沈爱宗 张圣雨 陈泳伍 苏丹 邵蓉

摘 要 目的：构建碳青霉烯类抗菌药物专档管理体系，规范该类抗菌药物的临床合理应用。方法：根据国家卫生健康委相关文件要求，构建中国科学技术大学附属第一医院（以下简称“我院”）碳青霉烯类抗菌药物专项管理体系，并对管理前后抗菌药物使用强度、处方合理率和耐碳青霉烯类肠杆菌检出率进行分析。结果：我院构建的碳青霉烯类抗菌药物专档管理体系包括组织建设、专档管理信息化建设、专档管理药品处方审核、处方点评干预等方面。实施专档管理体系后我院碳青霉烯类抗菌药物的使用强度由实施前的2.78下降到2.03;处方合理率由62.8%上升至98.3%（P<0.05）;耐亚胺培南鲍曼不动杆菌、大肠埃希菌和铜绿假单胞菌的检出率从91.4%、2.4%、49.5%下降至79.7%、1.6%、39.7%，但耐亚胺培南肺炎克雷伯菌检出率从34.4%上升至50.0%。结论：我院碳青霉烯类抗菌药物专档管理体系在实践中取得了一定的成效，有助于减少该类药物的滥用现象并提升合理用药水平，降低耐药菌检出率;同时，临床应加强对耐亚胺培南肺炎克雷伯菌的院感控制。

关键词 碳青霉烯类抗菌药物;专档管理;合理用药

ABSTRACT   OBJECTIVE： To establish a special management system of carbapenems， and to standardize the clinical and rational application of carbapenem antibacterial drugs. METHODS： According to the requirements of the relevant documents of National Health Commission of the Peoples Republic of China， the special management system of carbapenems in the First Affiliated Hospital of University of Science and Technology of China （called “our hospital” in short） was constructed. The use intensity， reasonable rate of prescription and the detection rate of carbapenem resistant Enterobacteriaceae were analyzed before and after management. RESULTS： The special management system of carbapenems in our hospital included organization construction， information construction of special management， prescription review of special management drugs， prescription comment intervention and so on. After the implementation of the special management system， the intensity of carbapenems use decreased from 2.78 to 2.03，the reasonable rate of prescription increased from 62.8% to 98.3% （P<0.05）. The detection rates of Acinetobacter baumannii， Escherichia coli and Pseudomonas aeruginosa resistance to carbapenems decreased from 91.4%， 2.4%， 49.5% to 79.7%， 1.6%， 39.7%， respectively. However， the detection rate of Klebsiella pneumoniae resistance to imipenem increased from 34.4% to 50.0%. CONCLUSIONS： The special management system of carbapenems in our hospital has achieved some results in practice， which helps to reduce the abuse of these drugs and improve the reasonable level of drug use and reduce the detection rate of drug-resistant bacteria. At the same time， hospital infection control of K. pneumoniae resistance to imipenem  should be strengthened.

KEYWORDS   Carbapenems; Special management; Rational drug use

碳青霉烯類抗菌药物（carbapenems）是一类β-内酰胺类药物，是目前治疗严重或耐药革兰氏阴性菌感染的重要药物[1]。随着耐碳青霉烯类肠杆菌在全球多家医疗机构不断被检出[2]，临床抗感染治疗药物的选择变得更加复杂与棘手[3]。2017-2018年间，我国的肺炎克雷伯菌对碳青霉烯类抗菌药物耐药率在20%左右，较往年上升了约5%;而在上海的30所三级医院中，耐碳青霉烯类肺炎克雷伯菌和耐碳青霉烯类鲍曼不动杆菌的检出率甚至高达30%、71.4%[4-5]。抗菌药物耐药率的增加对全球的公共卫生造成了极大的威胁，如果不采取措施，可能将出现无药可用的情况。近年来，我国出台了《国家卫生计生委办公厅关于进一步加强抗菌药物临床应用……