Evaluation of Drug Utilization in the Infected Patients with ESBLs Produced by Enterobacteriaceaein
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摘要:
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。 Abstract: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． -
表 1 药物DUI结果
Table 1. DUI of the drugs
药品名称 药品总用量（g） 用药天数（d） DDD DDDs DUI 头孢甲肟 1 109 276 2 554.50 2.00 头孢哌酮钠/舒巴坦 1087.33 278 4 271.83 0.98 美罗培南 461.6 210 3 153.87 0.73 左氧氟沙星 75.1 144 0.5 150.20 0.94 亚胺培南/西司他丁 241 98 2 120.50 0.95 头孢西丁 621 139 6 103.50 0.74 头孢曲松 182.2 69 2 91.08 1.32 替加环素 4.95 49 0.1 49.50 1.01 头孢美唑 192 48 4 48.00 1.00 莫西沙星 17.6 44 0.4 44.00 1.00 哌拉西林/他唑巴坦 421.76 57 14 30.13 0.76 头孢替安 112 28 4 28.00 1.00 氨曲南 56 14 4 14.00 1.00 阿米卡星 13.58 24 1 13.58 0.50 头孢噻利 22 11 2 11.00 1.00 环丙沙星 2.8 6 0.5 5.60 0.93 
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表 2 DUE标准应用结果 （n）
Table 2. Results of DUE standard application （n）
指标名称 标准内容 符合患者 符合用药标准
患者符合标准（%） 预期目标（%） 抗菌药物
选用评价及时进行经验性治疗：ESBLs危险因素评估；感染严重程度的评估 （1）无产ESBLs的危险因素选用头孢菌素、喹诺酮类等 24 21 87.5 90 （2）有产ESBLs的危险因素：
①轻中度感染选用头孢哌酮舒巴坦、哌拉西林他唑巴坦97 28 28.87 85 若降阶梯选用头霉素类 10 3 30 90 ②重症感染可选用碳青霉烯类抗菌药物 14 14 100 95 若降阶梯选用复合剂或头霉素类 6 4 66.67 90 目标治疗： （1）经验治疗与药敏结果一致，继续原方案治疗 74 58 79.45 95 （2）经验治疗与药敏结果不一致：
①治疗无效，根据ESBLs危险因素及感染严重程度及药敏结果综合选择抗菌药物51 24 47.06 85 ②临床结果好转，继续原方案治疗 11 9 81.81 90 抗菌药物
使用评价（1）合理的使用剂量及使用频次 135 96 71.11 95 （2）严重感染或全耐药情况下某些抗生素可延长输注时间 22 5 22.72 85 （3）联合用药：存在或怀疑有混合感染 29 26 89.66 95 （4）在使用过程中避免出现药物相互作用 135 131 97.04 95 （5）密切监测不良反应： ①发生不良反应，采取有效手段进行处理 2 2 100 95 ②收集药品不良反应，整理分析并及时上报云南省药品不良反应监测 2 2 100 90 使用结果 （1）医疗记录显示症状明显改善 135 73 54 85 （2）体征恢复正常或明显改善，例如：体温等 （3）实验室指标恢复正常或明显改善（白细胞、中性百分比、PCT等） （4）影像学检查病灶明显吸收 （5）细菌培养结果阴性
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