The injuries caused by earthquake were characterized as complicated injuries, multiple injuries, crush injury, commonly accompanied by the impairment of the organs, open wound with susceptibility to contamination, difficulties in the implementation of in-time treatment, and resource-limited settings. Considering the specialty of early treatment of earthquake victims and existing misconduct, we propose recommendations according to general principles of early rationale use of antibiotics, in order to treat the earthquake victims safely, effectively and feasibly, and to decrease wound infection rates after surgery.
目的 探讨加强抗菌药物合理应用管理后医院感染发生及分布的变化趋势，为实现循证管理提供科学依据。 方法 对2010年8月－2012年6月医院感染现患率调查结果进行比较分析。 结果 2012年医院感染现患率为1.78%，与2010年的3.61%相比较，差异有统计学意义（P＜0.05）。手术切口感染构成比由30.0%降为0.0%。抗菌药物使用率，由2010年的50.18%降至29.08%降低明显；2012年抗菌药物单联使用率为89.80%，较2010年71.22%明显提升，且无三联用药病例。 结论 规范抗菌药物临床应用后，医院感染现患率明显降低，防控医院感染取得了显著成效。
【摘要】 目的 了解外科围手术期预防性使用抗菌药物现状，评估其用药合理性。 方法 随机抽取2009年1-12月265例外科手术患者病历，根据《抗菌药物临床应用指导原则》和《卫生部办公厅关于抗菌药物临床应用管理有关问题的通知》对抗菌药物使用进行合理性评价。 结果 265例外科手术患者均使用了抗菌药物，使用率为100%，外科围手术期预防用抗菌药物不合理率为63.89%，存在的主要问题是用药指征过宽、起点过高、手术前预防用药时间不当、术后预防用药时间过长及盲目联合用药。 结论 外科围手术期抗菌药物预防性使用不合理现象突出，应积极开展合理使用抗菌药物培训，加强抗菌药物使用管理，规范围手术期抗菌药物的使用，从而提高外科围手术期抗菌药物使用合理性。【Abstract】 Objective To know the status of prophylactic use of antimicrobial agents in perioperative patients, and to evaluate the medication rationality. Methods The medical records of 265 patients who underwent the surgeries from January to December 2009 were randomly extracted, and the medication rationality was evaluated according to "Guiding Principles of Clinical Use of Antibiotics" and "Notice of Medical Department Office about Antibiotics Clinical practice Management Related Questions". Results All of the 265 perioperative patients were treated with antimicrobial drugs with a utilization rate of 100.00%, and the unreasonable rate of perioperative prophylactic use of antimicrobial agents was 63.89%. The main reasons included over-extended medication indications, high starting points, inappropriate time points of prophylactic medication, long duration of prophylactic medication and unreasonable drug combination. Conclusion The perioperative prophylactic use of antimicrobial agents is clinically unreasonable. It is necessary to carry out training on the rational use of antimicrobial agents to enhance the management of antimicrobial drug use and regulate the use of antimicrobial agents in perioperation.
【摘要】 目的 了解围手术期预防性应用抗菌药物的现状并评价其合理性。 方法 采用回顾性调查的方法，随机抽查2009年1-12月500例Ⅰ类切口围手术期患者资料，填写设计的《外科围手术期预防性应用抗菌药物调查表》，对预防用药的适应证、用药种类、联合用药、给药时机及持续时间进行统计分析。 结果 500例中，未使用抗菌药物5例，预防性使用抗菌药物495例，不合理或欠合理80例（16.00%）。预防性使用抗菌药物总例次为540，其中头孢菌素类453例次（83.89%），青霉素类（包括酶抑制剂）26例次（4.81%），喹诺酮类44例次（8.15%），林可酰胺类17例次（3.15%）。头孢唑啉钠使用178例次（32.96%）居第1位，头孢替唑钠使用151例次（27.96%）。 结论 Ⅰ类切口手术围手术期预防性使用抗菌药物较为合理，但仍存在用药指征把握不严，抗菌药物的选择、使用时间较长等问题，有待进一步规范化管理。【Abstract】 Objective To evaluate the prophylactic application of antibiotics during the perioperative period of type I incisions. Methods The clinical data of 500 patients with type I incisions from January to December of 2009 were retrospectively analyzed by self-designed questionnaire survey. The indication of antibiotics usage, choice of antibiotics categories, combination of antibiotics,giving time and length of antibiotics usage were analyzed. Results In 500 patients, only 5 were not given antibiotics, 80 (16%) were given antibiotics unnecessarily. In 540 patients who had underwent the antibiotic administration, 453 (16%) were administrated with cephalosporins, 44 (8.15%) were with fluoroquinolones, 26 (4.81%) were with penicillins, and 17 (3.15%) were with lincomycins. Cefazolin, the most used antibiotics, was given in 178 patients (32.96%)。Ceftezole was given in 151 patients (27.96%). Conclusion The prophylactic application of antibiotics during the perioperative period of type I incisions is basically rational, however, there were also some problems, such as using antibiotics unnecessary, mischoice of antibiotics and using antibiotics too long. Thus, we need management of prophylactic antibiotics usage.
目的：了解成都地区抗菌药物的使用现状，分析围手术期抗感染用药情况，并作出客观评价。方法：根据《抗菌药物临床应用基本原则》，回顾性分析2004年12月至2006年12月成都地区8家医院1268份围手术期病历。结果：围手术期患者使用抗菌药物用于预防术后感染的时间超过了抗菌药物临床应用指导原则规定的比例占91.40%，联合用药的比例占总病历数的53.56%，7.81%的患者在手术过程中应用去甲万古霉素、庆大霉素等冲洗伤口以预防感染。结论：围手术期抗菌药物的使用基本合理，但是存在频繁且长时间应用的问题，应当加强抗菌药物应用的管理。
Objective To systematically assess the efficacy and clinical significance of antibiotic prophylaxis in severe acute pancreatitis (SAP), so as to provide references for its rational clinical application. Methods For collecting the randomized controlled trials (RCTs) about antibiotic prophylaxis in SAP, a search was conducted in MEDLINE, EMbase, Cochrane Central Register of Controlled Trials, CBM and CNKI from the date of their establishment to August, 2010. After the clinical studies meeting the inclusive criteria were extracted and their quality was assessed. Meta-analysis was conduced by using RevMan 5.0 software. Results Twelve RCTs were included with a total of 777 patients. The results of Meta-analysis showed compared with the control group, the antibiotic prophylaxis group was not associated with a statistically significant reduction in mortality (RR=0.75, 95%CI 0.50 to 1.12), in the incidence of infected pancreatic necrosis (RR 0.82, 95%CI 0.63 to 1.09), in surgical interventions (RR=0.97, 95%CI 0.74 to 1.26), and in the incidence of nonpancreatic infections (RR=0.73, 95%CI 0.48 to 1.10). Conclusion Antibiotic prophylaxis for SAP does not reduce mortality, infected necrosis, or surgical intervention.
目的 了解本院病原菌分布及其耐药性趋势，为临床合理使用抗菌药物提供依据。 方法 对2011年1月－2012年1月门诊和住院患者送检的临床标本1 643份进行细菌培养及药物敏感性检测，并对其细菌耐药性进行分析。 结果 1 643份细菌培养标本中共检出致病菌750株，检出阳性率为45.6%；病原菌中，G+球菌242株，占32.3%，以金黄色葡萄球菌、凝固酶阴性葡萄球菌、肠球菌属为主。G−杆菌382株，占50.9%，以大肠埃希菌、铜绿假单胞菌、克雷伯菌属、肠杆菌属、鲍曼不动杆菌为主。耐甲氧西林金黄色葡萄球菌占金黄色葡萄球菌的59.0%。金黄色葡萄球菌对青霉素、头孢唑啉耐药率均为100.0%。肠球菌属中分离率最高的为粪肠球菌和屎肠球菌，粪肠球菌对青霉素的耐药率为35.3%。大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶检出率分别为77.6%和56.7%；非发酵菌以铜绿假单胞菌和鲍曼不动杆菌为主，耐碳青酶烯类鲍曼不动杆菌分离率占鲍曼不动杆菌37%。鲍曼不动杆菌、铜绿假单胞菌对亚胺培南的耐药率分别为46.3%、28.3%。 结论 本院细菌耐药性较高，应加强抗菌药物的合理应用，应谨慎使用第三代头孢菌素等β-内酰胺类抗菌药物，以减轻抗生素的选择性压力、防止耐药菌株在医院内播散。
目的 了解国内妊娠期抗菌药物的应用现状。 方法 通过检索1994年－2012年国内医学文献，筛选出妊娠期间使用抗菌药物的原始病例报道，对收集的病例按照用药原因、抗菌药物品种、妊娠安全性分级进行统计分析。其中妊娠安全性分级是根据美国药物和食品管理局（FDA）颁布的药物危害等级标准，分为A、B、C、D、X级。 结果 妊娠期使用抗菌药物的常见原因为泌尿系统感染，选用的抗菌药物以头孢菌素和青霉素类为主（B类），但仍有部分病例选用C类、D类药物及超说明书用药。 结论 存在妊娠期抗菌药物不合理应用现象，妊娠合并感染性疾病需用抗菌药物时，医生应权衡抗菌药物对胎儿的可能危害及对母体的治疗作用，最大限度地避免用药对胎儿造成不良影响。