Objective: To analyze the anti-infective treatment and pharmaceutical care of one patient with sepsis, and provide reference for clinical treatment and medication safety of sepsis patients. Methods and Results: The patient presenting with "fever and chills for 4 days" was admitted with high fever (39.5°C) and abnormal infection indicators (neutrophil percentage: 85.4%; C-reactive protein: 109.8 mg/L; procalcitonin: 30.37 ng/mL). After anti-infective treatment with ceftriaxone+azithromycin and imipenem-cilastatin sodium for several days, the infection symptoms did not improve significantly, and C-reactive protein and procalcitonin levels even increased progressively. Blood culture of the patient later identified Escherichia coli, confirming sepsis with the combination of other related results, then the anti-infective treatment regimen was adjusted to cefoperazone-sulbactam sodium+moxifloxacin according to the drug sensitivity results. After three days, the infection symptoms and infection indicators of the patient were significantly improved, indicating that the new anti-infective treatment regimen was effective. After another two days, the patient developed systemic pruritis and a local windlike rash, which was suspected to be caused by cefoperazone-sulbactam sodium and moxifloxacin based on the patient's medical history and recent medication history. Considering that the infection of the patient had been basically controlled, cefoperazone-sulbactam sodium and moxifloxacin were discontinued, and amoxicillin-clavulanate potassium tablets were taken orally, along with anti-allergic treatment. Two days later, the rash disappeared. After another three days, the patient was discharged. Conclusion: For patients with unexplained fever combined with infection, the pathogen and infection site should be actively explored in clinic in order to carry out the targeted anti-infective treatment. At the same time of treatment, clinical monitoring of adverse drug reactions should be performed to ensure the medication safety of patients.

Objective: Based on the FDA Adverse Event Reporting System (FAERS) database, to explore and analyze the epidemiological characteristics of drug-associated progressive multifocal leukoencephalopathy (PML), and provide reference for the medication safety of related drugs. Methods: Adverse events (AEs) with the preferred term (PT) of "progressive multifocal leukoencephalopathy" (PT code: 10036807) during the period from 2004 to 2022 were searched in the FAERS database. Primary suspect drugs (PS) were collected, and the epidemiological characteristics of these drug-associated PML were analyzed. Results: In the FAERS database, a total of 6 604 AEs of drug-associated PML were retrieved, among which 5 063 AEs were involved in the top 30 PS reports. Among 5 063 AEs, most of the patients were female (2 588 cases, 51.12%), the age was mainly concentrated in 18 to below 65 years old (2 829 cases, 55.88%), and the clinical outcome was 1 605 death cases (31.70%). Among the top 30 PS reported, the main categories of drugs were antitumor agents (14, 46.67%) and immunosuppressants (11, 36.67%), while natalizumab (1 826 cases, 36.07%) and rituximab (1 271 cases, 25.10%) were the mostly reported PS respectively, with the highest reporting odds ratio (43.31 and 29.13 respectively). Conclusion: Drug-associated PML has a high risk of death, and its PS mainly includes natalizumab and rituximab. For patients using these two drugs, clinical medication safety monitoring should be strengthened so that patients can receive timely treatment in case of AE.

Syphilis is a chronic and systemic infectious disease caused by the infection of Treponema pallidum. During the process of Treponema pallidum infection developing into syphilis, Treponema pallidum needs to evade the body's immune responses at various levels. Detecting related immunological indicators can assist clinicians in making accurate diagnoses, thus enabling targeted treatment. In this article, the immune escape mechanism of Treponema pallidum and the clinical application of related immunological indicators are reviewed to provide ideas and assistance for diagnosis of syphilis.

目的 分析医院产超广谱 β-内酰胺酶（extended-spectrum beta-lactamases,ESBLs）肺炎克雷伯菌（Klebsiella pneumoniae,KP）的临床检出情况及其流行病学特征,为临床产 ESBLs KP 感染的预防与治疗提供参考。方法 选取2021年1月—2023 年12月顺德区第五人民医院收治的 489 例 KP 感染患者作为研究对象,采集患者的年龄、性别、所在科室、所涉标本、所检出 KP 的相关病原学结果等信息,分析 KP 的流行病学特点。结果 489 例 KP 感染患者中,ESBLs 检查呈阳性的有 102 例,检出率为 20.86%;102 例产 ESBLs KP 感染患者主要来自重症医学科（18 例,占 17.65%）、肿瘤老年病科（16 例,占 15.69%）、呼吸内科（13 例,占 12.75%）、心血管内科（12 例,占 11.76%）和儿科（9 例,占 8.82%）;经比较,≥60 岁患者发生产 ESBLs KP 感染的风险明显高于<60 岁患者（P<0.05）,而是否发生产 ESBLs KP 感染与患者的性别无明显关系（P>0.05）;产 ESBLs KP 和不产 ESBLs KP 在标本来源上的差异无统计学意义（P>0.05）,但无论产或不产 ESBLs,KP 均主要检出自痰液和尿液;经比较,产 ESBLs KP 和不产 ESBLs KP 对头孢呋辛酯、头孢曲松、头孢呋辛钠、氨曲南、庆大霉素、复方磺胺甲噁唑、头孢吡肟、左氧氟沙星、头孢他啶、哌拉西林-他唑巴坦钠、阿米卡星的耐药率差异具有统计学意义（P<0.05）。此外,不产 ESBLs KP 对除氨苄西林的其他所有所试抗菌药物的耐药率均较低（<20.00%）,而产 ESBLs KP 仅对阿莫西林-克拉维酸钾、哌拉西林-他唑巴坦钠、头孢西丁、头孢哌酮-舒巴坦钠、阿米卡星、亚胺培南、厄他培南、替加环素的耐药率均较低（<20.00%）,对氨苄西林、头孢呋辛酯、头孢曲松、头孢呋辛钠、氨曲南、庆大霉素、复方磺胺甲噁唑、头孢吡肟、左氧氟沙星的耐药率均较高（>60.00%）。结论 医院临床上产 ESBLs KP 的检出率较高,其中老年人尤甚,而产 ESBLs 明显增强了 KP 对很多抗菌药物的耐药性,对此临床开展抗感染治疗时应尽量根据药敏结果合理选用抗菌药物,以提高抗感染治疗的准确性,同时临床还应加强对抗菌药物的用药管理,以尽可能减少细菌耐药的产生。

Berberine is a drug with a wide range of pharmacological effects, including anti-inflammatory, antibacterial, antiviral, anticancer, antidiarrheal, antihypertensive, hypoglycemic, and hypolipidemic effects. Its effects involve the digestive system, central nervous system, cardiovascular system, metabolic system, respiratory system, etc. In this article, the central nervous pharmacological effects of berberine such as body temperature regulation, sedation, hypnosis, anticonvulsion, and prevention and treatment of epilepsy, depression, Huntington's disease, Parkinson's disease, and schizophrenia, are reviewed to provide a reference for the clinical development of berberine in the central nervous system.

目的 分析结核菌核糖核酸检测（TB-RNA）、结核菌脱氧核糖核酸检测（TB-DNA）、结核分枝杆菌及利福平耐药基因检测（Xpert MTB/RIF）对肺结核患者的诊断效能,为优化肺结核的早期诊断策略提供循证依据。方法 选取 2024 年 1—5 月至苏州市第五人民医院就诊的 240 例疑似肺结核患者作为研究对象,采用涂片找抗酸杆菌（简称涂片法）、结核分枝杆菌培养（简称培养法）、TB-RNA、TB-DNA、Xpert-MTB/RIF 对患者的支气管肺泡灌洗液进行检测,分析和比较不同检测方法的阳性检出率,并采用受试者工作特征（receiver operating characteristic,ROC）曲线对 TB-RNA、TB-DNA、Xpert-MTB/RIF 单独或联合检测肺结核的效能进行判断。结果 240 例疑似肺结核患者中,确诊肺结核者有 170 例,确诊非肺结核者有 70 例,其中细菌性肺炎 18 例、肺部感染 30 例、非结核分枝杆菌感染 22 例;TB-RNA、TB-DNA、Xpert-MTB/RIF、涂片法、培养法对确诊肺结核患者的阳性率分别为 27.65%、47.06%、48.82%、17.65%、30.00%,5 种方法对肺结核患者的阳性率存在显著差异（P<0.05）;TB-RNA、TB-DNA、Xpert-MTB/RIF 3 种检测方法对涂（+）培（+）组、涂（+）培（–）组、涂（–）培（+）组、涂（–）培（–）组肺结核患者的阳性率均存在显著差异（P<0.01）;TB-RNA、TB-DNA、Xpert-MTB/RIF 3 种检测方法对各组肺结核患者的阳性率从高到低均依次为涂（+）培（+）组、涂（–）培（+）组、涂（+）培（–）组、涂（–）培（–）组;而对于相同表型的肺结核患者,Xpert-MTB/RIF 的阳性率均最高,而 TB-RNA 的则最低;ROC 曲线分析显示,TB-RNA、TB-DNA、Xpert-MTB/RIF 单独和三者联合检测诊断疑似肺结核的灵敏度分别为 27.65%、47.06%、48.82%、62.35%,其差异有统计学意义（χ²=41.86,P<0.01）;其特异度分别为 100.00%、98.57%、100.00%、98.57%,其差异无统计学意义（χ²=2.01,P>0.05）;其准确度分别为 48.75%、62.08%、63.75%、72.92%,其差异有统计学意义（χ²=30.29,P<0.01）;联合检测的灵敏度和准确率均显著高于任一方法单独检测（P<0.01）,并且联合检测的（area under the curve,AUC）为 0.805,95%CI 0.751~0.858）,高于任一方法单独检测的AUC。结论 相较于传统的涂片法和培养法,TB-RNA、TB-DNA、Xpert-MTB/RIF 对肺结核患者均具有更高的灵敏度,而 3 种方法联合检测可以获得更高的准确率,这为肺结核的早期诊断提供了较好的循证医学支持,临床上可根据患者不同的病原学特征选择合适的分子诊断方法。

目的 评价桂枝茯苓胶囊与甲硝唑联用对慢性盆腔炎（chronic pelvic inflammatory disease,CPID）患者的临床疗效与药物安全性,为临床 CPID 患者的治疗提供参考。方法 选取 2019 年 3 月—2021 年 12 月医院收治的 72 例 CPID 患者作为研究对象,根据治疗方案的不同将其分为甲硝唑组（n=36）和联合用药组（n=36）;甲硝唑组患者在对症治疗的基础上给予甲硝唑治疗,联合用药组患者在对照组基础上加用桂枝茯苓胶囊,疗程均为 1 个月;比较 2 组患者治疗后的临床有效率、治疗期间药物不良反应的发生率,以及治疗前后各炎症因子指标和免疫功能指标的变化情况。结果 联合用药组患者治疗后的临床总有效率显著高于甲硝唑组（97.22% vs 83.33%,P<0.05）;用药后,2 组患者血清中 白介素（interleukin,IL）-6、肿瘤坏死因子-α、超敏 C 反应蛋白水平均显著下降（P<0.05）,而 IL-2 水平均显著上升（P<0.05）,但联合用药组患者的改善幅度均大于甲硝唑组（P<0.05）;用药后,2 组患者血清中 CD4⁺、CD4⁺/CD8⁺ 水平均显著上升（P<0.05）,而 CD8⁺ 水平均显著下降（P<0.05）,但联合用药组患者的改善幅度均大于甲硝唑组（P<0.05）;用药期间,2 组患者用药期间药物不良反应的发生率无统计学意义（5.56% vs 8.33%,χ²=0.215,P>0.05）。结论 桂枝茯苓胶囊与甲硝唑联用能明显改善 CPID 患者的炎症反应和免疫功能,其临床疗效优于单用甲硝唑,并且用药的安全性较高。

目的 探究 BACTEC MGIT 960 分枝杆菌分析系统结核分枝杆菌（Mycobacterium tuberculosis,MTB）假阳性的规律和特点,为提高临床 MTB 检测的准确度提供参考。方法 选取 2024 年 1—2 月苏州市第五人民医院门诊和住院的 1 100 例患者送检的 1 100 份采用 BACTEC MGIT 960 系统检测的 MTB 标本作为研究资料,对所有送检标本采用 BACTEC MGIT 960 系统进行培养,然后用抗酸染色镜检和 VITEK MS 微生物质谱鉴定系统进行复核检查,分析 BACTEC MGIT 960 系统的 MTB 假阳性情况。结果 经复核,发现 1 100 份标本经 BACTEC MGIT 960 系统培养共产生 93 份假阳性报告（假阳性率为 8.45%）,涉及患者 93 例,其中肺科门诊患者的 MTB 假阳性率明显高于住院患者（12.27% vs 4.58%,P<0.05）;93 份 MTB 假阳性标本中的微生物均为其他细菌,其中革兰阳性菌 79 株（占 84.95%）、革兰阴性菌 14 株（占 15.05%）,而涉及的主要菌属有葡萄球菌属（46 株,占 49.46%%）、芽孢杆菌属（11 株,占 11.83%）和戈登菌属（11 株,占 11.83%）,涉及的主要菌种有表皮葡萄球菌（21 株,占 22.58%）、溶血葡萄球菌（21 株,占 22.58%）、痰戈登菌（11 株,占 11.83%）。结论 BACTEC MGIT 960 系统检测 MTB 存在一定的假阳性情况,而杂菌污染可能是主要的原因,对此临床应加强标本留取的宣教培训、标本前处理的优化、无菌实验操作的严格执行等,从而最大程度地减少 BACTEC MGIT 960 系统检测的假阳性情况。

Objective: To analyze the process of anti-infective treatment and pharmaceutical care for one diabetic patient with concurrent skin and soft tissue infection and bloodstream infection, and provide a reference for the clinical treatment of secondary infections in diabetic patients. Method sand Results: The patient was hospitalized due to "skin ulcer on the right shoulder for 4 days", reported a 9-year history of diabetes with poor blood glucose control. Physical examination showed obvious necrosis and abscess in the shoulder ulcer, suggesting skin and soft tissue infection. Piperacillin-tazobactam sodium was empirically administered, combined with wound debridement and vacuum sealing drainage. On day 4, wound secretion culture results revealed Staphylococcus aureus, and drug susceptibility test showed resistance to penicillin but sensitivity to oxacillin, gentamicin, levofloxacin, erythromycin, clindamycin, vancomycin, tetracycline, etc. As the patient's infection symptoms and related indicators did not improve significantly, the anti-infective treatment regimen was adjusted to cefazolin + clindamycin. Subsequently, the patient's fever and related infection indicators gradually improved. During this period, Staphylococcus aureus was also detected in the patient's blood culture, which quickly turned negative. Conclusion: Diabetic patients with poor blood glucose control are prone to secondary skin and soft tissue infection, and severe cases may be complicated with bloodstream infection. In clinical practice, while initiating empirical treatment, etiological diagnosis should be performed as early as possible, and more targeted anti-infective treatment regimen should be formulated based on drug susceptibility test results to ensure the treatment efficacy of patients.

目的 分析 PDCA 循环管理在降低临床抗菌药物使用强度（antibiotics use density,AUD）、抗菌药物使用率和抗菌药物联用中的效果,为临床抗菌药物的精细化管理提供参考。方法 借助医院信息系统,采集2022 年 1 月—2023 年 4 月徐州仁慈医院住院患者的抗菌药物的使用数据和联用情况,其中 2022 年 1—6 月为开展 PDCA 循环管理前的准备阶段,2022 年 7—9 月为 PDCA 循环管理实施期,2022 年 10—12 月和 2023 年 2—4 月为 PDCA 循环管理成效观察期,比较 PDCA 循环管理前后医院住院患者 AUD、抗菌药物使用率和抗菌药物联用比例的变化情况。结果 开展 PDCA 循环管理后,医院住院患者的 AUD 从 45.70 降至 31.11,后又降至 26.44,其中手外科、足踝科、关节外科的 AUD 均有较大幅度下降,而创伤骨科基本没有变化;开展 PDCA 循环管理后,医院住院患者的抗菌药物使用率从 72.51% 降至 64.92%,后又降至 58.62%,其中手外科、足踝科、创伤骨科、关节外科的抗菌药物使用率均有较大幅度下降;开展 PDCA 循环管理后,医院住院患者的抗菌药物联用比例从 10.02%% 降至 5.30%%,后又微涨至 5.84%,其中手外科、足踝科、创伤骨科、关节外科 4 个重点监控科室的抗菌药物联用比例均始终低于全院水平,并且开展 PDCA 循环管理后其抗菌药物联用比例甚至均降至 1.5% 以下。结论 通过临床药师主导的 PDCA 循环管理的实施,各临床科室对抗菌药物规范使用的意识和能力得到了明显提升,使得全院,尤其是手外科、足踝科、创伤骨科、关节外科 4 个重点监控科室的 AUD、抗菌药物使用率和抗菌药物联用比例得到了明显改善。

Objective: To analyze the occurrence and treatment process of thrombocytopenia caused by the concomitant use of vancomycin and piperacillin-tazobactam sodium, and provide a reference for the safe clinical use of vancomycin and piperacillin-tazobactam sodium. Methods and Results: The patient was admitted to the hospital due to "unconsciousness with limb convulsions for 2 hours". The examinations at admission showed that the patient had fever, and infection indicators such as white blood cell (WBC) count, neutrophil percentage (NEUT%), and C-reactive protein (CRP) were at high levels, suggesting the presence of infection. Therefore, piperacillin-tazobactam sodium was empirically administered. Subsequently, pathogens such as Klebsiella pneumoniae subsp. pneumoniae, Staphylococcus aureus, and Pseudomonas aeruginosa were successively detected in various specimens of the patient, so vancomycin was added. However, the patient's fever symptoms and infection indicators did not improve significantly, so the dosage of vancomycin was adjusted from "500 mg, q12h" to "500 mg, q6h". In the following days, the patient's platelet count rapidly decreased from 124×10⁹/L to 7×10⁹/L, so platelet transfusion was immediately given. Meanwhile, after evaluation, the thrombocytopenia was possibly related to vancomycin and piperacillin-tazobactam sodium, so the two drugs were immediately discontinued, and cefoperazone-sulbactam sodium was used for antimicrobial treatment. The next day, the patient's platelet count recovered to 74×10⁹/L. Conclusion: Both piperacillin-tazobactam sodium and vancomycin have the potential risk of inducing thrombocytopenia, and the concomitant use of them may have a superimposed risk. Therefore, it is necessary to strengthen the monitoring of adverse drug reactions for the clinical use of the two drugs to ensure the safety of medication for patients.

As a representative drug of glycopeptide antibiotics, vancomycin is a first-line therapeutic agent for infections caused by drug-resistant Gram-positive bacteria such as methicillin-resistant Staphylococcus aureus. According to the existing theories, it is believed that prolonging the administration time via continuous intravenous infusion can improve the clinical efficacy and safety of time-dependent antibiotics. However, the efficacy and safety of vancomycin administered by continuous intravenous infusion, despite as a time-dependent antibiotic, remain at the theoretical level and case study stage. Therefore, in this article, the efficacy and safety of vancomycin administered by continuous intravenous infusion in different populations are reviewed to provide a reference for improving the clinical efficacy and medication safety of vancomycin.

目的：采用回顾性横断面分析法分析多西环素治疗儿童大环内酯类药物无反应性肺炎支原体肺炎（macrolide-unresponsive Mycoplasma pneumoniae pneumonia,MUMPP）的用药特点和用药合理性,为临床患儿的多西环素合理使用提供参考。方法：选取 2023 年 1 月—2024 年 6 月威海市妇幼保健院收治的 306 例使用多西环素治疗的 MUMPP 患儿作为研究对象,采集患儿的性别、年龄、药物过敏史、诊断、耐药基因检测结果,以及多西环素的用法、用量、疗程、药物不良反应发生情况、联合用药情况等信息,并依据相关权威资料进行合理用药点评,分析多西环素治疗儿童 MUMPP 的用药特点和用药合理性。结果：306 例 MUMPP 患儿在年龄上以 8~14 岁为主（220 例,占 71.90%）,其次为 6~<8 岁（69 例,占 22.55%）;306 例 MUMPP 患儿中共有 68 例进行了 MP 耐药基因检测,其中 23SrRNA 基因 2063 位点发生突变的有 12 例;306 例 MUMPP 患儿中,多西环素的疗程主要为 5~<14 d（228 例,占 74.51%）,有 160 例（占 52.29%）患儿存在与其他抗菌药物联用的情况,还有 216 例（占 70.59%）患儿存在于糖皮质激素甲泼尼龙联用的情况;点评结果显示,306 例 MUMPP 患儿中多西环素的适应证、用法、用量均较为合理,仅 86 例（占 28.10%）因年龄<8 岁而存在超说明书用药的情况;住院期间,306 例 MUMPP 患儿中发生多西环素相关药物不良反应的仅 1 例,发生率为 0.33%。结论：医院 MUMPP 患儿多西环素的使用除存在超说明书用药外整体较为规范、合理,并且用药安全性较好,对于多西环素的超说明书用药情况,临床应持续做好与患儿家属的事前沟通与宣教,以减少不必要的医患矛盾。

Objective: To analyze the process of anti-infective treatment and pharmaceutical care for one patient with bloodstream infection secondary to urinary tract infection caused by Staphylococcus aureus, and provide a reference for the clinical diagnosis and treatment of such patients. Methods and Results: The patient was hospitalized due to "dyskinesia". At admission, the patient had a fever. The percentage of neutrophils (NEUT%), high-sensitivity C-reactive protein (CRP) and procalcitonin (PCT) levels in the blood were abnormal, and urinalysis showed positive for white blood cells and urine protein, which was considered as urinary tract infection. Therefore, cefotaxime was empirically administered. A few days later, the patient's infection symptoms and related indicators were significantly improved. One month later, the patient had a high fever again, and the white blood cell (WBC) count, NEUT%, CRP and PCT increased again. Cefotaxime and levofloxacin were successively administered, but there was no obvious improvement. During this period, Staphylococcus aureus was detected in the urine culture. The clinician then asked the clinical pharmacist for consultation, and the clinical pharmacist recommended switching to vancomycin (1 g as the first dose, 0.5 g for maintenance, q24h) and continuing to perform the etiological examination. However, considering the patient's poor renal function, the doctor used piperacillin-tazobactam sodium. Three days later, the patient did not alleviate, and Staphylococcus aureus was also detected in the blood culture. The clinical pharmacist was asked for consultation again. In combination with the patient's renal function conditions, the clinical pharmacist recommended the vancomycin regimen again, and the doctor accepted this regimen. Five days later, the patient's WBC count, NEUT%, CRP and PCT all decreased obviously; later, because of the obvious decrease in the patient's serum creatinine level, the clinical pharmacist recommended adjusting the administration frequency of vancomycin to "0.5 g, q12h" after calculation. After the infection was basically controlled, the doctor suggested the patient to receive bladder fistulization in another hospital, taking his/her inability to urinate independently into account. Conclusion: Bloodstream infection is a relatively serious infectious disease in clinical practice. After the pathogen is basically identified, targeted anti-infective treatment should be carried out as soon as possible to control the infection as early as possible. Due to the nephrotoxicity of vancomycin, the administration dosage and frequency of vancomycin should be determined in combination with renal function conditions of patients, so as to guarantee their medication safety.

目的 基于乙肝五项检查,分析成人乙肝疫苗接种 10 年后的保护效果及其影响因素,为乙肝疫苗接种策略的深入研究提供科学依据。方法 随机选取太仓市域范围内北部和南部各 2 个乡镇 2010—2011 年参与乙肝疫苗免费接种项目、2023 年 4—7 月可参加年度体检且体检时年龄 ≥45 岁者作为研究对象,采集被调查者的年龄、性别、文化程度、身体质量指数、吸烟史、饮酒史、合并慢性病情况、疫苗是否全程接种、乙肝五项检查等信息,根据被调查者乙肝五项检查是否正常将其分为乙肝五项正常组和乙肝五项异常组,采用 Logistic 回归分析法分析成人乙肝疫苗接种 10 年后保护效果的影响因素。结果 1 780 名预调查人员中,成功完成体检和信息采集的有 1 013 人,其中北部乡镇和南部乡镇的完成率分别为 59.68%（598/1 002）、53.34%（415/778）;1 013 名被调查者中,乙肝五项检查结果均正常的有 293 人,而有 720 人乙肝五项检查存在异常结果;Logistic 回归分析结果显示,乙肝疫苗接种 10 年后的保护效果与性别、有无吸烟史、是否全程接种具有相关性（P<0.05）,而未全程接种是影响乙肝疫苗接种 10 年后保护效果的独立危险因素（P<0.05）。结论 未全程接种严重影响乙肝疫苗接种 10 年后的保护效果,对此医疗机构在开展乙肝疫苗接种时务必做好追踪随访,以保证接种者完成 3 剂次全程接种,从而最大程度发挥疫苗的保护作用。

目的 分析医院门诊第二类精神药品（简称“精二药品”）的用药情况,为临床精二药品的合理使用提供参考。方法 借助 PASS 软件,选取 2023 年 4 月—2024 年 3 月苏州大学附属第一医院门诊的 22 240 张精二药品处方作为研究资料,采集处方中患者的年龄、性别,以及精二药品的品种、规格、用量等信息,分析医院门诊精二药品的用药情况。结果 22 240 张精二药品处方中,女性患者多于男性患者（13 607 张 vs 8 633 张）,患者年龄上以>50 岁者为主（15 255 张,占 68.59%）;22 240 张精二药品处方共涉及 10 种精二药品,其中艾司唑仑片（9 814 张,占 44.13%）和唑吡坦片（7 406张,占 33.30%）使用最多,其次为佐匹克隆胶囊（2 750张,占 12.37%）、阿普唑仑片（2 365 张,占 10.63%）和奥沙西泮片（1 883 张,占 8.47%）;10 种精二药品中,艾司唑仑片的用药频度（defined daily doses,DDDs）最大（为 1 111 353.3）,其次为唑吡坦片和佐匹克隆胶囊（其 DDDs 分别为 151 753.0 和 100 308.0）。此外,所有精二药品的药物利用指数均未超过 1;22 240 张精二药品处方中共发现不合格处方 471 张(不合理发生率为 2.12%）,其中联合用药不适宜（269 张,占 57.11%）和适应证不适宜（125 张,占 26.54%）是主要的不合理原因;不合格精二药品处方的所涉药品有 7 种,其中主要为艾司唑仑片（188 例次,占 25.75%）、唑吡坦片（169 例次,占 23.15%）、佐匹克隆胶囊（139 例次,占 19.04%）、阿普唑仑片（98 例次,占 13.42%）。结论 医院门诊精二药品中艾司唑仑片、唑吡坦片和佐匹克隆胶囊的用量最大,同时其不合格处方也最多,但门诊精二药品的使用整体较为合理,尽管如此临床仍应持续加强管理,以进一步减少不合理用药的发生。

Objective: To investigate the stability of ceftriaxone-tazobactam sodium finished infusion under different temperature and solvent conditions, and provide a reference for improving the quality of ceftriaxone-tazobactam sodium finished infusions prepared in the Pharmacy Intravenous Admixture Services. Methods: 1.0 g of ceftriaxone-tazobactam sodium (750 mg ceftriaxone and 250 mg tazobactam) was sequentially dissolved in 250 mL of 0.9% sodium chloride injection, 5% glucose injection, 5% glucose sodium chloride injection, and 10% glucose injection. The solutions were then placed at 25 °C and 2-8 °C for 0, 2, 4, 8, 12, and 24 hours, respectively. The changes in pH values and the degradation rates of active ingredients of ceftriaxone-tazobactam sodium finished infusions under different temperature and solvent conditions were observed. Results: At 25 °C, the degradation rates of ceftriaxone in 0.9% sodium chloride injection, 5% glucose injection, 5% glucose sodium chloride injection, and 10% glucose injection within 24 hours were all lower than 10.00%, while the degradation rates of tazobactam in these four solvents within 12 hours were all lower than 10.00%, and only the degradation rate in 5% glucose and sodium chloride injection was lower than 10.00% when placed for 24 hours. At 2-8 °C, the degradation rates of both ceftriaxone and tazobactam in 0.9% sodium chloride injection, 5% glucose injection, 5% glucose sodium chloride injection, and 10% glucose injection within 24 hours were lower than 5.00%. Under both 25 °C and 2-8 °C conditions, the pH values of ceftriaxone-tazobactam sodium finished infusions showed minimal fluctuations (ranging from 0.00 to 0.17) within 24 hours. Conclusion: The ceftriaxone-tazobactam sodium finished infusions prepared with four common solvents should not be stored for more than 12 hours at 25 °C or more than 24 hours at 2-8 °C. Under these conditions, the degradation rates and changes in pH values of the ceftriaxone-tazobactam sodium finished infusions are small, which can ensure the safety and efficacy of the drug.

目的 调查2022年泉州地区妊娠期女性梅毒的发生状况,并剖析其影响因素,为梅毒的科普宣传和预防提供参考。方法 选取 2022 年 1—12 月泉州地区 11 750 例妊娠期女性作为研究对象,采集该群体的年龄、婚姻状况、学历、职业、居住地、经济收入、性伴情况、安全套使用情况、配偶梅毒史,以及梅毒血清学筛查结果等信息,采用 Logistic 回归分析法分析该地区妊娠期女性发生梅毒的影响因素。结果 2022 年泉州地区 11 750 例妊娠期女性中,确诊梅毒的有 226 例,感染发生率为1.92%;单因素分析结果显示,妊娠期女性发生梅毒与其婚姻状况、学历、职业、居住地、经济收入、性伴数、是否互联网寻伴、安全套使用情况、配偶有无梅毒史存在相关性（P<0.05）;多因素 Logistic 回归分析结果显示,未婚、学历为高中及以下、职业为服务业、居住地为城市、经济收入<2 000 元/月、性伴数≥3 个、有互联网寻伴情况、偶尔使用安全套、配偶有梅毒史是妊娠期女性发生梅毒的独立危险因素（P<0.05）。结论 妊娠期女性发生梅毒与其婚姻状况、学历、职业、居住地、经济收入、性伴数、是否互联网寻伴、安全套使用情况、配偶有无梅毒史密切相关,临床应就相关风险对公众（尤其是备孕和已孕女性）做好科普宣教,并为孕检中高风险人群制定针对性的干预措施,以减少妊娠期女性梅毒的发生。

Objective: To compare the antibacterial activity of alcohol extracts from different parts of Foeniculum vulgare Mill., and provide reference for further medicinal development of Foeniculum vulgare Mill. Methods: Effective components from roots, branches and leaves, and fruits of Foeniculum vulgare Mill. were extracted using 20% ethanol solution. The inhibitory zone diameters and minimal inhibitory concentrations (MIC) of alcohol extracts from roots, branches and leaves, and fruits of Foeniculum vulgare Mill. against Staphylococcus aureus, Escherichia coli, and Bacillus subtilis were measured using the filter paper disc method and microdilution method, then the antibacterial activity of alcohol extracts from different parts of Foeniculum vulgare Mill. was compared. Results: The detection results with the filter paper disc method showed that alcohol extracts from roots, branches and leaves, and fruits of Foeniculum vulgare Mill. exhibited antibacterial activity against Staphylococcus aureus, Escherichia coli, and Bacillus subtilis. The alcohol extracts from fruits of Foeniculum vulgare Mill. demonstrated the strongest antibacterial activity against Staphylococcus aureus and Escherichia coli, while the alcohol extracts from roots of Foeniculum vulgare Mill. showed the strongest antibacterial activity against Bacillus subtilis. The detection results with the microdilution method indicated that MIC values of alcohol extracts from roots, branches and leaves, and fruits of Foeniculum vulgare Mill. against Staphylococcus aureus were 5.00, 10.00, and 5.00 mg/mL respectively, MIC values against Escherichia coli were 10.00 mg/mL uniformly, and MIC values against Bacillus subtilis were 20.00, 20.00, and 10.00 mg/mL respectively. Conclusion: Alcohol extracts from roots, branches and leaves, and fruits of Foeniculum vulgare Mill. exhibit strong antibacterial activity against Staphylococcus aureus, Escherichia coli, and Bacillus subtilis, with the highest antibacterial effect on Staphylococcus aureus, followed by Escherichia coli, and Bacillus subtilis.

目的 分析医院急性呼吸道感染（acute respiratory infection,ARI）患儿呼吸道标本中非细菌性病原体的检出情况及其流行病学特点,为临床 ARI 患儿的病原学诊断和精准治疗提供参考。方法 采集 2023 年 5 月—2024 年 4 月焦作市人民医院收治的 4080 例 ARI 患儿作为研究对象,采集患儿的咽拭子或肺泡灌洗液标本,分析患儿标本中鼻病毒、呼吸道合胞病毒、腺病毒、甲型流感病毒、乙型病毒流感病毒、人副流感病毒、人偏肺病毒、博卡病毒、人冠状病毒、肺炎支原体、衣原体等 11 种常见非细菌性病原体的检出情况及其流行病学特点。结果 4 080 例患者中,非细菌性病原体检查呈阳性的有 3 186 例（占 78.09%）,其中单一病原体感染者 2 552 例,多病原体感染者 634 例,而感染数前 5 位的病原体依次为鼻病毒（870 例）、肺炎支原体（833 例）、腺病毒（539 例）、呼吸道合胞病毒（461 例）、人偏肺病毒（382 例）;3 186 例非细菌性病原体感染患儿中,患儿的年龄总体上主要集中于≥6 岁（1 152 例,占 36.16%）和3~<6 岁（997 例,占 31.29%）,而患儿的发病季节总体上主要集中于秋季（1 038 例,占 32.58%）和冬季（1 022 例,占 32.08%）。结论 医院非细菌性病原体所致的儿童 ARI 在病原体种类、发病年龄、发病季节等方面有一定的规律和特点,临床应充分认识不同病原体的发病特点,从而做到正确诊断和精准治疗。

Objective: To analyze the anti-infective treatment process and pharmaceutical care key points of one patient with pulmonary infection complicated with intracranial infection, and provide reference for rational use and medication safety of clinical antibacterial drugs. Methods and Results: The patient with lung cancer was treated at a local hospital due to fever (39℃) and headache. Based on the procalcitonin level and lung CT examination results, it was initially considered as pulmonary infection, so azithromycin+piperacillin-tazobactam sodium were administrated. However, on the next day, there were symptoms such as unconsciousness and not waking up, so the patient was admitted to Department of Neurology of our hospital for further treatment. Based on the clinical combination of fever, confusion, neck resistance and other symptoms of the patient, as well as the hemogram and cerebrospinal fluid examination results, it was determined that the patient still had intracranial infection, so vancomycin+meropenem were empirically administrated. After 3 days, the patient's infection symptoms and related indicators were significantly improved, and the cerebrospinal fluid metagenomic next-generation sequencing indicated Streptococcus pneumoniae. Clinically considering that meropenem had a strong antibacterial effect on Streptococcus pneumoniae, vancomycin was discontinued. After 6 days, intracranial infection recurred in the patient. Considering that Streptococcus pneumoniae was resistant to meropenem, vancomycin was added. Later, the infection was controlled, but the patient developed severe tinnitus and hearing loss, which might be related to vancomycin in clinical consideration, so vancomycin was discontinued again and linezolid was used instead, and symptomatic treatment was given. However, after 1 week of treatment, the intracranial infection worsened, so the treatment regimen was adjusted to moxifloxacin+ceftriaxone. After that, the patient's infection symptoms and related indicators were gradually improved, and the discharge follow-up showed that the hearing was also partially recovered. Conclusion: Intracranial infection is a relatively complex and serious infection. In the clinical anti-infective treatment regimen, the antibacterial spectrum of antibacterial drugs and the passage of the blood-brain barrier should be fully considered, and the pharmaceutical care and disposal of adverse drug reactions should be prepared to ensure the treatment effect and medication safety of patients.

目的 分析医院肛瘘患者术后并发切口感染的病原菌分布与耐药特点,为临床肛瘘患者的术后感染防治提供参考。方法 选取 2021 年 1 月—2022 年 12 月南城县人民医院收治的 92 例行手术治疗后并发切口感染的肛瘘患者作为研究对象,采集患者的切口分泌物行微生物培养和药敏试验,分析患者术后并发切口感染的病原菌分布与耐药情况。结果 92 例术后并发切口感染的肛瘘患者切口分泌物中共检出病原菌 119 株,其中革兰阴性菌 83 株（占 69.75%,主要为大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌）、革兰阳性菌31 株（占 26.05%,主要为表皮葡萄球菌、金黄色葡萄球菌和粪肠球菌）和真菌 5 株（占 4.20%）;药敏结果显示,大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌对亚胺培南、美罗培南的耐药率均为 0.00%,对阿米卡星的耐药率亦较低（<30.00%）,而对头孢唑林、头孢他啶、头孢曲松的耐药率较高（≥80.00%）;表皮葡萄球菌、金黄色葡萄球菌和粪肠球菌对万古霉素、利奈唑胺的耐药率均为 0.00%,而对青霉素、红霉素、四环素的耐药率较高（>70.00%）。结论 医院肛瘘患者术后并发切口感染的病原菌主要为革兰阴性菌,各主要病原菌的耐药性普遍较强,对此临床在进行抗感染治疗时应尽量根据其药敏结果合理选用抗菌药物,以保证患者的治疗效果。

Antibacterial drugs are widely used in clinical practice, and related adverse drug reactions/adverse drug events (ADRs/ADEs) occur from time to time, particularly in elderly patients. While emphasizing the rational use of antibacterial drugs, clinicians should attach great importance to ADRs/ADEs induced by these drugs, especially rare but severe ADRs/ADEs that are easily overlooked. This article reviews rare yet severe ADRs/ADEs of antibacterial drugs that are easily overlooked in clinical settings, such as neurotoxicity, hypoglycemia, thrombocytopenia, cardiotoxicity, eosinophilic pneumonia, and drug reaction with eosinophilia and systemic symptoms syndrome, aiming to provide a reference for the safe clinical use of antibacterial drugs.

目的 基于药学门诊,分析 1 例妊娠妇女早期药物暴露的药学风险,为探索针对特殊人群的药学工作模式提供参考。方法与结果： 患者孕 6⁺⁵ 周,自诉半个多月前因“气管炎”就诊,并使用过头孢呋辛、利福霉素、左氧氟沙星、莫西沙星、替硝唑、阿昔洛韦、氨茶碱、氨溴索、地塞米松、咳克平、中药汤剂、止咳宝片和黄芪精等药物,为评估药物对胎儿的影响,遂于药学门诊就诊;药师查阅相关资料发现,利福霉素、左氧氟沙星、莫西沙星、替硝唑、氨茶碱为 C 级妊娠用药,而地塞米松在妊娠早期为 D 级,此外中药或中成药中含射干、蝉蜕、地龙等可能潜在妊娠风险的成分;考虑患者当前暂无不良表现,建议暂予保胎,并做好定期检查和妊娠评估。结论 临床药师针对特殊人群（尤其是妊娠妇女）开展专业的药学服务,不仅有助于患者实现更有针对性的个体化治疗,更可为其用药安全提供充足保障,而这又可为临床药师拓展实践领域提供经验。

Objective: To analyze and identify drug-induced liver injury caused by voriconazole based on therapeutic drug monitoring and carry out the corresponding management, and provide a reference for the clinical safe use of voriconazole in pediatric patients. Methods and Results: A 10-year-old male patient (body weight: 35.5 kg) was hospitalized for the first time due to acute lymphoblastic leukemia requiring chemotherapy. During hospitalization, the patient was diagnosed with pulmonary aspergillosis and received voriconazole (300 mg, q12h). During treatment, the patient developed abnormally elevated alanine transaminase (ALT), and compound glycyrrhizin tablets were administered for liver protection, after which ALT returned to normal. One week later, the patient was re-admitted due to fever. Considering the patient's granulocytopenia and a history of liver injury, cefoperazone-sulbactam sodium and compound glycyrrhizin injection were added while continuing voriconazole treatment. However, the next day, the patient's levels of ALT and aspartate transaminase (AST) remained abnormally elevated. Tests for hepatitis viruses, TORCH antibodies, human immunodeficiency virus, syphilis, Epstein-Barr virus, etc. were performed and all results were normal. As ALT and AST levels continued to rise, ademetionine 1, 4-butanedisulfonate for injection was added, but the transaminase level continued to increase progressively. After excluding possible diseases and discontinuing multiple suspected drugs, the clinical pharmacist suspected that liver injury might be caused by voriconazole, so repeatedly suggested the blood concentration detection of voriconazole. The doctor eventually adopted this suggestion. The results showed that the blood concentration of voriconazole was 12.9 μg/mL, far beyond the recommended value; so the single dose of voriconazole was reduced from 300 mg to 150 mg, after which the transaminase level decreased significantly. Conclusion: Voriconazole may cause severe liver injury during administration. Therefore, the blood concentration of voriconazole should be routinely monitored during medication, especially when liver dysfunction has already occurred, to prevent more severe liver damage. In this case, the clinical pharmacist actively advocated for the therapeutic drug monitoring of voriconazole based on the professional knowledge, and finally ruled out the causes of liver injury, ensuring the patient's medication safety.

目的：汇总分析医院临床药师参与的抗感染药学会诊的病例特点,并就典型案例进行剖析,为今后临床药师药学会诊工作的优化提升提供参考。方法：选取 2024 年 1—4 月中山大学附属第一医院广西医院临床药师参与的 104 例抗感染药学会诊病例作为研究对象,采集会诊病例的性别、所在科室、病史资料、病原学检查结果、会诊目的、会诊建议的采纳情况、病情转归等信息,分析抗感染药学会诊病例的规律和特点。结果：104 例抗感染药学会诊病例中,男性多于女性（67 例 vs 37 例）,并且有 18 例（占 17.31%）存在肝肾功能损伤;104 例会诊病例主要来自急诊监护病房（23 例,占 22.12%）、普外科（17 例,占 16.35%）、耳鼻咽喉头颈外科（13 例,占 12.50%）、肾内科（10 例,占 9.62%）和神经内科（8 例,占 7.69%）;104 例会诊病例中有 48 例病原学检查呈阳性,共检出病原菌 56 株,其中主要为革兰阴性菌（36 株,占 64.29%）;104 例会诊病例中,会诊目的主要为咨询调整抗感染治疗方案（84 例,占 80.77%）,而有 95 例（占 91.35%）的会诊建议得到了临床采纳,其中有 77 例患者的病情得到了好转。结论：临床药师通过参与多学科会诊,并基于抗感染药物的药学特点和患者的实际病情提出个体化用药建议,可有效提升抗感染治疗的精准性,从而使患者获得更好的治疗效果。

目的：分析医院腰椎骨折手术患者术后切口感染的发生情况及其影响因素,为临床腰椎骨折手术患者术后感染的预防提供参考。方法：选取 2020 年 3 月—2023 年 3 月医院收治的 205 例行内固定术的腰椎骨折患者作为研究对象,采集患者的年龄、性别、身体质量指数、基础疾病、骨折类型、手术节段数、切口长度、手术时长、术中失血量、术中体温、抗菌药物预防使用情况、引流时间、相关实验室指标和术后切口感染发生情况等信息,采用 Logistic 回归分析法分析腰椎骨折手术患者并发术后切口感染的影响因素。结果：205 例腰椎骨折手术患者术后 3 个月内共有 40 例发生切口感染,感染发生率为19.51%;Logistic 回归分析结果显示,腰椎骨折手术患者并发术后切口感染与是否合并糖尿病、手术节段数、切口长度、手术时长、术中失血量、术中体温、引流时间、是否预防性使用抗菌药物、白蛋白水平、血红蛋白水平、球蛋白水平具有相关性（P<0.05）,而合并糖尿病、切口长度>5 cm、术中低体温、引流时间>3 d、球蛋白<20 g/L 是腰椎骨折手术患者并发术后切口感染的独立危险因素（P<0.05）,预防性使用抗菌药物、白蛋白≥35 g/L、血红蛋白≥110 g/L 是腰椎骨折手术患者并发术后切口感染的保护性因素（P<0.05）。结论：医院腰椎骨折手术患者术后切口感染的发生率较高,而是否合并糖尿病、切口长度、术中体温、引流时间、是否预防性使用抗菌药物、白蛋白水平、血红蛋白水平、球蛋白水平是患者发生术后切口感染的重要影响因素,对此临床应加强对高风险患者的监护和管理,以减少患者术后感染的发生。

Objective: To explore the bacteriostatic effect and related mechanism of Biyan Qingdu Granules (BQG) against Staphylococcus aureus (SA), and provide a reference for the relevant clinical application of BQG. Methods: SA was inoculated on a nutrient agar plate, and a well-grown single colony of SA was taken, dissolved in physiological saline and blown evenly for later use. Liquid medium and BQG were added to the corresponding wells in a 96-well plate, and then a fixed quantity of bacterial suspension was added. The antibacterial effect of BQG on SA and its effect on the biofilm and cell membrane permeability of SA were observed. Results: The minimum inhibitory concentration of BQG for SA was 62.5 mg/mL, while the minimum bactericidal concentration was not detected. When the drug concentration of BQG was 15.625 mg/mL, the biofilm formation of SA could be inhibited significantly (P<0.01) and the 50% minimum biofilm inhibitory concentration (MBIC₅₀) of BQG was 63.125 mg/mL. The BQG at concentrations of 125-250 mg/mL had a significant inhibitory effect on the biofilm activity of SA that was cultured for 2 hours (P<0.05), while the BQG at concentrations of 3.9-250 mg/mL had a significant inhibitory effect on the biofilm activity of SA that was cultured for 4 hours and 6 hours (P<0.01). The MBIC₅₀ values of BQG for the biofilms of SA that was cultured for 2 hours, 4 hours and 6 hours were 35.762, 19.838, and 36.278 mg/mL respectively. When the drug concentration of BQG was more than 20 mg/mL, the protein content in the supernatant increased significantly (P<0.01). Conclusion: BQG has a bacteriostatic effect on SA, and its mechanism is related to interference with the biofilm formation and adhesion of SA and increase in the cell membrane permeability.

Objective: To analyze the key points of diagnosis and treatment of immune reconstitution inflammatory syndrome (IRIS) during anti-tuberculosis therapy in one tuberculosis patient without infection with human immunodeficiency virus (HIV), and provide reference for the clinical diagnosis and treatment of IRIS. Methods and Results: The patient was diagnosed with tuberculosis over a month ago and began anti-tuberculosis therapy immediately. One week ago, the patient had aggravated cough with fever without obvious cause, with abnormal increase of white blood cell count, neutrophil percentage (NEUT%), C-reactive protein and other indicators. It was clinically considered as complicated bacterial pneumonia, so the patient was treated with moxifloxacin+meropenem, and visited the hospital for treatment due to no improvement. However, after admission, relevant examinations showed insufficient evidence to support respiratory viral infection, bacterial infection, fungal infection and atypical pathogen infection, and the possibility of drug fever was even ruled out, then IRIS was finally considered, and methylprednisolone was immediately administrated. After 3 days, the patient's symptoms improved significantly, and subsequent chest CT examination indicated that the lung lesions were reduced and the pleural effusion was reduced. Conclusion: IRIS rarely occurs in non-HIV infected patients, and its clinical manifestations are mostly aggravation of the original disease, and it is difficult to establish its diagnosis without excluding other possible causes. Therefore, it is necessary to strengthen the understanding of IRIS in order to identify IRIS in time and carry out targeted treatment.

目的：分析 1 例患者使用伊立替康致急性乙酰胆碱能综合征的发生和处置过程,为临床伊立替康的用药安全提供参考。方法与结果：该患者因结肠和肾脏的恶性肿瘤复发又行手术治疗,之后经历了近 4 年的化疗和免疫靶向治疗;其间,患者也多次使用伊立替康,但患者在静脉滴注伊立替康约 30 min 后出现急性腹泻（水样便）伴出汗的情况;临床初步判断为急性乙酰胆碱能综合征,考虑此反应与伊立替康的时序关系紧密,遂立即停用伊立替康,并予洛哌丁胺胶囊对症治疗;但临床药师提出,洛哌丁胺主要用于治疗伊立替康引起的迟发性腹泻,对于急性腹泻伴出汗宜用阿托品,遂改用阿托品;30 min后,患者腹泻、出汗症状基本好转;14 d 后,在临床药师建议下,患者在再次使用伊立替康前预防性使用了阿托品,结果未再出现腹泻情况。结论：临床药师在临床实践过程中应密切关注患者的用药安全情况,尤其对于体质虚弱的癌症化疗患者,并协助医生做好药物不良反应的识别和处置,从而保证患者的用药安全。

目的 分析医院颅脑损伤患者术后并发肺部感染的病原菌分布与影响因素,并针对性提出应对策略,为临床此类患者的术后感染防治提供参考。方法 选取 2018 年 10 月—2023 年 3 月进贤县人民医院收治的 148 例行手术治疗的颅脑损伤患者作为研究对象,统计患者术后肺部感染的发生情况,采集患者的性别、年龄、基础疾病、意识状况、误吸情况、蛋白水平、术中输液量、气切情况、病原学检查结果、抗菌药物使用等信息,采用 Logistic 回归分析法分析颅脑损伤患者术后并发肺部感染的影响因素。结果 148 例行手术治疗的颅脑损伤患者中,术后发生肺部感染的有 62 例,感染发生率为 41.89%;62 例术后并发肺部感染患者的标本中共检出病原菌65 株,其中革兰阴性菌 42 株（占 64.62%,主要为铜绿假单胞菌、鲍曼不动杆菌）、革兰阳性菌 23 株（占 35.38%,主要为金黄色葡萄球菌）;Logistic 回归分析结果显示,颅脑损伤患者术后并发肺部感染与是否合并糖尿病、是否合并低蛋白血症、有无意识障碍、有无误吸史、是否气管切开、术中输液量相关（P<0.05）,而有意识障碍、合并糖尿病、合并低蛋白血症、气管切开、术中输液量≥3 000 mL、有误吸史是颅脑损伤患者术后并发肺部感染的独立危险因素（P<0.05）。结论 医院颅脑损伤患者术后并发肺部感染的病原菌主要为革兰阴性菌,而肺部感染的发生与是否合并糖尿病、是否合并低蛋白血症、有无意识障碍、有无误吸史、是否气管切开、术中输液量密切相关,临床对高风险患者应加强监护,并采取针对性干预措施,以避免或减少感染的发生。

血站承担着保障临床用血安全的重要职责,是医疗卫生系统的重要组成部分。在新时代背景下,加强血站党建工作对推动采供血事业高质量发展、保障人民群众生命健康安全具有极为重要的意义。该文深入探讨了新时期血站党建工作的创新发展路径,以充分发挥党建工作的龙头带动作用,推动各项工作持续健康稳定发展,从而让血站更好地适应新形势下面临的挑战和机遇。

Objective: To analyze the process of anti-infective treatment and pharmaceutical care for one patient with severe Chlamydia psittaci pneumonia and secondary infection with Candida glabrata, and provide a reference for the clinical diagnosis and treatment of such complicated and severe infections. Methods and Results: The patient had symptoms such as cough, expectoration and fever half a month ago. Examinations at an external hospital showed that the infection indicators such as the white blood cell count, percentage of neutrophils, C-reactive protein, and procalcitonin were all abnormal, and the chest CT suggested lobar pneumonia. During this period, amoxicillin, ceftazidime, and levofloxacin were successively administered, but the patient's condition did not improve, so the patient was transferred to our hospital. Considering that the patient's infection was severe and the pathogen was not identified, meropenem + moxifloxacin was empirically administered. After several days of treatment, the patient did not improve, and the targeted next-generation sequencing (tNGS) revealed Chlamydia psittaci (sequence number 58 971). Therefore, the doctor added doxycycline following the advice of the clinical pharmacist, later the patient's infection symptoms and related indicators gradually improved. However, one week later, the patient's condition relapsed again. The tNGS revealed Chlamydia psittaci (sequence number 1 131) and Candida glabrata (sequence number 626). The patient was clinically considered to have a fungal infection, so voriconazole was added at the suggestion of the clinical pharmacist, and meropenem was discontinued at the same time. 10 days later, the tNGS revealed Candida glabrata only (sequence number 388), while Chlamydia psittaci was not detected, and the chest CT suggested that the lung lesions were significantly absorbed compared with before, so doxycycline + moxifloxacin was discontinued; 13 days later, the patient's various symptoms and abnormal indicators basically disappeared, achieving clinical cure; so the patient was discharged from the hospital. Conclusion: For severe infections, anti-infective treatment should be carried out as early as possible in clinical practice, and the selected antibacterial drugs should cover common pathogens as much as possible. Meanwhile, various detection methods should be used to identify the pathogens as early as possible to facilitate the development of targeted treatment. During this period, clinical pharmacists should give full play to their professional expertise, actively assist doctors in the medication regimen and help them make a more scientific treatment regimen to ensure the effective treatment of patients.

Objective: To analyze the process of antimicrobial therapy and pharmaceutical care for one patient with cervical necrotizing fasciitis (CNF) caused by Streptococcus constellatus, and provide a reference for the treatment of such patients in clinical practice. Methods and Results: The patient presented with sore throat and bloody sputum after consuming fish one week ago, followed by swelling and pain in the left neck, chest tightness, and difficulty in eating. CT examination in another hospital suggested cervical soft tissue infection, and considering the severe condition, the patient was transferred to our hospital. Admission examinations showed persistent fever, significantly abnormal infection indicators such as white blood cell count, neutrophil percentage, and C-reactive protein. CT indicated possible infectious lesions in the larynx and neck, so debridement and drainage surgery was performed, and pus and drainage fluid were collected for microbial culture. Empirical antimicrobial therapy with linezolid plus meropenem was initiated postoperatively. Three days later, Streptococcus constellatus was isolated from the pus and drainage fluid, which was sensitive to linezolid. Considering the possibility of mixed infection, the current antimicrobial therapy regimen was maintained. Another four days later, the patient's infection indicators improved significantly, but large-area rash appeared on the back. Clinical pharmacists ruled out other causes and considered it might be caused by meropenem, so meropenem was discontinued. Another four days later, the patient developed intermittent fever again, and the white blood cell count increased. Sputum culture detected Stenotrophomonas maltophilia, but lung imaging showed no abnormalities. Therefore, it was considered that Stenotrophomonas maltophilia was likely a colonizing bacterium, and the recurrence of the disease was possibly attributed to incomplete treatment of CNF. Clinical pharmacists suggested adding levofloxacin, which was adopted by the doctor. One week later, the patient no longer had fever, and the white blood cell count returned to normal. Conclusion: As a severe infectious disease, CNF is caused by complex pathogens. Even if a single pathogen is detected, the possibility of mixed infection should not be ruled out. The principles of combined and full-course treatment should be adhered to ensure the effect of antimicrobial therapy.

Objective: To analyze the epidemiological characteristics of patients with ceftriaxone-induced gallbladder pseudolithiasis using the China Hospital Pharmacovigilance System (CHPS), and provide a reference for the safe clinical use of ceftriaxone. Methods: Patients treated with ceftriaxone at the First Affiliated Hospital of Xiamen University between January 2022 and December 2023 were selected as the research objects. Using CHPS, rules were established to actively monitor ceftriaxone-induced gallbladder pseudolithiasis. All suspected cases identified were manually reviewed to confirm diagnosis, and the occurrence and clinical characteristics of ceftriaxone-induced gallbladder pseudolithiasis were analyzed. Results: From 2022 to 2023, a total of 10 056 patients received ceftriaxone. CHPS flagged 84 suspected cases of gallbladder pseudolithiasis, of which 31 cases were confirmed as ceftriaxone-induced gallbladder pseudolithiasis by pharmacists, yielding an accuracy rate of 36.90% (31/84). Among 31 confirmed patients, there were 18 males and 13 females; 16 (51.61%) were minors (below 18 years old), and 9 (29.03%) were elderly patients (60 years old or above). Prior to ceftriaxone administration, 21 patients underwent color ultrasound or CT, with no gallstones detected. After ceftriaxone administration, pseudolithiasis was detected by color ultrasound in 18 cases (58.06%) and by CT in 13 cases (41.94%). The time from ceftriaxone initiation to pseudolithiasis detection was no more than 5 days in 16 cases (51.61%), more than 5-10 days in 7 cases (22.58%), and more than 10 days in 8 cases (25.81%). 7 patients underwent follow-up imaging, showing pseudolithiasis resolution within 7-71 days. In addition, among 31 confirmed patients, most ceftriaxone infusions lasted more than 40-60 minutes (20 cases, 64.52%), and 22 patients (70.97%) had no prior surgical history. Conclusion: CHPS is a feasible tool for monitoring ceftriaxone-induced gallbladder pseudolithiasis. Ceftriaxone-induced gallbladder pseudolithiasis often occurs within the first 10 days of ceftriaxone administration, and is more common in minors and elderly patients. Therefore, clinicians should strengthen medication education and imaging surveillance during ceftriaxone therapy to ensure the medication safety of patients.

Objective: To analyze the process of antifungal therapy and pharmaceutical care for one patient with AIDS complicated by Talaromyces marneffei (TM) infection, and provide a reference for the clinical treatment of such patients. Methods and Results: The patient with AIDS was admitted to the hospital due to unexplained sore throat, dry mouth, shortness of breath after activity, and general malaise. Examinations at admission showed significant abnormalities in indicators such as neutrophil percentage (NEUT%), C-reactive protein (CRP), and procalcitonin (PCT), so empirical treatment with compound sulfamethoxazole was given. The next day, the patient developed fever, and lung CT showed scattered inflammation and local consolidation in both lungs, so piperacillin-tazobactam sodium was added. One day later, fungal hyphae were detected in the patient's blood culture, and the result of G test was 242.664 pg/mL. In combination with the umbilicated rashes and acne-like lesions scattered on the face and back, TM infection was highly suspected. Then, amphotericin B colloidal dispersion (ABCD) was immediately given for induction therapy. The next day, the patient's blood culture reported positive for TM, and bone marrow smear also showed phagocytes phagocytizing TM, confirming the diagnosis of TM infection. During ABCD treatment, when the dose was "150 mg, q24h", the patient developed acute kidney injury, so the dose was reduced to "100 mg, q24h". After 2 weeks of ABCD induction therapy, the patient's body temperature returned to normal, and the levels of infection indicators such as NEUT%, CRP, and PCT significantly decreased, so it was switched to voriconazole (0.2 g, q12h) for sequential therapy. Four days later, considering that the patient's condition was relatively stable, he/she was allowed to be discharged. However, one month after discharge, the reexamination of CT scan showed that the pulmonary infection had progressed compared with that at discharge, which was considered possibly related to insufficient ABCD dose during induction therapy or individual differences in voriconazole. Conclusion: ABCD and voriconazole are recommended drugs for the treatment of patients with AIDS complicated by TM infection. Standardized treatment with sufficient course and dose is the guarantee to achieve good curative effect. Due to the large individual differences in voriconazole plasma concentration, clinical plasma concentration monitoring should be carried out as much as possible to achieve individualized adjustment of medication and ensure the treatment effect of patients.

目的 分析2021—2023年医院肺结核患者的耐药特点,为临床肺结核患者的精准治疗提供参考。方法 选取 2021 年 1 月—2023 年 12 月厦门大学附属第一医院收治的 755 例病原学结果明确的肺结核患者作为研究对象,采集患者所检出结核分枝杆菌的药敏结果,分析肺结核患者对异烟肼（isoniazid,INH）、利福平（rifampin,RFP）、乙胺丁醇（ethambutol,EMB）、链霉素（streptomycin,SM）、左氧氟沙星（levofloxacin,LVFX）等常规抗结核药物的耐药情况。结果 755 例肺结核患者中,敏感性肺结核者有 545 例（占 72.19%）,耐药性肺结核者有 210 例（占 27.81%,其中以单耐药者为最多）;患者在性别上以男性为主（531 例,占 70.33%）,在年龄上则以>40~60 岁（317 例,占 41.99%）和>60~80岁（204 例,占 27.02%）为主;755 例肺结核患者中,患者对 INH、SM 的耐药率最高（分别为 16.03% 和 14.17%）,其次为 RFP、LVFX（耐药率分别为9.93% 和 8.08%）;在 210 例耐药肺结核患者中,单耐药主要表现为对 SM（37 例,占 17.62%）和 INH（22 例,占 10.48%）耐药,多耐药主要表现为对 INH+SM（17 例,占 8.10%）耐药,耐多药主要表现为对 INH+RFP（16 例,占 7.62%）和 INH+RFP+SM（13 例,占 6.19%）耐药,广泛耐药则以对 INH+RFP+SM+EMB+LVFX 为最多（7 例,占 3.33%）,其他耐药类型中以对 LVFX 单耐药为最多（25 例,占 11.90%）。结论 当前肺结核患者的耐药情况较为严峻,好在尚以单一耐药居多,对此临床应积极开展针对结核病的耐药监测,并以此开展更精准的抗结核治疗,从而保证患者的抗结核治疗效果。

Objective: To analyze the clinical diagnosis and treatment process of one child with Mycoplasma pneumoniae-induced rash and mucositis (MIRM) misdiagnosed as drug-induced dermatitis, and provide a reference for the clinical diagnosis and treatment of MIRM. Methods and Results: An 8-year-old male patient initially came to our hospital due to Mycoplasma pneumoniae infection, and was treated with azithromycin and doxycycline successively, with basic control of the infection. During this period, the patient developed oral mucosal ulcers and edematous erythema on the limbs. The family sought self-treatment without improvement, so the patient was referred to a local hospital, where drug-induced dermatitis was suspected. Doxycycline was discontinued, and anti-allergic symptomatic treatment was performed, but his condition did not improve, so the patient returned to our hospital. After completing clinical examinations, combined with the patient's medical history and medication history, it was considered that the condition was not drug-induced dermatitis but MIRM. Then the treatment with azithromycin for anti-infection, methylprednisolone and human immunoglobulin for immune blockade, and other symptomatic treatments were initiated. 8 days later, most of the oral ulcers healed, the swelling and skin lesions subsided, and the pain alleviated significantly. Conclusion: MIRM is rare in clinical practice and rarely reported in China, and doctors with limited understanding of MIRM may easily misdiagnose it as drug-induced dermatitis. Therefore, clinical learning and understanding about MIRM should be strengthened to achieve correct diagnosis and ensure the effective treatment of patients.

目的：分析医院门急诊不合理处方的发生情况与特点,并就此提出针对性的应对策略,为促进医院门急诊合理用药提供参考。方法：选取 2023 年 1 月—2024 年 2 月常熟市第一人民医院本部和滨江院区门急诊进行处方点评的 80 990 张处方作为研究资料,采集处方中的前记、正文、后记等信息,然后依据相关权威资料对其进行合理用药点评,分析不合理处方的发生情况与特点。结果：处方点评结果显示,门急诊 80 990 张处方中共有不合理处方 880 张（不合理发生率为 1.09%）,其中门诊的处方不合理发生率略高于急诊（1.16% vs 0.88%）,滨江院区的处方不合理发生率略高于医院本部（1.18% vs 1.07%）;880 张不合理处方中,所涉患者在性别上女性多于男性（483 例 vs 397 例）,而在年龄上以 18~<45 岁者为最多（261 张,占 29.66%）,其次为 60~<75 岁者（199 张,占 22.61%）;880 张不合理处方共涉及 35 个门诊科室与 8 个急诊科室,其中不合理处方数居前 3 的科室依次为普通内科（116 张,占 13.18%）、急诊内科（95 张,占 10.80%）和耳鼻咽喉科（67 张,占 7.61%）;880 张不合理处方共涉及不合理原因类型 14 项,其中“用法用量不适宜”“处方未写临床诊断或临床诊断书写不全”“医师签名签章不规范,或者与签名签章的留样不一致”“联合用药不适宜”是主要的不合理原因类型;根据不合理原因类型进行分类,2023 年 1—6 月和2023 年 7 月—2024 年 2 月分别涉及不合理处方 342 张次和 613 张次,其前 3 位不合理原因类型均为“用法用量不适宜”“处方未写临床诊断或临床诊断书写不全”“医师签名签章不规范,或者与签名签章的留样不一致”。结论：医院门急诊处方的不合理率总体处于较低水平,但临床仍应加强合理用药的相关培训与考核,以进一步提高临床的合理用药水平。

目的：分析医院静脉用药调配中心（pharmacy intravenous admixture services,PIVAS）不合理用药医嘱的规律和特点,为提高临床合理用药水平提供参考。方法：选取 2022 年1 月—2024 年 9 月常熟市第一人民医院 PIVAS 的全部 1 609 810 条医嘱作为研究资料,采集医嘱所涉患者的年龄、性别、诊断、所在科室,以及所涉药物的名称、剂型、用法、用量、溶媒、联合用药等信息,依据相关权威文献资料对医嘱进行合理用药审核,然后采用帕累托图分析法分析不合理用药医嘱的规律和特点。结果：3 年间共发现不合理用药医嘱 572 条（不合理发生率为 0.355‰）,其中 2022—2024 年不合理医嘱的发生率分别为0.608‰、0.282‰、0.138‰,呈逐年下降趋势;572 条不合理医嘱共涉及 28 个临床科室,其中前 3 位的依次为肿瘤科（53 条,占 9.27%）、普外科（47 条,占 8.22%）和急诊科（40 条,占 6.99%）;帕累托图分析显示,PIVAS 不合理医嘱的原因类型主要为溶媒种类选择不当（220 条,占 38.46%）和溶媒用量不当（213 条,占 37.24%）,而其涉及的药物种类主要为消化系统用药（165 条,占 28.85%）、抗肿瘤药物（65 条,占 11.36%）、抗菌药物（62 条,占 10.84%）、神经系统用药（59 条,占 10.31%）、血液系统用药（58 条,占 10.14%）和维生素及肠内外营养药等（31 条,占 5.42%）;572 条不合理医嘱中,不合理医嘱数≥10 条的药品有 14 种,涉及不合理医嘱共 267 条（占 46.68%）,其中前 3 位的药品依次为盐酸雷尼替丁注射液（59 条,占 10.31%）、注射用奥美拉唑钠（44 条,占 7.69%）和香菇多糖注射液（21 条,占 3.67%）。结论：医院 PIVAS 的医嘱整体较为合理,并且不合理发生率呈逐年下降趋势,但审方药师仍应加强用药医嘱审核,以保障患者的用药安全。