毛亚佩 卫英

摘 要 目的：了解与评估我院碳青霉烯类抗菌药物的临床使用情况与用药合理性，为规范临床碳青霉烯类抗菌药物的使用提供参考。方法：回顾性调查我院2016 年1 月—2018年12月期间使用碳青霉烯类抗菌药物的全部住院患者1 360例，统计与分析其临床使用情况，参考相关资料进行用药合理性评估。结果：相较前2年，2018年我院碳青霉烯类抗菌药物在用药指征、微生物送检、给药方案、会诊权限4个方面有明显提升。结论：在我院建立专档管理后，2018年碳青霉烯类抗菌药物在临床使用合理性明显好转，但仍存在适应证不适宜、联合用药不适宜等问题。我院将进一步干预及持续改进，为临床合理使用碳青霉烯类抗菌药物提供参考依据。

关键词 碳青霉烯类 抗菌药物 用药合理性

中图分类号：R978.11； R969.3 文献标志码：C 文章编号：1006-1533（2019）19-0044-04

Investigation and analysis of the rationality of clinical use of carbapenems in our hospital*

MAO Yapei**， WEI Ying***

（Department of Pharmacy， Shidong Hospital of Yangpu District， Shanghai 200438， China）

ABSTRACT Objective： To understand and evaluate the clinical use and rationality of carbapenems in our hospital， and to provide reference for regulating the use of carbapenems in clinic. Methods： The clinic use of carbapenems in 1 360 inpatients were retrospectively analyzed. The rationality of their medication was evaluated according to the grade criterions for Clinical Application Evaluation of Carbapenems. Results： Compared with 2016 and 2017， the use of carbapenems showed significant improvement in 2018 in four aspects such as drug indication， microbial testing， drug delivery plan and consultation authority. Conclusion： After the establishment of special management in our hospital， the rationality of the clinical use of carbapenems has been significantly improved since 2018， but there are still problems such as inappropriate indications and unsuitable combination of drugs， to which intervention and improvement should be further performed so as to provide reference for rational use of carbapenems in clinic.

KEy WORDS carbapenems； antimicrobials； rational use of drugs

碳青霉烯類是临床上治疗多重耐药革兰阴性杆菌最有效的治疗药物之一。作为非典型的b-内酰胺类抗菌药物，它与头孢菌素类不存在交叉耐药性，具有抗菌谱广、抗菌活性强的特点，尤其对产超广谱b-内酰胺酶（extended-spectrum b-lactamase， ESBL）肠杆菌科细菌感染有显著的疗效，在临床治疗重症感染及免疫缺陷患者感染等的抗菌治疗中发挥着重要作用[1]。然而，随着碳青霉烯类药物的广泛使用，我国不动杆菌属对亚胺培南和美罗培南的耐药率已高达66.7%和69.3%，肺炎克雷伯菌对亚胺培南和美罗培南的耐药率分别从2005年的3.0%和2.9%上升到了2017年的20.9% 和24.0%，耐药率上升幅度高达8倍[2]，革兰阴性杆菌对碳青霉烯类抗菌药物耐药已经成为临床面临的严峻问题。……