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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 application status of antibacterials in hospitalized patients and provide reference for the rational use of antibacterials in clinic. Methods: A retrospective random selection of Beijing Anzhen Hospital in 2006 and 2007, the application of antibacterial drugs inpatients with 500 copies of each patient during hospitalization for the prevention, treatment and application of antimicrobial drugs, “Beijing Medical Institutions Guide to the application of antimicrobial agents” for the Based on the analysis of the existence of an antimicrobial application of unreasonable phenomenon. Results: Of the 500 patients in 2006, there were 317 males and 183 females, ranging in age from 5 months to 89 years (mean 55.6 ± 15.6 years). There were 194 surgical patients and 306 non-surgical patients. Of the 500 patients in 2007, 236 were male and 264 were female, ranging in age from 1 month to 90 years, with an average of (52.7 ± 24.6) years, 209 patients undergoing surgery, and 291 non-operative patients. There were 162 cases (87.1%) and 122 cases (93.1%) of preventive medicine for type I surgery in 2006 and 2007 respectively. 154 cases (95.1%) and 118 cases (96.7%) were treated with preoperative medication for more than 48 hours. Type II and type III preoperative medication more than 24h were 49 cases (28.8%) and 77 cases (38.5%). There were 152 cases (30.4%) and 97 cases (19.4%) without indications for treatment in 2006 and 2007 respectively. Irrational treatment courses were 153 cases (30.6%) and 115 cases (23.0% 62 cases (74.7%) and 198 cases (65.8%). There were 35 cases (7%) and 500 cases (100%) of the drug-sensitive tests for bacteriology respectively. There were 17 cases without adjustment for drug sensitivity test (48.8%) and 172 patients (34.4%). Fluoroquinolones were unreasonable in 4 patients <18 years of age in 2006; 3 in 2006 and 9 in 2007> 60 years in 2007 and 2 in children. Vancomycin was not monitored for renal function and individualized administration. Conclusion: The rational use of antibacterials in hospitalized patients in 2007 showed a significant improvement over 2007, but according to the guidelines, the level of rational drug use needs to be further improved.