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临床药师参与儿童泌尿系统感染的药学会诊实践与分析
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| 篇名： | 临床药师参与儿童泌尿系统感染的药学会诊实践与分析 |
| TITLE： | |
| 摘要： | 目的：为临床药师参与儿童泌尿系统感染药学会诊、促进临床合理用药提供参考。方法：回顾性收集2016年1月－2017年1月我院临床药师参与会诊的40例泌尿系统感染患儿资料，并对患儿的尿培养病原菌检出情况、革兰氏阳性及阴性菌对常用抗菌药物的耐药情况、临床药师会诊情况、转归情况及会诊前后抗菌药物的使用情况等进行分析。结果：40例患儿中有37例患儿尿培养呈阳性，共检出58株菌。革兰氏阳性菌以屎肠球菌和粪肠球菌为主，其中屎肠球菌对青霉素、氨苄西林、阿莫西林/克拉维酸钾的耐药率均为100％，粪肠球菌对高浓度庆大霉素、四环素的耐药率大于50％；但两者对利奈唑胺、万古霉素、替考拉宁、奎奴普丁/达福普丁及替加环素的敏感度为100％。革兰氏阴性菌以大肠埃希菌和肺炎克雷伯菌为主，对青霉素、哌拉西林的耐药率均为100％，对阿米卡星的耐药率均较低（大肠埃希菌为21.43％，肺炎克雷伯菌为20.00％）。会诊原因以耐药菌感染的抗菌药物选用为主，其次为混合细菌感染的抗菌药物选用；临床药师会诊意见以加用/换用抗菌药物最多，其次为继续目前治疗。37例患儿接受40例次会诊并调整医嘱后均痊愈出院。会诊前抗菌药物使用较多的为哌拉西林/他唑巴坦（11例）和拉氧头孢（9例），会诊后使用较多的为万古霉素（8例）和阿米卡星（7例）。结论：临床药师参与儿童泌尿系统感染药学会诊，可从药学角度提出建议并调整治疗方案，促进抗菌药物的合理应用、提高治疗效果。 |
| ABSTRACT： | OBJECTIVE： To provide reference for clinical pharmacists participating in pharmaceutical consultation for children with urinary tract infection， and to improve rational drug use in clinic. METHODS： The information of 40 children with urinary tract infection consulted by clinical pharmacists were collected retrospectively from Jan. 2016 to Jan. 2017. The detection of pathogenic bacteria in urine culture， drug resistance of Gram-positive bacteria and Gram-negative bacteria to commonly used antibiotics， clinical pharmacist consultation， outcome， the utilization of antibiotics before and after consultation were analyzed. RESULTS： Among 40 children， urine culture of 37 children was positive， and 58 strains were detected. Gram-positive bacteria were mainly Enterococcus faecium and Enterococcus faecalis； resistance rates of E. faecium to penicillin， ampicillin， amoxicillin/clavulanate potassium were 100％； resistance rate of E. faecalis to high-concentration of gentamicin and tetracycline was higher than 50％. Both were completely sensitive to linezolid， vancomycin， teicoplanin， quinupristin/dalfopristin and tigecycline. Gram-negative bacteria were mainly Escherichia coli and Klebsiella pneumoniae； resistance rates of them to penicillin， piperacillin were 100％； all of them showed low resistance to amikacin （21.43％ to E. coli， 20.00％ to K. pneumoniae）. The main reason for the consultation was the selection of antibiotics for drug-resistant bacteria infection； the following reason was the selection of antibiotics for mixed bacterial infection. The consultation advices of clinical pharmacists were mostly addition or replacement of antibiotics， followed by continuing the current treatment. Totally 37 cases were recovered from the hospital after receiving 40 times of consultation and adjusting medical orders. Before consultation， antibiotics with high utilization rate were piperacillin/tazobactam （11 cases） and roxavidospora （9 cases）. After consultation， antibiotics with high utilization rate were vancomycin （8 cases） and amikacin （7 cases）. CONCLUSIONS： Clinical pharmacists participate in pharmaceutical consultation of urinary tract infection in children， provide suggestions and adjust therapy plan from aspect of pharmacy to promote rational use of antibiotics and therapy efficacy. |
| 期刊： | 2018年第29卷第6期 |
| 作者： | 何翠瑶，吴青，樊继山 |
| AUTHORS： | HE Cuiyao，WU Qing，FAN Jishan |
| 关键字： | 泌尿系统感染；会诊；临床药师；儿童 |
| KEYWORDS： | Urinary tract infection； Consultation； Clinical pharmacists； Children |
| 阅读数： | 372 次 |
| 本月下载数： | 112 次 |
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