患者并发胰腺感染的危险因素与病原学特征,为临床急性胰腺炎患者胰腺感染的防治提供参考.方法:选取 2020 年 5 月—2022 年 5 月吉水县人民医院收治的 66 例急性胰腺炎患者作为研究对象,采用回归分析法分析急性胰腺炎患者并发胰腺感染的危险因素和患者检出病原菌的分布情况.结果:纳入研究的 66 例患者中,并发胰腺感染的 25 例,感染率为37.88%;单因素分析结果显示,急性胰腺炎患者继发胰腺感染与C反应蛋白(C reactive protein,CRP)水平、机械通气时间、静脉留置导管时间、胃肠功能障碍时间、禁食时间、WBC计数,以及合并多器官功能衰竭、全身炎症反应、心血管并发症与否有关(P＜0.05);多因素Logistic回归分析显示,急性胰腺炎患者的入院WBC计数、禁食时间≥15 d、长时间留置中心静脉导管和胃肠功能障碍是其并发胰腺感染的独立危险因素;25 例感染患者标本分离出病原菌 29 株,其中阴沟肠杆菌、铜绿假单胞菌的构成比高于其他菌株.结论:急性胰腺炎患者继发胰腺感染的潜在可能性较高,根据危险因素和患者的实际情况选择针对性的治疗方法和抗菌药物,可减少或预防感染的发生.
目的:探究慢性阻塞性肺疾病(chronic obstructive pulmonary diseases,COPD)患者并发肺部真菌感染的危险因素和病原学特征,为临床COPD患者的肺部真菌感染防治提供参考.方法:选取 2020 年 1 月—2022 年12 月赣县区人民医院收治的 113 例COPD患者作为研究对象,采用医院调查问卷采集患者的性别、年龄、糖尿病、抗菌药物滥用、激素长期应用史、机械通气信息,分析COPD患者合并肺部真菌感染的危险因素,并统计感染患者标本检出真菌的分布及其耐药情况.结果:113 例COPD患者中,发生肺部真菌感染 11 例(9.73%);年龄≥60 岁、合并糖尿病、存在抗菌药物滥用、存在机械通气是COPD患者发生肺部真菌感染的危险因素(P＜0.05);11 例肺部真菌感染患者标本中共分离出 18 株真菌,其中白假丝酵母 8 株(占 44.44%),热带假丝酵母 4 株(占 22.22%);肺部真菌感染患者检出主要真菌白假丝酵母、热带假丝酵母对制霉菌素、两性霉素B的耐药率为0.00%.结论:年龄≥60 岁、合并糖尿病、存在抗菌药物滥用、存在机械通气是COPD患者发生肺部真菌感染的危险因素,患者标本检出的主要真菌为白假丝酵母、热带假丝酵母,临床应结合危险因素进行科学防控,针对已发生肺部真菌感染患者给予耐药率较低的抗菌药物,以提高感染的防控和治疗效果.
Objective:To analyze the diagnosis,treatment and pharmaceutical care process of one patient with Clostridium difficile infection caused by cefazolin,and provide reference for the clinical medication safety of antibacterial drugs.Methods:The patient was admitted to the hospital for"lumbosacral pain,accompanied by numbness in both lower extremities for 3 years,and worsening for half a year".On the 6th day after admission,the patient received surgery,and cefazolin was used before and after surgery to prevent postoperative infection;on the 9th and 10th days,the patient developed the symptoms such as fever,diarrhea,and abdominal pain;so a clinical pharmacist was invited for consultation.The clinical pharmacist consulted relevant literature and gave pharmaceutical suggestions based on the patient's current symptoms,examination results,and medication history.Results:After analysis,the clinical pharmacist considered it to be antibiotic-associated diarrhea,and suggested the tests related to Clostridium difficile;on the 14th day,the Clostridium difficile test showed positive result,so the treatment with vancomycin(125 mg,q6h,orally)was recommended;after 2 weeks of treatment,the formed stool was produced and the abdominal pain disappeared.Conclusion:Clostridium difficile infection caused by cefazolin is relatively rare in clinical practice.Clinical pharmacists can suspect it is caused by cefazolin very quickly based on their pharmaceutical knowledge and believes that Clostridium difficile may be the pathogenic bacterium,achieving the purpose of early detection and early treatment and improving the quality of clinical diagnosis and treatment.
目的:分析医院乳腺癌患者术后并发切口感染的病原菌分布与危险因素,为乳腺癌患者术后切口感染的防治提供参考.方法:选取 2021 年 9 月—2022 年 8 月医院收治的 148 例行手术治疗的乳腺癌患者作为研究对象,统计患者术后切口感染的发生情况和切口分泌物病原菌培养结果,并采用回归分析法分析患者术后并发切口感染的危险因素.结果:148 例乳腺癌患者中共有 17 例发生术后切口感染(占 11.49%),经培养分离出病原菌25 株,其中革兰阴性菌 15 株(占 60.00%)、革兰阳性菌 9 株(占 36.00%)、真菌 1 株(占 4.00%);患者的年龄、是否接受根治术、手术时间、临床分期、术后引流时间、白蛋白水平、是否接受辅助化疗、是否合并糖尿病与其是否发生切口感染相关(P＜0.05);Logistic多因素回归分析结果显示,年龄≥60 岁(OR=3.204)、接受根治术(OR=4.171)、手术时间≥3h(OR=2.709)、临床分期≥Ⅲ期(OR=3.892)、术后引流时间≥10 d(OR=5.815)、白蛋白水平＜35 g/L(OR=3.027)、接受辅助化疗(OR=1.613)、合并糖尿病(OR=4.112)是影响乳腺癌术后切口感染的独立危险因素(P＜0.05).结论:乳腺癌术后切口感染主要由革兰阴性菌导致,年龄≥60 岁、接受根治术、手术时间≥3 h、临床分期≥Ⅲ期、术后引流时间≥10 d、白蛋白水平＜35 g/L、接受辅助化疗、合并糖尿病均为其独立危险因素.
目的:分析医院呼吸科住院患者医院感染的发生情况及其病原学特点,为临床抗菌药物的合理使用提供参考.方法:选取 2019 年 3 月—2022 年 3 月呼吸科收治的 394 例住院患者作为研究对象,采集患者各标本(痰液、分泌物、支气管肺泡灌洗液、血液、尿液等)中病原菌检测与药敏试验结果,分析主要病原菌的分布与耐药特点.结果:394 例呼吸科住院患者中,发生医院感染 59 例,其感染率为 14.97%;医院感染患者标本中分离出病原菌82 株,其中革兰阴性菌 47 株(占 57.32%,以铜绿假单胞菌、肺炎克雷伯菌为主)、革兰阳性菌27 株(占 32.93%,以金黄色葡萄球菌为主),以及真菌 8 株(占 9.76%,以假丝酵母为主);病原菌主要来自痰液(占 78.05%)和支气管肺泡灌洗液(占 8.54%);药敏结果显示,铜绿假单胞菌对美罗培南、庆大霉素、环丙沙星、左氧氟沙星、氨曲南、头孢他啶的耐药率较低(＜20.00%);肺炎克雷伯菌对美罗培南、左氧氟沙星、头孢他啶、氨曲南的耐药率较低(＜20.00%);金黄色葡萄球菌对环丙沙星、左氧氟沙星、氨苄西林、头孢曲松、复方磺胺甲噁唑、庆大霉素的耐药率较低(≤20.00%).结论:呼吸科住院患者医院感染的病原菌主要来源于痰液、支气管肺泡灌洗液标本,铜绿假单胞菌、金黄色葡萄球菌、肺炎克雷伯菌是引发呼吸科住院患者感染的主要致病菌,且不同致病菌对常用抗菌药物均表现出较强的耐药性,临床应依据药敏结果选用敏感率高的抗菌药物治疗,以有效控制医院感染,确保其疗效.
目的:分析 558 份中成药处方点评结果,提出相应的改进对策.方法:回顾性分析 2020 年 1 月—2021 年 12 月横峰县中医院门、急诊药房的使用中成药物处方 558 张,将处方中的患者信息、临床诊断、药品相关信息逐条登记在Excel表中,以药品说明书、《处方管理办法》《医院处方点评管理规范》和临床指南为依据,对处方进行合理性点评,统计、分析处方中患者的年龄、性别和科室分布,以及不合理处方情况.结果:558 张处方中,患者为男性的 235 例(占 42.11%),其中＞60 岁例数最多为 80 例(占 34.04%),其次为 45～60 岁为 69例(占29.36%),患者为女性的 323 例(占 57.89%),其中＞60 岁的例数最多为 102 例(占 31.58%),其次为 45～60 岁为95 例(占 29.41%);558 张处方的分布科室为 6 个,包括大内科、中医科、妇产科、骨科、普外科和康复针灸科,其中张数排名前 3 位的科室为大内科(215 张,占 38.53%)、中医科(95 张,占 17.03%)、妇产科(88 张,占 15.77%);558 张处方中不合理处方为 32 张(占 5.73%),其中不规范处方 10 张(占 31.25%),占总处方的 1.79%;超常规处方4张(占 12.50%),占总处方的 0.72%;不适宜处方 18 张(56.25%),占总处方的 3.23%.结论:医院门、急诊中成药处方存在较多不合理情况,医院应加大对中成药使用的管控力度,提高处方审核率,从而保障患者使用中成药的有效性、安全性和合理性.
Objective:To analyze the clinical characteristics and treatment process of adverse drug reactions such as decrease in red blood cells(RBC)and hemoglobin and discoloration of radula caused by linezolid in patients,and provide reference for safe and rational use of linezolid clinically.Methods:The patient went to the hospital for treatment due to fever and knee joint pain.The past history showed that the patient had recently developed ulcers and pus on the inner thigh 10 cm away from the knee.The CT scan showed the presence of knee joint effusion,so it was considered to be a bone and joint infection.Linezolid was given for treatment;however,in the treatment process,the patient's RBC and hemoglobin levels decreased progressively,and his/her tongue coating turned yellow,and his/her teeth turned light brown.Results:Multidisciplinary expert consultation believed that the decrease in RBC and hemoglobin levels caused by linezolid could not be ruled out.The patient was discharged from the hospital on the same day and linezolid was discontinued;1 week later,the patient came to the hospital for review,and his/her RBC and hemoglobin levels returned to 3.54×1012/L and 100 g/L;2 weeks later,the patient's RBC and hemoglobin levels recovered to 4.22×1012/L and 121 g/L,and the color of tongue coating and teeth turned to normal.Conclusion:By reviewing the patient's disease course,it can be basically confirmed that the decrease in RBC and hemoglobin levels and the discoloration of radula are caused by linezolid,which suggests that sensitivity and identification ability of adverse drug reactions shall be strengthened during clinical medication to ensure the patient's medication safety.
Berberine is a medicine with a wide range of pharmacological effects.It has strong pharmacological activity against bacteria,fungi and viruses.Clinically,it is mainly used for intestinal infections.Researchers have found that berberine has a strong antibacterial effect on Escherichia coli both in vivo and in vitro when they studied its pharmacological effect on Escherichia coli,and its mechanism is possibly related to the interference with the nucleic acid metabolism and glucose metabolism of bacteria;in addition,berberine can enhance the antibacterial effect of other antibacterial drugs by interfering with the efflux system of drug-resistant Escherichia coli.In this article,the antibacterial effect of berberine on Escherichia coli and its pharmacological mechanism are reviewed and analyzed,to provide a reference for further clinical studies on berberine.
目的:分析医院 2020 年—2021 年住院患者抗菌药物使用强度(antibacterial use density,AUD),为临床抗菌药物的合理使用提供参考.方法:利用医院信息系统,调取 2020 年 1 月—2021 年 12 月上饶市立医院所有住院患者所使用抗菌药物的品种、规格、单价、用量、金额等数据,并按相关公式计算出相应的用药频度(defined daily doses,DDDs)、日均消费(defined daily dose cost,DDC)和AUD等,分析医院住院患者抗菌药物的使用特点.结果:医院 2020 年、2021 年住院患者AUD分别为 37.05、39.57,2021 年AUD较 2020 年略有上升趋势,但均符合国家规定的＜40 的标准;AUD排名前 3 位的药物均为氟喹诺酮类、头孢菌素类和青霉素类复方制剂类药物;2020 年AUD排名前 5 位的分别为头孢唑肟、哌拉西林-他唑巴坦钠、左氧氟沙星、拉氧头孢、头孢呋辛;2021 年AUD排名前 5 位的分别为哌拉西林-他唑巴坦钠、左氧氟沙星、头孢呋辛、美洛西林、头孢唑肟;2020 年DDC排名前 5 位的分别为卡泊芬净、哌拉西林-他唑巴坦钠、利奈唑胺、伏立康唑、亚胺培南;2021 年DDC排名前 5 位的分别为替加环素、伏立康唑、亚胺培南、美罗培南、哌拉西林-舒巴坦钠;2 年间DDC前 10 位药物的B/A比值均＜1.结论:医院抗菌药物使用逐渐趋于合理化,管理成效较为显著;但部分药物仍存在AUD过高,对患者经济负担过重情况,医院行政部门还应持续加强管理,以促进抗菌药物使用的合理使用.
目的:分析医院烧伤整形外科烧伤感染患者标本中病原菌的分布及其耐药情况,为临床烧伤感染患者的防治提供参考.方法:选取 2019 年 4 月—2021 年 4 月医院烧伤整形外科收治的 109 例烧伤感染患者作为研究对象,采集患者标本(创面分泌物、血液、痰液等)的病原菌培养及药敏试验结果,分析患者标本中病原菌的分布及其耐药情况.结果:109 例烧伤感染患者各标本中培养、分离出 223 株病原菌,其中革兰阴性菌140 株(占 62.78%,位列前 3 的分别为肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌)、革兰阳性菌 78 株(占 34.98%,位列前 3 的分别为金黄色葡萄球菌、凝固酶阴性葡萄球菌和粪肠球菌)和真菌 5 株(占 2.24%);药敏结果显示,肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌对亚胺培南的耐药率均较低(＜10.00%),铜绿假单胞菌、鲍曼不动杆菌对阿米卡星的耐药率亦较低(＜20.00%);金黄色葡萄球菌、凝固酶阴性葡萄球菌和粪肠球菌对利奈唑胺、万古霉素的耐药率极低(＜10.00%);金黄色葡萄球菌、凝固酶阴性葡萄球菌对莫西沙星的耐药率较低(≤20.00%),对其他抗菌药物的耐药率均各不相同;白假丝酵母对制霉菌素、伊曲康唑和氟胞嘧啶的耐药率均为 0.00%.结论:烧伤感染患者感染病原菌主要以革兰阴性菌为主,且其对抗菌药物普遍呈现多重耐药,临床应结合药敏试验结果选用敏感率高的抗菌药物治疗,以有效控制其感染,确保其疗效.
Objective:To analyze the multidisciplinary diagnosis and treatment(MDT)process of one patient with urinary tract infection complicated by acute ischemic stroke caused by multidrug-resistant Escherichia coli,and provide reference for clinical pharmacists to participate in MDT practices in similar patients.Methods:The patient visited the hospital's emergency department due to"sudden chills,fever,soreness in the waist,and difficulty in urinating".The examination at admission showed that the patient had obvious indications of urinary tract infection,and the NIHSS score revealed the presence of acute ischemic stroke.Results:For the patient's urinary tract infection,levofloxacin was used clinically for empirical treatment.However,after several days of treatment,the infection indications had not improved and showed a trend of aggravation;in addition,the urine culture result revealed infection with Escherichia coli,which was resistant to levofloxacin,cefuroxime,cefoxitin and ceftazidime.On the 5th day after admission,a multidisciplinary consultation was implemented,and experts participating in the consultation unanimously believed that the patient was at the risk of worsening the infection to sepsis or even septic shock,so the anti-infective treatment regimen was adjusted to meropenem(0.5 g,q8h)+ compound sulfamethoxazole(0.96 g,q12h);after 2 days of treatment,the infection indications had not improved and a multidisciplinary consultation was implemented again,and it was believed that the infection had progressed to septicopyemia.It was recommended that the anti-infective treatment regiment was adjusted to meropenem(2 g for the first dose,1 g,q8h for maintenance treatment)+ amikacin(0.3 g,q24h).One week later,the patient's infection indications improved obviously,so only meropenem(1 g,q12h)was given;another week later,the patient's infection indications disappeared basically,so all antibacterial drugs were discontinued,and the patient was discharged from the hospital.Conclusion:Clinical pharmacists can participate in the patient's MDT process with their professional expertise and provide more personalized support for patients'drug therapy,so as to ensure the treatment safety and effectiveness.
目的:探究医院烧伤科患者标本中病原菌的分布与耐药特点,为临床该类患者的感染防治提供参考.方法:选取 2019 年 6 月—2022 年 6 月信丰县人民医院烧伤科收治的 123 例患者作为研究对象,收集所有患者的创面分泌物、血液等标本行病原菌培养与药敏试验,分析患者标本中病原菌的分布,以及主要革兰病原菌的耐药情况.结果:123 例烧伤科患者标本中共检出 112 株病原菌,其中革兰阴性菌 64 株(占 57.14%,以铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌为主),革兰阳性菌 44 株(占 39.29%,以金黄色葡萄球菌、溶血葡萄球菌为主),和真菌 4 株(占 3.57%);药敏结果显示,铜绿假单胞菌、大肠埃希菌和肺炎克雷伯菌对头孢唑林、头孢曲松、氨苄西林、头孢西丁、复方磺胺甲噁唑、阿莫西林-克拉维酸钾、头孢替坦的耐药率较高(＞60.00%),对美罗培南、亚胺培南的耐药率为 0.00%;金黄色葡萄球菌、溶血葡萄球菌对红霉素、克林霉素、青霉素G、复方磺胺甲噁唑、苯唑西林、四环素的耐药率较高(＞60.00%),对万古霉素、利奈唑胺的耐药率为 0.00%.结论:革兰阴性菌是基层医院烧伤科患者感染的常见病原菌,主要病原菌对多种抗菌药物的耐药率较高,临床应按药敏试验结果规范选用抗菌药物.
Lonicerae japonicae flos is a common traditional Chinese medicine with multiple pharmacological activities such as antiviral,antibacterial,anti-inflammatory and immune-enhancing activities.Presently,a variety of antibacterial active ingredients have been isolated from lonicerae japonicae flos,mainly including organic acids,flavonoids,triterpene saponins,and volatile oils.In-depth studies of the antibacterial effects and pharmacological mechanisms of some active ingredients have been performed.In this article,the types,antibacterial effects and pharmacological mechanisms of antibacterial active ingredients in lonicerae japonicae flos are reviewed,to provide a theoretical basis for the subsequent development of these active ingredients.
