Objective: To analyze the occurrence, treatment measures and possible causes of acute kidney injury caused by combined use of vancomycin and flurbiprofen axetil, and provide a reference for the safe and rational use of vancomycin and flurbiprofen axetil in clinical practice. Methods and Results: The patient 1 underwent cardiothoracic surgery during hospitalization and was given flurbiprofen axetil for pain relieving after surgery. During this period, the patient's renal function indicators were normal. Later, due to wound infection, vancomycin was given. On the second day, the patient developed oliguria, and the levels of creatinine, urea nitrogen and urea increased significantly, which was considered to be acute kidney injury. These clinical manifestations progressively worsened in the next 2 days, so vancomycin and flurbiprofen axetil were discontinued clinically and symptomatic treatment was given. Later, the patient's urine volume and renal function indicators gradually improved to normal. The Naranjo's Assessment Scale showed that the patient's acute kidney injury was "probably" associated with vancomycin, and "possibly" associated with flurbiprofen axetil. The patient 2 underwent total knee arthroplasty; one and a half years later, the redness, swelling and pain symptoms occurred in the knee joint and calf, which was clinically considered to be caused by infection. So vancomycin was given for anti-infection and flurbiprofen axetil was given for relieving pain. From the 6th day, the patient's creatinine level increased progressively, and then the urea nitrogen level also became abnormal, which was considered acute kidney injury. On the 17th day, vancomycin and flurbiprofen axetil were discontinued clinically and symptomatic treatment was given. Later, the patient's creatinine level gradually decreased. The Naranjo's Assessment Scale showed that the patient's acute kidney injury was "possibly" associated with vancomycin and flurbiprofen axetil. Conclusion: Both vancomycin and flurbiprofen axetil may cause acute kidney injury. The combined use of them or even the superposition of other risk factors may increase the possibility of risk. Therefore, necessary risk assessment should be performed when nephrotoxic drugs are clinically used or used in combination to reduce the risk of related adverse drug reactions.

Objective: To analyze the potential active ingredients and mechanism of action of "Coptidis rhizoma-Scuteliariae radix-Phellodendri chinensis cortex" for the treatment of bacillary dysentery by using network pharmacology methods and molecular docking technology, so as to provide a basis for subsequent research and development of new drugs. Methods: The active compounds and the potential targets of "Coptidis rhizoma-Scuteliariae radix-Phellodendri chinensis cortex" were acquired from Traditional Chinese Medicine Systems Pharmacology Database (TCMSP), and the disease targets of bacillary dysentery were acquired from the databases such as GeneCards, CTD, TTD and drugbank, then the potential targets of "Coptidis rhizoma-Scuteliariae radix-Phellodendri chinensis cortex" for the treatment of bacillary dysentery were identified. Subsequently, the protein-protein interaction (PPI) analysis was performed to screen the core targets, and the biological processes and related pathways of "Coptidis rhizoma-Scuteliariae radix-Phellodendri chinensis cortex" for the treatment of bacillary dysentery were screened by GO functional analysis and KEGG pathway enrichment analysis. Finally, the affinity between receptors and ligands was analyzed by molecular docking. Results: Through the TCMSP, a total of 87 key active ingredients were screened from "Coptidis rhizoma-Scuteliariae radix-Phellodendri chinensis cortex", and there were 228 corresponding targets. A total of 313 disease targets of bacillary dysentery were obtained in the relevant database, and 34 intersection targets were obtained through comparative analysis. By PPI analysis, 14 core targets were screened from the 34 intersection targets. The KEGG pathway enrichment analysis showed that there were 14 important signaling pathways for the treatment of bacillary dysentery. By using the software Cytoscape and based on the 34 intersection targets and 14 important signaling pathways, the top five active ingredients with the largest degree were screened, which were quercetin, wogonin, baicalein, β-sitosterol, and isocorypalmine in sequence. The molecular docking results showed that the tumor necrosis factor (TNF), interleukin-6 (IL-6) and cyclooxygenase 2 (PTGS2) had good affinity to quercetin, wogonin, baicalein, β-sitosterol, and isocorypalmine (binding energy less than -5 kJ/mol). Conclusion: Quercetin, wogonin, baicalein, β-sitosterol, and isocorypalmine may be the main potential active ingredients of "Coptidis rhizoma-Scuteliariae radix-Phellodendri chinensis cortex" for the treatment of bacillary dysentery, and TNF, IL-6 and PTGS2 may be the main targets.

Objective: To analyze the epidemiological characteristics of acute kidney injury (AKI) caused by intravenous voriconazole in patients, and provide a reference for the clinically safe medication of voriconazole. Methods: A total of 87 adverse drug reaction reports of AKI caused by intravenous voriconazole reported by Jiaozuo People's Hospital from 2020 to 2022 were selected as research data. The data of patients such as age, sex, diagnosis, usage and dosage of voriconazole, and drug combination, as well as the occurrence time, severity and outcome of AKI were collected to analyze the clinical characteristics of AKI caused by voriconazole. Results: Among the 87 patients with AKI caused by voriconazole, the number of males was significantly higher than that of females (59 cases vs 28 cases), and the majority of patients were the elderly over and equal to 60 years old (66 cases, 75.86%); most patients were diagnosed with pulmonary infection (64 cases, 73.56%), and the rest were mostly with mixed infections based on pulmonary infection (22 cases, 25.29%). In terms of the usage and dosage of voriconazole, most patients (52 cases, 59.77%) doubled the first dose, and the maintenance dose was mainly "0.2 g, q12h" (64 cases, 73.56%). In addition, the vast majority (84 cases, 96.55%) of patients had combined use of other drugs. According to the KGIGO staging, most patients belonged to AKI stage 1 (62 cases, 71.26%). The AKI occurred within 7 days after use of voriconazole for most patients (67 cases, 77.01%); and in 34 patients (39.08%), the AKI occurred within 3 days after administration. Among the 87 patients with AKI, the drugs were discontinued immediately in 45 cases, while the drugs were not discontinued in the remaining 42 cases; finally 18 cases died. Conclusion: AKI caused by intravenous voriconazole mostly occurs in male and elderly patients. In addition, AKI has a high mortality rate. Clinical education and monitoring should be strengthened to ensure the medication safety for patients.

Objective: To establish a method for determination of plasma concentration of ceftazidime-avibactam sodium by liquid chromatography-tandem mass spectrometry (LC-MS/MS), and provide a reference for the safe and rational use of ceftazidime-avibactam sodium in clinical practice. Methods: A method for determination of plasma concentration of ceftazidime-avibactam sodium by LC-MS/MS was established by using an ACQUITY UPLC BEH C18 column (2.1 mm×50 mm, 1.7 μm), 10 mmol/L ammonium acetate (A)-100% acetonitrile (B) as a mobile phase, a flow rate of 0.3 mL/min, and a positive/negative ionization switching multiple reaction monitoring (MRM) mode, etc., and the specificity, precision, accuracy, recovery, stability of the method were tested. Results: The retention times of ceftazidime and avibactam were 0.89 min and 0.46 min, respectively. Endogenous substances in plasma had no interference with the detection of ceftazidime and avibactam. The linear equation of ceftazidime was y=537.989x+56.449 6 (r=0.995 3), with good linear performance within the concentration range of 0.5-200μg/mL; the linear equation of avibactam was y=1 788.74x+25.226 9 (r=0.998 0), with good linear performance within the concentration range of 0.05-25μg/mL. The intra-batch and inter-batch precisions of high-, medium- and low-concentration ceftazidime and avibactam samples were all within 15.00%, and their accuracy was within ±15.00%. The recoveries of ceftazidime and avibactam in this method were above 80.00%. In addition, when the samples were stored at room temperature for 6 h, stored in the sample injection tray for 24 h, stored at 4 ℃ for 24 h and repeatedly frozen and thawed (-80 ℃→25 ℃) for 3 cycles, the measurement deviations of high-, medium- and low-concentration ceftazidime and avibactam samples were all within ±15.00%. Conclusion: This method has good specificity and a large linear range, and has good precision, accuracy and stability, which can provide a basis for the individualized medication of ceftazidime-avibactam sodium in clinical patients.

Objective: To explore the mechanism of action of Shashen Maidong decoction in treatment of viral pneumonia using network pharmacology and molecular docking technology, and provide reference for further research on Shashen Maidong decoction. Methods: The active ingredients and their effect targets in Shashen Maidong decoction were obtained from the Traditional Chinese Medicine Systems Pharmacology Database (TCMSP), and gene targets associated with viral pneumonia were obtained from databases such as GeneCards, OMIM. The common targets between the active ingredients and viral pneumonia were obtained. Protein-protein interaction (PPI) network analysis was performed to screen for core targets, and Gene Ontology (GO) functional analysis and KEGG pathway enrichment analysis were used to screen the biological processes and related pathways through which Shashen Maidong decoction may exert effects on viral pneumonia. Finally, molecular docking technology was used to analyze the binding affinity between key ingredients and their targets. Results: A total of 124 active ingredients and 248 corresponding effect targets of Shashen Maidong decoction were screened from TCMSP. 524 gene targets associated with viral pneumonia were obtained from GeneCards, OMIM and other databases. Among them, there were 75 common targets. PPI network analysis of 75 common targets yielded 34 core targets. GO functional analysis suggested that Shashen Maidong decoction may exert anti-viral pneumonia effects by regulating inflammation and cell activity. KEGG pathway enrichment analysis revealed that Shashen Maidong decoction may act for treatment of viral pneumonia through pathways such as AGE-RAGE signaling pathway in diabetic complications, T cell receptor signaling pathway, NF-κB signaling pathway, IL-17 signaling pathway, TNF signaling pathway, and trypanosomiasis signaling pathway. Molecular docking results showed that six key ingredients of Shashen Maidong decoction, quercetin, kaempferol, beta-carotene, naringenin, arachidonic acid, and stigmasterol, demonstrated good binding affinity with the key targets of viral pneumonia, including tumor necrosis factor (TNF), interleukin-6 (IL-6), IL-1β, protein kinase B (AKT1), albumin (ALB), and Chemokine (CC-motif) ligand 2 (CCL2), with binding energies all less than -5 kJ/mol. Conclusion: Quercetin, kaempferol, beta-carotene, naringenin, arachidonic acid, and stigmasterol may be the main active components of Shashen Maidong decoction in the treatment of viral pneumonia, while TNF, IL-6, IL-1β, AKT1, ALB, and CCL2 may be its primary effect targets.

Objective: To analyze the off-label use of doxycycline in pediatric outpatient and emergency departments of a hospital, and provide reference for the clinical safe use of doxycycline in children. Methods: 68 660 prescriptions from pediatric outpatient and emergency departments of the First Affiliated Hospital of Sun Yat-sen University from November 2023 to June 2024 were selected as research data. The information on the prescriptions such as patient age, gender, clinical diagnosis, medication and laboratory test results was collected to analyze the characteristics and rationality of off-label use of doxycycline. Results: Among 68 660 prescriptions from pediatric outpatient and emergency departments, there were 605 prescriptions (0.88%) that contained doxycycline. Among 605 prescriptions containing doxycycline, the clinical diagnosis of involved children included upper respiratory tract infection (373 prescriptions, 61.65%) and lower respiratory tract infection (232 prescriptions, 38.35%). There were 287 prescriptions (47.44%) for off-label use, of which the main type was "use of drugs beyond the suitable groups" (189 prescriptions, 65.85%), followed by "use of drugs beyond the indications" (99 prescriptions, 34.49%). Among 287 prescriptions for off-label use, 195 prescriptions contained drug combination, of which the most common was combined use with anti-cold drugs (145 prescriptions, 50.52%), and there were 11 prescriptions for combined use with antiviral drugs and 12 prescriptions for combined use with other antibacterial drugs. Among the children involved in 605 prescriptions for doxycycline, 533 cases were tested for Mycoplasma pneumoniae, with a positive detection rate of 86.12%, while the positive detection rates of children with off-label use and those who used drugs beyond the suitable groups were 75.21% and 93.82% respectively. There were 297 cases who received testing for Mycoplasma pneumoniae resistance genes, with a positive detection rate of 86.53%, while the positive detection rates of children with off-label use and those who used drugs beyond the suitable groups were 83.46% and 92.92% respectively. In addition, 395 children (65.29%) had taken macrolides within 7 days before using doxycycline, while 157 children (83.07%) had taken macrolides within 7 days among those who used doxycycline beyond the suitable groups. The evidence-based analysis results showed that 266 prescriptions (92.68%) had evidence-based medicine support among 287 prescriptions for off-label use of doxycycline. Conclusion: There are many cases of off-label use of doxycycline in pediatric department, especially more cases with use of drugs beyond the suitable groups. Although only a few cases are not supported by evidence-based medicine, the relevant clinical training on off-label use should be strengthened to ensure the safe medication for children.

Objective: To analyze the diagnosis and treatment process of one patient with orbital cellulitis and bloodstream infection caused by Streptococcus constellatus, and provide a reference for the clinical diagnosis and treatment of similar patients. Methods and Results: The patient (male, 60 years old) was admitted to the hospital due to "redness and swelling of the right eye for 10 days with suppuration for 1 week". After admission, the physical examination showed that the patient's right eye was severely swollen, with a lot of yellow-white purulent secretions; the laboratory test results of serum showed that the infection indicators such as white blood cell count, neutrophil percentage, C-reactive protein, procalcitonin, etc. were slightly high. Considering that the pathogens of eye infection were mostly Gram-positive bacteria and the combined intracranial infection could not be ruled out, linezolid + piperacillin-tazobactam sodium was given empirically, supplemented with debridement and drainage; on the next day, the blood culture result showed the presence of Streptococcus constellatus; on the third day, Streptococcus constellatus was also detected in the purulent secretion specimens, and the drug susceptibility test results showed that it was sensitive to penicillin, erythromycin, clindamycin, levofloxacin, and ceftizoxime. In combination with the patient's poor blood glucose control, poor oral hygiene, and presence of chronic sinusitis, among other conditions, Streptococcus constellatus was considered to be the pathogen of this infection, and the possibility of methicillin-resistant Staphylococcus aureus infection was ruled out, so linezolid was discontinued; but piperacillin-tazobactam sodium continued to be used for its good antibacterial effect. After 13 days of anti-infection treatment, the patient's symptoms such as redness and swelling, and suppuration of right eye and the infection indicators were significantly improved. Conclusion: As a common bacterium on the body surface and in the oral and nasal cavities, Streptococcus constellatus rarely causes infection in normal people, but has significantly increased risk of infection in people with poor basic conditions. Therefore, it is necessary to identify the pathogens clinically, so as to provide guidance for targeted anti-infection treatment.

Bacterial resistance is a global public health problem, especially carbapenem-resistant Gram-negative bacteria (CR-GNB) have more serious harm. Clinically, there are very limited methods for prevention and treatment of CR-GNB infection, so novel antibacterial drugs are urgently needed. Cefepime-taniborbactam sodium is a compound preparation composed of the fourth-generation cephalosporin cefepime and the novel broad-spectrum β-lactamase inhibitor taniborbactam sodium, and has direct inhibitory activity against four types of β-lactamases (types A, B, C and D), so it may have good antibacterial effects on CR-GNB and other drug-resistance bacteria. In this article, the mechanism of action, pharmaceutical properties, antibacterial activity, clinical study, enzyme inhibition/antibacterial spectrum of cefepime and taniborbactam sodium are reviewed, so as to provide reference for the rational clinical use of cefepime-taniborbactam sodium.

Objective: To analyze the diagnosis and treatment process of pulmonary infection with Pneumocystis jirovecii and Cryptococcus neoformans in patients after renal transplantation, and provide a reference for the diagnosis and treatment of fungal infections in such immunosuppressed patients in the clinical practice. Methods and Results: One patient who had been taking immunosuppressants for a long time after renal transplantation visited the hospital due to "chest tightness, shortness of breath, and poor appetite for more than 20 days". According to the chest CT result, the patient was considered to have community-acquired pneumonia. After admission, the patient's routine blood test, routine biochemical test, and arterial blood gas analysis showed no obvious abnormalities except for a high creatinine level. However, 2 days later, the cryptococcal capsular polysaccharide antigen test reported positive result, the (1,3)-β-D-glucan test reported positive result. Cryptococcal fungal spores and a small amount of Pneumocystis jirovecii were found in the smear and methenamine silver staining of the alveolar lavage fluid. The next-generation sequencing (NGS) on alveolar lavage fluid showed positive fungi (Cryptococcus neoformans and Pneumocystis jirovecii). Therefore, the patient was diagnosed with fungal pneumonia caused by Cryptococcus neoformans and Pneumocystis jirovecii, and fluconazole and compound sulfamethoxazole were given immediately. After about one week, the patient's creatinine level continued to rise. In order to reduce the impact on the patient's renal function, the dosage of fluconazole and the dosing frequency of compound sulfamethoxazole were reduced; then after 18 days, the patient's symptoms of chest tightness and shortness of breath had been relieved obviously, and the creatinine level was significantly decreased, so the patient was allowed to be discharged. After more than 3 months, the patient's chest CT showed that the lesions were significantly absorbed or improved. Conclusion: Mixed pulmonary fungal infection is relatively rare in clinical practice, and it is extremely dangerous for immunocompromised patients if it is not well managed. Therefore, it is extremely important to complete the examinations and make an early definite diagnosis for the treatment and prognosis of patients.

Objective: To analyze the compatibility and contraindication of papaverine hydrochloride and coping strategies through literature retrieval, and provide reference for clinical safe use of papaverine hydrochloride. Methods: A literature retrieval was conducted using keywords such as "papaverine", "compatibility and contraindication", "stability" in databases such as CNKI, Wanfang Data, and Chongqing VIP. Relevant information on drugs with compatibility and contraindication was collected from the literature, and safe medication strategies for using papaverine hydrochloride with these drugs were explored. Results: A total of 19 articles related to the compatibility and contraindication of papaverine hydrochloride were found in databases, involving 11 categories of 27 drugs, 20 of which had been experimentally validated. Among 11 categories, the main drug types were digestive system drugs (6), anti-infective drugs (5), traditional Chinese medicine injections (4), and cardiovascular system drugs (3). After combining papaverine hydrochloride with 27 drugs, the primary feature was appearance of turbidity, flocculent substances or precipitation. Of these, 16 drugs were clearly associated with compatibility and contraindication issues related to pH. For these 27 drugs, it is recommended to avoid co-administration or sequential infusion with papaverine hydrochloride. If sequential infusion is necessary, appropriate solvents should be selected for thorough flushing. Conclusion: Papaverine hydrochloride is a weakly alkaline drug with strong acidic properties, and its stability is closely related to pH of the solution. When combining it with other drugs or performing sequential infusion, it is essential to consider pH of drugs to avoid any adverse event associated with compatibility and contraindication, so as to ensure the medication safety of patients.

Objective: To analyze the anti-infective treatment process of a patient with intracranial infection caused by enterococci and secondary pulmonary infection caused by extensively drug-resistant Enterobacteriaceae and provide a reference for the anti-infective treatment of similar patients in clinical practice. Methods and Results: The patient was admitted to the hospital for treatment because of headache and dizziness caused by a fall for more than one month without improvement. Considering that the patient had fever for nearly 2 weeks and the protein and chloride in cerebrospinal fluid were abnormal, it was believed to be intracranial infection; so moxifloxacin was given empirically for anti-infective treatment. Later, MRI examination prompted that the patient might have subdural abscess, and the high-throughput gene testing of PMseq-DNA pathogens indicated Enterococcus casselifavus and Enterococcus faecium, so subdural abscess drainage and decompressive craniectomy were performed. During the operation, a large amount of yellow-white pus and extensive pus mosses covering the surface of the cerebral cortex were seen, so the anti-infective treatment regimen was adjusted to linezolid plus meropenem. After 10 days of anti-infective treatment, the patient's body temperature dropped significantly, and the results of cerebrospinal fluid culture were negative for many times. But one week later, the patient's chest CT scan showed that the exudative changes in both lungs had progressed compared with before, and the sputum culture had detected extensively drug-resistant Klebsiella pneumoniae and Pseudomonas aeruginosa. Therefore, meropenem was discontinued and replaced with ceftazidime-avibactam sodium + ornidazole. After 7 days of treatment, the patient's infection indicators were significantly improved, and meropenem was downgraded to use, but the infusion time was extended to consolidate the anti-infection effect. Conclusion: Many patients with severe infections such as intracranial infection are prone to secondary pulmonary infection. Clinical pharmacists should actively work with doctors to strength the relevant monitoring and adjust anti-infective treatment regimens in a timely manner, so as to promote the improvement of patients' prognosis.

Objective: To analyze the anti-infection treatment and pharmaceutical care of one patient with osteomyelitis and obesity, and provide a reference for the clinical anti-infection treatment of obese patients. Methods and Results: The patient was admitted to the hospital due to "swelling and pain of right knee joint with limited activity for more than 10 days". After admission, the patient was empirically given cefuroxime for anti-infection treatment. On the next day, the serological test showed that the patient's infection indicators such as white blood cell count, neutrophil percentage, C-reactive protein, procalcitonin, etc. were significantly abnormal. Since the patient has the history of fracture and osteomyelitis, the disease of osteomyelitis was considered this time, so cefuroxime was changed to piperacillin-tazobactam sodium. Two days later, the debridement and drainage were performed, and pus was taken for pathogenic examination. Staphylococcus aureus was detected, which was sensitive to methicillin and levofloxacin. According to the patient's pathogenic results and past medical history, the pathogen was likely to have biofilm; in addition, during the use of piperacillin-tazobactam sodium, wheal-like rashes occurred twice, so the anti-infection treatment regimen was switched to levofloxacin + rifampicin. Since levofloxacin is a fat-soluble drug, and the patient's height and body weight meet the obesity criteria, it was recommended that the dosage of levofloxacin should be "0.75 g, q24h". Nearly two weeks later, the patient's symptoms and infection indicators were significantly improved, so the patient was allowed to be discharged. Conclusion: For obese patients, full consideration should be given to the in vivo pharmacokinetic characteristics of drugs when developing a clinical dosing regimen, to ensure that the drugs reach effective therapeutic concentrations and thus improve the patient's therapeutic effect.

Objective: To analyze the clinical characteristics of polymyxin B-induced neuromuscular block based on actual cases and relevant literature reports, and provide reference for the clinical medication safety of polymyxin B. Methods: The clinical characteristics for occurrence of one patient with polymyxin B-induced neuromuscular block were collected, and the relevant literatures were searched from Chinese and foreign databases using "polymyxin", "neurotoxicity" or "neuromuscular block" as keywords. The relevant data of the reported cases were collected, and the clinical characteristics of polymyxin B-induced neuromuscular block were analyzed. Results: A total of 6 valid articles were searched, involving 8 cases. Among 9 cases with polymyxin B-induced neuromuscular block, 8 cases occurred within 5 days after the first medication, with the main clinical manifestations of dyspnea (7 cases) and perioral abnormality (5 cases). Six patients with dyspnea underwent endotracheal intubation or tracheotomy. After treatment, one case died of septic shock, and the rest cases improved or were cured. Conclusion: Neuromuscular block is a rare adverse reaction of polymyxin B. Although rare, its consequences are serious, especially special attention should be paid to dyspnea. Therefore, clinical monitoring of the use of polymyxin B should be strengthened to ensure the safe medication for patients.

目的：分析集中带量采购背景下特殊使用级抗菌药物多元化管理的效果,为促进临床特殊使用级抗菌药物的规范、合理使用提供参考。方法：借助医院信息系统和相关软件,提取 2022 年 1 月—2023 年 12 月无锡市中医医院使用特殊使用级抗菌药物患者的相关数据作为研究资料,将其中 2022 年 1—12 月采取常规管理模式时的数据设为对照组,将 2023 年 1—12 月采取多元化管理模式时的数据设为干预组,分析干预前后抗菌药物（尤其是特殊使用级抗菌药物）的用药频度（defined daily doses,DDDs）和抗菌药物使用强度（antibiotics use density,AUD）;随机抽取 2022 年和 2023 年使用特殊使用级抗菌药物的住院病历各 360 份,进行合理用药点评,分析多元化管理前后特殊使用级抗菌药物的合理用药状况。结果：经过多元化管理干预,全院的 AUD 由 2022 年的 32.86 下降至 2023 年的 32.23,而特殊使用级抗菌药物的 AUD 则由 2022 年的 4.81 下降至 2023 年的 3.48;多元化管理干预前后亚胺培南-西司他丁、美罗培南、替加环素均是临床主要使用的特殊使用级抗菌药物品种,其中亚胺培南-西司他丁和替加环素的 DDDs 均较干预前有所升高,美罗培南的 DDDs 则较前下降;多元化管理干预后医院抗菌药物使用前的总微生物送检率明显高于干预前（86.39% vs 82.56%,P<0.05）,其中特殊使用级抗菌药物的病原学送检率亦较前明显上升（91.01% vs 84.19%,P<0.05）;合理用药点评结果显示,合理用药点评结果显示,干预组特殊使用级抗菌药物的不合理使用发生率明显低于对照组（5.00% vs 9.44%,P<0.05）。结论：在集中带量采购背景下采取多元化管理可以有效规范医院特殊使用级抗菌药物的使用,减少其不必要使用,并且提高其合理用药水平。

Pseudomonas aeruginosa is a common pathogen of hospital-acquired infection. Its strong drug resistance poses a great challenge to clinical treatment. Cefiderocol is a novel siderophore cephalosporin and has strong in vitro and in vivo antibacterial activity against a number of Gram-negative bacteria, including carbapenem-resistant Pseudomonas aeruginosa, Acinetobacter baumannii and Enterobacteriaceae. In this article, the mechanism of action and in vitro activity of cefiderocol, the clinical study on Pseudomonas aeruginosa infection, and the antimicrobial resistance patterns of Pseudomonas aeruginosa to cefiderocol are reviewed, to provide a reference for the clinical application of cefiderocol against Pseudomonas aeruginosa infection.

Objective: To analyze the comments on rational drug use for outpatient and emergency prescriptions in the hospital in 2023, and provide a reference for promoting rational drug use in clinical practice. Methods: A total of 15 060 outpatient and emergency prescriptions from the First Affiliated Hospital of Soochow University from January to December 2023 were selected as research data. The information such as patients' ages, sex and diagnosis, and type, dosage form, usage and dosage of drugs in the prescriptions was collected, and comments on rational drug use for the prescriptions were made based on relevant guidelines, consensus, package inserts of drugs and other relevant data, and the main reasons for irrational drug use and department distribution were analyzed. Results: The results of comments on prescriptions showed that among 15 060 prescriptions, there were 146 irrational prescriptions, with an irrational incidence of 0.97%. In addition, the use rate of antibacterial drugs in the outpatient clinics throughout the year was 7.00%, while the use rate of national essential drugs was 65.73%. Among the 146 irrational prescriptions, the main reasons for irrational drug use were "inappropriate usage and dosage" (62 prescriptions, 42.47%) and "inappropriate indications" (37 prescriptions, 25.34%), and the secondary reason was "irregular signature and seal of physicians" (20 prescriptions, 13.70%). The 146 irrational prescriptions basically involved all outpatient and emergency departments of the hospital, and the top three departments with the highest irrational rates were general surgery, gastroenterology and radiotherapy departments, with irrational incidences of 1.75%, 1.60% and 1.60%, respectively. Conclusion: The overall drug use in the outpatient and emergency departments of the hospital in 2023 is relatively rational, but there are still some problems. The inspection and training should be strengthened to promote clinical rational drug use and ensure the medication safety.

Objective: To analyze the practice of anti-infective pharmacy consultation for inpatients in the hospital and provide a reference for the implementation of pharmacy consultation by clinical pharmacists. Methods: A total of 77 inpatients who were admitted to Xiamen Haicang Hospital from January 2022 to February 2023 and received anti-infective pharmacy consultation were selected as the research subjects. The data of the patients, such as age, sex, department, microbiological examination results, consultation opinions and their adoption, treatment outcomes, etc. were collected to analyze the clinical characteristics of patients who received anti-infective pharmacy consultation. Results: Among the 77 patients who received anti-infective pharmacy consultation, the number of males was significantly more than that of females (50 cases vs 27 cases), and the majority of patients were the elderly over 60 years old (43 cases, 55.84%). The patients were mainly from general surgery II (26 cases, 33.77%) and department of urology and pain (20 cases, 25.97%), followed by the department of cardiovascular medicine (11 cases, 14.29%) and the department of oncology and hematology (10 cases, 12.99%). Among the 77 patients, 46 cases had positive microbiological examination results, and a total of 46 strains of pathogenic bacteria were detected, including 22 strains of Gram-positive bacteria, 22 strains of Gram-negative bacteria and 2 strains of fungi. The consultation opinions proposed by clinical pharmacists mainly included "adjusting the types of antibacterial drugs" (46 cases, 59.74%) and "maintaining the current anti-infective treatment regimen" (21 cases, 27.27%). Among the 77 patients, pharmacy consultation opinions for 73 cases were adopted by doctors, of which 57 cases had the outcomes of recovery or improvement, and 16 cases had the outcomes of worsening of the condition or ineffective treatment. Conclusion: In the hospitals, clinical pharmacists carry out the pharmacy consultations and put forward personalized drug treatment suggestions, which are welcomed and accepted by clinicians and greatly promote the recovery of patients.

目的：分析医院耐碳青霉烯肺炎克雷伯菌（carbapenem-resistant Klebsiella pneumoniae,CRKP）的表型类型和其院内感染的影响因素,为临床 CPKP 的预防和治疗提供参考。方法：选取 2017 年 11 月 1 日—2021 年 5 月 31 日张家港市第一人民医院不同住院患者分离出的 98 株 CRKP 作为研究资料,采用改良碳青霉烯灭活试验（modified carbapenem inactivation method,mCIM）、乙二胺四乙酸碳青霉烯灭活试验（ethylenediaminetetraacetic acid-carbapenem inactivation method,eCIM）和聚合酶链反应（polymerase chain reaction,PCR）扩增仪检测 CRKP 的耐药表型和耐药基因,并通过纳入同时期碳青霉烯类敏感的肺炎克雷伯菌感染患者,分析发生 CRKP 院内感染的危险因素。结果：PCR 检测结果显示,98 株 CRKP 中检出 89 株产 KPC 酶菌株,其中 blaKPC 阳性菌株 87 株、blaNDM 阳性菌株 2 株,未检出 blaVIM 和 blaOXA-48 阳性菌株;mCIM 与 eCIM 联合检测结果显示,98 株 CRKP 中,产 KPC 型丝氨酸酶的有 86 株,产金属 β-内酰胺酶的有 4 株;与 PCR 法相比,单用 mCIM 检测产 KPC 酶 CRKP 的敏感性为 98.88%,特异性为 77.78%,Kappa 值为 0.807（P<0.05）;mCIM 和 eCIM 联合检测产 KPC 型丝氨酸酶 CRKP 的敏感性为 97.70%,特异性为 90.91%,Kappa 值为 0.852（P<0.05）;mCIM 和 eCIM 联合检测产金属 β-内酰胺酶 CRKP 的敏感性为 100.00%,特异性为 97.92%,Kappa 值为 0.657（P<0.05）;Logistic 回归分析结果显示,行机械通气和使用碳青霉烯类药物是发生 CRKP 院内感染的独立危险因素（P<0.05）。结论：产 KPC 酶型是医院住院患者所检出的 CRKP 的主要耐药表型,mCIM 与 eCIM 联合检测可以检测出 CRKP 的耐药表型;此外,行机械通气和使用碳青霉烯类药物是发生 CRKP 院内感染的重要危险因素,对此临床应加强监护和管理,以减少感染的发生。

Berberine is a bioactive substance with a wide range of pharmacological effects. It has the effects against tumors in addition to anti-inflammatory, antibacterial, antiviral, antihypertensive, anti-hypoxic, hypoglycemic, and hypolipidemic effects. In recent years, domestic and foreign scientific research groups have conducted many in-depth studies on the roles of berberine in the field of anti-pancreatic cancer and achieved many important results. Therefore, the anti-pancreatic cancer effect and pharmacological mechanism of berberine are reviewed, and related studies are analyzed in this article.

目的: 调查医院呼吸内科患者吸入制剂的用药依从性状况,分析用药依从性差的相关因素,并提出相应对策,为患者正确、规范使用吸入制剂提供参考。方法: 选取 2021 年 10—12 月苏州市中医医院呼吸内科收治的使用吸入制剂治疗且接受用药依从性调查的呼吸系统疾病患者作为研究对象,采集患者的年龄、性别、文化程度、收入状况、疾病诊断、病程、所用药物、用药依从性评分等信息,分析影响患者用药依从性的相关因素和原因。结果: 本研究共筛选到符合要求的患者 82 例,其中使用布地奈德福莫特罗粉吸入剂的有 56 例（占 68.29%）,使用沙美特罗替卡松粉吸入剂的有 26 例（占 31.71%）;82 例患者中,用药依从性良好的有 23 例（占 28.05%）,用药依从性差的有 59 例（占 71.95%）;单因素分析结果显示,患者吸入制剂用药依从性差与患者的收入水平、病程长短具有相关性（P<0.05）;布地奈德福莫特罗粉吸入剂不正确使用主要体现在“吸药之前尽力呼气但对着吸嘴呼气”（19 例,占 33.93%）、“吸入药物后用温水漱口部位为口腔而非深咽喉部位”（18 例,占 32.14%）、“未屏住呼吸 10 秒”（16 例,占 28.57%）、“吸药之前没有尽力呼气”（14 例,占 25.00%）;沙美特罗替卡松粉吸入剂不正确使用主要体现在“未屏住呼吸 10 秒”（17 例,占 65.38%）、“吸入药物后用温水漱口部位为口腔而非深咽喉部位”（14 例,占 53.85%）、“吸药之前没有保持平稳呼吸并尽力呼气”（13 例,占 50.00%）、“未完全包住吸嘴,深长平稳地吸气”（11 例,占 42.31%）。结论: 医院呼吸内科多数患者吸入制剂的用药依从性较差,并且不少患者不能正确、规范地使用吸入剂,对此临床应积极主动地加强对患者的宣教,使其正确、主动、规律地使用吸入制剂,以提高药物治疗的效果。

目的: 分析妊娠晚期孕妇发生生殖道 B 族链球菌感染的影响因素,以及分娩前抗感染治疗对其妊娠结局的影响,为临床孕产妇的孕期安全和分娩安全提供参考。方法: 选取 2020 年 1 月—2023 年 2 月赣县区妇幼保健院收治的 812 例妊娠晚期孕妇作为研究对象,将发生生殖道 B 族链球菌感染的孕妇随机分为抗感染干预组和对照组;采集所有孕妇的年龄、产史、流产史、文化程度、妊娠期合并症、孕检状况等信息,采用 Logistic 回归分析法分析孕妇发生生殖道 B 族链球菌感染的影响因素;对照组孕妇分娩期不进行抗感染治疗,而抗感染干预组孕妇分娩前≥4 h 予注射用氨苄西林抗感染治疗,比较 2 组孕妇的不良妊娠发生情况和脐血中 C 反应蛋白（C-reactive protein,CRP）、降钙素原（procalcitonin,PCT）和白介素-6（interleukin-6,IL-6）等感染指标的水平。结果: 812 例妊娠晚期孕妇中发生生殖道 B 族链球菌感染的有 80 例,感染发生率为 9.85%;单因素分析结果显示,妊娠晚期孕妇发生生殖道 B 族链球菌感染与孕妇的年龄、产史、孕期肥胖与否、人口类型、是否合并妊娠期高血压、是否合并妊娠期糖尿病、是否合并阴道炎和是否孕期定期检查具有相关性（P<0.05）;多因素 Logistic 回归分析结果显示,年龄≥35 岁、有产史、孕期肥胖、合并妊娠期高血压、合并妊娠期糖尿病、合并阴道炎、孕期未定期检查、孕妇为流动人口是妊娠晚期孕妇发生生殖道 B 族链球菌感染的独立危险因素（P<0.05）;抗感染干预组孕妇不良妊娠结局的发生率明显低于对照组（2.50% vs 22.50%,P<0.05）;抗感染干预组孕妇 CRP、PCT 和 IL-6 等感染指标水平均低于对照组（P<0.05）。结论: 孕妇的年龄、产史、孕期肥胖与否、人口类型、是否合并妊娠期高血压、是否合并妊娠期糖尿病、是否合并阴道炎和是否孕期定期检查均与妊娠晚期孕妇生殖道 B 族链球菌感染的发生密切相关,而进行抗感染干预可以有效减少孕妇不良妊娠结局的发生,还可以降低相关感染指标水平,从而保证孕妇分娩的安全。

Psoraleae fructus is dried mature fruit of Psoralea corylifolia L., a plant from the Fabaceae family, and has various therapeutic effects, including warming the kidneys and assisting yang, relieving asthma, warming spleen and stopping diarrhea. However, psoraleae fructus has raised concerns regarding its medication safety due to its hepatotoxic side effects. This article mainly reviews the relationship between psoraleae fructus and liver injury, its hepatotoxic components, hepatotoxic characteristics, and methods to reduce its toxicity, aiming to provide reference for the safe and rational use of psoraleae fructus.

Objective: To analyze the pharmaceutical care process of one pregnant woman with immune abnormality and Listeria monocytogenes bloodstream infection during anti-infection treatment, and provide reference for the clinical treatment of pregnant women complicated with Listeria monocytogenes infection. Methodsand Results: A pregnant woman (31 years old, 16⁺⁴ weeks of menelipsis) was admitted to the hospital due to fever for 6 days; after admission, bilateral blood culture was performed and cefuroxime was given for empirical anti-infection treatment. On the next day, Listeria monocytogenes was detected from the blood culture, which was sensitive to penicillin, ampicillin and meropenem. Since ampicillin was not available in the hospital and piperacillin-tazobactam sodium was speculated to be effective based on the bacterial drug susceptibility results and the antibacterial spectrum of antibacterial drugs, the anti-infection treatment regimen was switched to piperacillin-tazobactam sodium. After 2 days, the patient had no fever, but Listeria monocytogenes was still detected from the blood culture. About 2 weeks later, the patient had fever again, the influenza A virus antibody IgM was detected positive and the influenza B virus antibody IgM was detected weakly positive. The patient and her family decided to terminate the pregnancy in view of the patient's complex conditions. After induced abortion, the patient received infusions of piperacillin-tazobactam sodium for 3 times and developed symptoms such as muscle soreness, which was suspected to be related to piperacillin-tazobactam sodium, so penicillin was used instead; 4 days later, amoxicillin-clavulanate potassium was taken orally, but the patient had rash and itching after administration, which were considered as drug-induced rash. Because the patient had terminated the pregnancy, compound sulfamethoxazole was used instead; the patient's condition improved soon and she was discharged from the hospital. The clinical pharmacist recommended continued treatment with compound sulfamethoxazole and regular follow-up visits. Conclusion: For special populations such as pregnant women with Listeria monocytogenes infection, clinical pharmacists should fully consider patients' specific conditions, assist doctors in formulating a more personalized treatment regimen and adjust it in a timely manner with the disease condition changes, to ensure the safe medication and treatment effects for patients.

目的: 分析新干县 2020—2022 年儿童呼吸系统肺炎支原体感染的流行病学特征,为今后儿童的肺炎支原体感染防治提供参考。方法: 选取 2020 年 1 月—2022 年 12 月新干县妇幼保健院和新干县人民医院收治的 2 000 例呼吸系统感染患儿作为研究对象,统计患儿的肺炎支原体感染发生情况,并采集患儿的性别、年龄、发病年份和季节、所引发疾病等信息,分析儿童呼吸系统肺炎支原体感染的流行病学状况。结果: 2 000 例呼吸系统感染患儿中确诊为肺炎支原体感染的有 599 例,发生率为 29.95%;2020—2022 年 3 年间,肺炎支原体感染的发生率逐年升高（依次为 12.91%、31.58% 和 44.22%）,且其差异有统计学意义（χ²=157.013,P<0.001）;在性别方面,不同性别患儿的肺炎支原体感染的发生率经比较其差异无统计学意义（χ²=2.645,P=0.104）;在年龄方面,不同年龄段患儿的肺炎支原体感染的发生率经比较其差异有统计学意义（χ²=9.818,P=0.007）,其中>3~7 岁的感染发生率最高（为 33.01%）;在季节方面,不同季节患儿的肺炎支原体感染的发生率经比较其差异有统计学意义（χ²=28.076,P<0.001）,其中冬季和秋季的感染发生率最高（分别为 37.22% 和 30.04%）;不同呼吸系统疾病患儿的肺炎支原体感染的发生率经比较其差异有统计学意义（χ²=154.445,P<0.001）,其中肺炎的支原体感染率最高（为 43.44%）。结论: 新干县 2020—2022 年儿童呼吸系统肺炎支原体感染的发生率呈逐年上升趋势,其在患儿年龄、发生季节和所引发疾病方面存在各自的特点,医院可进行科普宣教时可呼吁高风险群体在高发季节做好防护,以避免肺炎支原体感染的发生。

目的：分析医院门急诊抗菌药物处方的合理用药状况,为临床抗菌药物的合理使用提供参考。方法：随机抽取 2023 年 7—12 月遂川县人民医院门急诊的抗菌药物处方 2 700 张（450 张/月）作为研究资料,采集处方中患者的年龄、性别、诊断、就诊科室,以及所用药物的种类、数量、用法用量等信息,依据相关权威资料对处方中抗菌药物的使用进行合理用药点评,分析医院门急诊抗菌药物处方的用药状况。结果：2 700 张门急诊抗菌药物处方涉及的药物种类主要为头孢菌素类 865 张（32.04%）、青霉素类 711 张（26.33%）和喹诺酮类 533 张（19.74%）;处方点评结果显示,2 700 张抗菌药物处方中有不合理处方 246 张,不合理率为 9.11%;246 张不合理抗菌药物处方中,门诊处方明显多于急诊处方（223 张 vs 23 张）,并且不合理处方主要来自内科（153 张）,而不合理用药的主要原因为“用法用量不合理”（162 张,占 65.85%）。结论：医院门急诊所用抗菌药物以头孢菌素类、青霉素类和喹诺酮类为主,抗菌药物的使用整体较为合理,但仍存在一些问题,临床应对重点问题和重点科室加强监督、管理和培训,以提高其抗菌药物合理用药水平。

目的：分析经尿道前列腺电切术（transurethral resection of the prostate,TURP）患者术后并发尿路感染的影响因素,并针对性提出干预措施,为临床 TURP 患者术后尿路感染的预防提供参考。方法：选取 2021 年 1 月—2023 年 6 月分宜县人民医院收治的 86 例行 TURP 治疗的患者作为研究对象,根据患者术后是否发生尿路感染将其分为感染组（n=20）和未感染组（n=66）,采集所有患者的年龄、婚姻状况、收入状况、家族疾病史、基础疾病、吸烟史、饮酒史、抗菌药物使用、手术时长、前列腺体积等信息,分析 TURP 患者术后并发尿路感染的影响因素。结果：回归分析结果显示,TURP 患者术后并发尿路感染与患者年龄、是否合并糖尿病、术前尿潴留是否行导尿术、术前是否预防使用抗菌药物、前列腺体积、手术时长具有相关性（P<0.05）,而年龄≥60 岁、合并糖尿病、术前尿潴留行导尿术、术前未预防使用抗菌药物、前列腺体积、手术时长是 TURP 患者术后发生尿路感染的独立危险因素（P<0.05）;以相关独立危险因素构建的列线图预测模型显示,其接受者操作特征（receiver operating characteristic,ROC）曲线的曲线下面积（area under the curve,AUC）为 0.924,而列线图预测模型的校正曲线、原始曲线与理想曲线均较相近,并且当列线图预测模型的阈值>0.328 时,可获得临床净收益。结论：TURP 患者术后并发尿路感染与患者年龄、是否合并糖尿病、术前尿潴留是否行导尿术、术前是否预防使用抗菌药物、前列腺体积、手术时长密切相关,而以相关独立危险因素构建的预测模型可以较好地预测感染的发生,故临床对相关风险患者应加强管控和监护,以减少相关感染的发生。

目的：分析医院门诊在优化抗菌药物管理制度前后抗菌药物的合理使用状况,为下一步继续加强抗菌药物的管理提供依据。方法：通过医院信息系统,选取 2020 年 1—12 月实施优化管理前医院门诊的 185 789 张处方（设为管理前组）,以及 2021 年 1—12 月实施优化管理前医院门诊的 213 570 张处方（设为管理后组）作为研究资料,采集处方中患者的年龄、性别、诊断,以及所用药物的种类、名称、用法、用量等信息,并依据相关权威文献对抽取的抗菌药物处方进行合理用药点评,分析医院门诊抗菌药物的使用情况和管理成效。结果：医院 2021 年门诊总的抗菌药物使用率低于 2020 年（16.42% vs 17.11%,P<0.05）,但 2021 年 3 月、4 月、5 月、6 月和7 月的抗菌药物使用率则高于 2020 年（P<0.05）;处方点评结果显示,2021 年门诊抗菌药物的不合理使用率明显低于 2020 年（6.00% vs 22.53%,P<0.05）。结论：实施优化管理后,医院门诊抗菌药物的使用明显更加规范,并且不合理使用情况明显减少。

目的: 分析 PDCA 对医院抗菌药物使用强度（antibiotics use density,AUD）的管理成效,为临床抗菌药物的规范使用提供参考。方法: 采集厦门市第五医院 PDCA 干预前（即 2021 年 1—10 月）和干预后（即 2021 年 11 月—2022 年 12 月）的抗菌药物 AUD 数据资料,统计和比较全院和重点科室相应时期内的 AUD 差异,分析实施 PDCA 对 AUD 的影响。结果: 通过实施 PDCA,全院 AUD 由 PDCA 干预前的 36.16 降至干预后的 30.46,降幅为 15.76%（P<0.001）;各重点科室在实施 PDCA 后,妇科的 AUD 从 PDCA 干预前（即 2022 年 4—7 月）的61.57 降至干预后（即 2022 年 8—10 月）的 39.10,降幅为 36.50%（P<0.05）;泌尿外科的 AUD 由 PDCA 干预前（即 2022 年 4—6 月）的 98.05 降至干预后（即 2022 年 7—9 月）的 75.25,降幅为 23.25%（P<0.05）,但仍未控制在科室目标值以内;骨二科的 AUD 从 PDCA 干预前（即 2022 年 7—9 月）的 30.64 降至干预后（即 2022 年 10—12 月）的 14.53,降幅达 52.58%（P<0.01）。结论: PDCA 的实施对医院和各科室控制 AUD 具有显著效果,有效提高了医院抗菌药物的使用水平,促进了抗菌药物的规范、合理使用。

目的：分析医院住院患者抗菌药物医嘱的合理用药点评结果,为促进临床合理用药提供参考。方法：随机选取 2022 年 1—12 月开封市人民医院的 612 份住院患者病历作为研究资料,针对其中的抗菌药物医嘱进行合理用药点评,分析临床中抗菌药物不合理使用的原因和特点。结果：612 份病历中有抗菌药物使用情况的有 378 份,抗菌药物使用率为 61.76%,并且从第一至第四季度抗菌药物的使用率整体呈下降趋势;378 份病历中有 82 份的抗菌药物医嘱存在不合理情况,不合理使用率为 21.69%;而抗菌药物不合理使用的原因主要为联合用药不适宜（28 份,占 34.15%）、用法用量不适宜（25 份,占 30.49%）和药物遴选不适宜（14 份,占 17.07%）;从第一至第四季度,存在抗菌药物不合理使用的病历从 30 份降低至 6 份,其不合理发生率则从 28.04% 降至 7.89%;在所涉科室中,神经内科、呼吸内科、儿科和 ICU 抗菌药物使用病历的微生物送检率均大于 80.00%,仅神经外科的微生物送检率较低（仅 15.19%）。结论：2022 年医院住院患者的抗菌药物不合理使用情况较为严重,并且个别科室的微生物送检率偏低,对此医院应加强对临床医生抗菌药物使用的培训和管理,以提高其抗菌药物用药水平。

Objective: To analyze the epidemiological characteristics of adverse drug reactions (ADRs) caused by anti-tuberculosis drugs in the hospital and provide a reference for the safe medication of anti-tuberculosis drugs in clinical practice. Methods: A total of 897 patients with tuberculosis admitted to the hospital for anti-tuberculosis treatment from January 2020 to December 2023 were selected as research objects, the occurrence of ADRs caused by anti-tuberculosis drugs was summarized, and the information of patients such as age, occurrence time, clinical manifestations and severity of ADRs was collected to analyze the clinical characteristics of ADRs caused by anti-tuberculosis drugs. Results: Among 897 tuberculosis patients, anti-tuberculosis drug-related ADRs occurred in 378 patients, with an ADR incidence of 42.14%, and the ages of the 378 patients with ADRs were mainly elder than 60 years old (192 cases, 50.79%), followed by 40-60 years old (90 cases, 23.81%) and 18-40 years old (81 cases, 21.43%). The ADRs caused by anti-tuberculosis drugs mostly occurred in 15-30 days after medication (123 cases, 32.54%), followed by less than and equal to 15 days after medication (78 cases, 20.63%), and 45-60 days after medication (76 cases, 20.11%). ADRs caused by anti-tuberculosis drugs were mainly manifested as liver damage (141 cases, 37.30%), gastrointestinal reactions (90 cases, 23.81%) and urinary system abnormalities (69 cases, 18.25%). For the severity of ADRs caused by anti-tuberculosis drugs, most of them were mild (287 cases, 75.93%) and only 6 cases (1.59%) were severe. Conclusion: The anti-tuberculosis drug-related ADRs have a high incidence in hospitals, and the target populations are mainly middle-aged and elderly people, and their symptoms are mostly mild. Clinically, it is necessary to attach importance to them, monitor their medications to ensure the safe medication of patients.

Objective: To explore and analyze the adverse drug events (ADEs) of oxcarbazepine in the real world based on the US FDA Adverse Event Reporting System (FAERS) database, and provide a reference for the clinical medication safety of oxcarbazepine. Methods: By using "oxcarbazepine" as a key word, ADEs with oxcarbazepine as the primary suspected drug from May 1, 2018 to May 1, 2023 were searched in the FAERS database, and the related information on ADEs was collected to analyze the epidemiological characteristics of oxcarbazepine-related ADEs. Results: A total of 4 287 cases of oxcarbazepine-related ADEs that met the criteria were searched from the FAERS database, most of which were from the United States (3 288 cases, 76.70%), and most of the patients involved were aged 18-50 years old (2 041 cases, 47.61%). The 4 287 cases of oxcarbazepine-related ADEs involved 142 ADE signals and 20 system organ classes, among which the numbers of signals (34) and cases (1 744 cases) of various nervous system disorders were the most. Among the 4 287 cases of ADEs, the top five preferred terms (PTs) in terms of occurrence frequency were seizure, somnolence, focal epileptic seizures with cognitive impairment, fatigue and hyponatremia, and the top three PTs in terms of reporting odds ratio signal intensity were simple partial seizures, partial epilepsy followed by generalized seizures, and focal epileptic seizures with cognitive impairment. Among the 142 ADE signals, after the signals unrelated to the adverse drug reactions of oxcarbazepine itself were excluded, there were still 109 signals, of which 23 are not described in the oxcarbazepine package insert. Conclusion: Many oxcarbazepine-related ADEs are manifested as nervous system reactions, and some of them are similar to the drug indications, which should be identified during clinical monitoring of the adverse drug reactions of oxcarbazepine to ensure the safe medication of patients.

目的：分析医院急性白血病患者化疗期间并发肺部感染的病原菌分布与耐药特点,为临床此类患者的经验性抗感染治疗提供参考。方法：选取 2021 年 1月—2023 年 12 月濮阳市人民医院收治的 98 例化疗期间并发肺部感染的急性白血病患者作为研究对象,采集患者的痰液标本进行微生物培养和药敏试验,分析并发肺部感染患者痰标本中病原菌的分布与耐药情况。结果：98 例并发肺部感染患者痰液标本中共检出病原菌 115 株,其中革兰阴性菌 84 株（占 73.04%,主要为肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌）、革兰阳性菌 28 株（占 24.35%,主要为金黄色葡萄球菌、表皮葡萄球菌）和真菌 3 株（占 2.61%）;药敏结果显示,肺炎克雷伯菌对美罗培南、亚胺培南、环丙沙星、哌拉西林、哌拉西林-他唑巴坦钠、四环素、头孢吡肟、妥布霉素的耐药率较低（<30.00%）,铜绿假单胞菌对阿米卡星、哌拉西林-他唑巴坦钠、庆大霉素的耐药率较低（<30.00%）,大肠埃希菌对阿米卡星、美罗培南、亚胺培南、哌拉西林-他唑巴坦钠的耐药率较低（<30.00%）,三者对其他抗菌药物则均有不同程度耐药;金黄色葡萄球菌对利福平、利奈唑胺、莫西沙星、四环素、替加环素、万古霉素的耐药率较低（<30.00%）,表皮葡萄球菌对利福平、利奈唑胺、氨苄西林-舒巴坦钠、四环素、替加环素、万古霉素的耐药率较低（<30.00%）,二者对其他所试抗菌药物均有不同程度耐药。结论：医院急性白血病患者化疗期间并发肺部感染的主要致病菌为革兰阴性菌,不同致病菌对抗菌药物的耐药性差异较大,临床应根据药敏试验结果合理用药。

Objective: To analyze the pharmaceutical care process in anti-infective treatment for a hemodialysis patient complicated by catheter-related infection and pulmonary infection, and provide reference for the anti-infective treatment of clinical dialysis patients. Methodsand Results: The patient was admitted with "chills for 1 hour during dialysis". Upon admission, the examination revealed erythema and swelling at the catheter insertion site, with a white blood cell count of 16.71×10⁹/L and a neutrophil percentage of 93.40%, suggesting catheter-related infection, so anti-infective treatment with cefazolin was initiated. On the second day of hospitalization, a CT scan revealed pulmonary infection. After consultation with a clinical pharmacist, considering the common pathogen spectrum for both catheter-related infection and pulmonary infection as well as the patient's baseline renal function, the treatment was switched to piperacillin-tazobactam sodium, with a dosage of 2.25 g every 12 hours based on the patient's creatinine clearance. This recommendation was adopted by the physician. On the fifth day, blood cultures of the patient identified Stenotrophomonas maltophilia which was sensitive to piperacillin-tazobactam sodium. Conclusion: When developing an empirical anti-infective treatment regimen for complicated infections in hemodialysis patients, clinicians should first consider the common pathogen spectrum associated with infections. Additionally, the treatment regimen should be optimized and adjusted based on clear etiological results and tailored to the patient's liver and renal function to ensure the therapeutic efficacy.

目的：分析医院多重耐药菌（multidrug-resistance organism,MDRO）医院感染的发生情况及其流行病学特点,为临床 MDRO 医院感染的防控提供依据。方法：选取 2023 年 1—6 月合肥市第二人民医院收治的 2 035 例感染 5 类 7 种重点监测菌（金黄色葡萄球菌、肠球菌、大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌）的住院患者作为研究对象,采集患者的年龄、诊断、所在科室、基础疾病、病原菌种类及其耐药情况、手术史、抗菌药物使用、“三管”（包括中心静脉置管、导尿管和呼吸机插管）留置等信息,分析 MDRO 医院感染的发生情况及其流行病学特点。结果：2 035 例感染患者中 MDRO 感染的有 878 例,其中检出率排前 3 的 MDRO 依次为大肠埃希菌、肺炎克雷伯菌和金黄色葡萄球菌;878 例 MDRO 感染患者中,MDRO 医院感染的有 67 例（发生率为 7.63%）,而 ICU 的 MDRO 医院感染发生率明显高于普通科室（13.26% vs 6.17%,P<0.05）;MDRO 医院感染的主要类型有肺部感染（28 例,占 41.79%）、血流感染（16 例,占 23.88%）和尿路感染（16 例,占 23.88%）;67 例 MDRO 医院感染患者中,以“三管”留置（45 例,占 67.16%）和高龄（34 例,占 50.75%）为主要特征。结论：医院 5 类 7 种重点监测菌感染患者的 MDRO 检出率较高,而 MDRO 医院感染在 ICU 和“三管”留置、高龄患者中的发生率明显更高,提示临床应对相关患者加强监测和护理,做好医院感染的防控措施,以减少感染的发生。

Objective: To analyze the clinical diagnosis and treatment process of liver injury and diarrhea caused by crizotinib in one patient with non-small cell lung cancer (NSCLC), and provide a reference for the clinically safe medication of crizotinib. Methods and Results: The patient received chemotherapy for NSCLC. During the chemotherapy, the patient developed symptoms such as fatigue and nausea 15 days after taking crizotinib, and the liver function test results showed significant abnormalities in alanine aminotransferase and aspartate aminotransferase. After investigating the patient's medical history and medication history, the clinical pharmacist believed that the liver injury was possibly related to crizotinib, and suggested doctors to discontinue crizotinib and provide liver protection therapy and the doctors accepted the suggestion. One week later, the patient's liver function basically returned to normal; afterwards, the patient used crizotinib again on the basis of liver protection therapy. Although there was no abnormal liver function, diarrhea symptoms occurred 2 months later. The clinical pharmacist believed that it was still possibly related to crizotinib, and suggested using lorlatinib instead. The doctors accepted the suggestion; 3 days later, the patient's diarrhea symptoms were completely relieved. Conclusion: For patients using anti-tumor drugs such as crizotinib that may induce more adverse reactions, clinicians and pharmacists should strength the relevant monitoring and give instructions for safe medication, so as to detect and handle them early and guarantee the medication safety for patients.

目的：分析医院 2020—2022 年所上报的抗菌药物相关药物不良反应（adverse drug reactions,ADRs）的临床特点,为临床抗菌药物的用药安全提供参考。方法：选取 2020 年 1 月—2022 年 12 月郑州大学附属郑州中心医院上报至国家药品不良反应监测系统的 658 例抗菌药物相关 ADRs 报告作为研究资料,采集相关患者的年龄、性别、所用抗菌药物的种类和给药方式,以及 ADRs 的报告类型和转归情况等信息,分析抗菌药物相关 ADRs 的临床特点。结果：658 例抗菌药物相关 ADRs 报告中,性别上男性略多于女性（345 例 vs 313 例）,而年龄上以≤10 岁者（135 例,占 20.52%）和>80 岁者（97 例,占 14.74%）较多;658 例抗菌药物相关 ADRs 所涉及的药物种类主要为喹诺酮类（180 例,占 27.36%）、头孢菌素类（142 例,占 21.58%）和青霉素类（103 例,占 15.65%）,而所涉具体药物中前 5 位的依次为左氧氟沙星（128 例）、哌拉西林-他唑巴坦钠（51 例）、头孢哌酮-舒巴坦钠（48 例）、红霉素（40 例）、阿奇霉素（37 例）,而抗菌药物的给药方式主要为静脉给药（600 例,占 91.19%）,口服（37 例,占 5.62%）和其他给药方式均较少;抗菌药物相关 ADRs 主要累及患者的皮肤及其附件（299 例,占 45.44%）和消化系统（216 例,占 32.83%）;658 例抗菌药物相关 ADRs中,报告类型以“一般”为主（594 例,占 90.27%）,而“严重”和“新的”均较少（分别为 26 例和 38 例）;经相应处置后,658 例发生 ADRs 患者均痊愈（380 例,占 57.75%）或好转（268 例,占 40.73%）,仅 10 例（占 1.52%）因转院或出院后未追踪到而结局不详。结论：抗菌药物引起的 ADRs 多见于儿童和老年患者,主要涉及喹诺酮类、头孢菌素类和青霉素类抗菌药物,给药方式以静脉给药居多,多累及皮肤及其附件,临床对相关患者应加强监护和管理,以保证患者的用药安全。

Berberine is a bioactive substance with a wide range of pharmacological effects. In addition to anti-inflammatory, antibacterial, antiviral, antidiarrheal, antihypertensive, antihypoxic, hypoglycemic and hypolipidemic effects, berberine also has antitumor effects. There have been reports on the effects of berberine against gastric cancer, colorectal cancer, skin cancer, pancreatic cancer, etc. The pharmacological effects and mechanisms of berberine against esophageal cancer and sarcoma are reviewed, and relevant comments and analyses are made in this article.

目的：探究医院慢性化脓性中耳炎（chronic suppurative otitis media,CSOM）患者发生真菌感染的影响因素,为临床 CSOM 患者防治真菌感染提供参考。方法：选取 2022 年 9 月—2023 年 10 月都昌县妇幼保健院收治的 102 例 CSOM 患者作为研究对象,采集患者的年龄、性别、基础疾病、既往病史、抗菌药物和激素的使用、住院时间、CSOM 的发生情况等信息,采用 Logistic 回归分析法分析 CSOM 患者发生真菌感染的影响因素。结果：102 例 CSOM 患者中发生真菌感染的有 30 例,感染发生率为 29.41%;单因素分析结果显示,CSOM 患者发生真菌感染与患者年龄、是否合并糖尿病、和否合并上呼吸道感染、是否存在抗菌药物联用、是否合并低蛋白血症、住院时间具有相关性（P<0.05）;而多因素 Logistic 回归分析显示,年龄≥60 岁、合并糖尿病、存在抗菌药物联用、合并低蛋白血症、住院时间≥7 d 是CSOM 患者发生真菌感染的独立危险因素（P<0.05）;对独立危险因素构建预测模型,结果显示,预测模型的曲线下面积（area under the curve,AUC）为 0.711,95%CI 为 0.595~0.826,预测敏感度为 66.67%,特异度为 69.44%。结论：CSOM 患者发生真菌感染与患者年龄、是否合并糖尿病、和否合并上呼吸道感染、是否存在抗菌药物联用、是否合并低蛋白血症、住院时间有着密切的关联,临床应对高风险患者加强管理和监测,以减少真菌感染的发生。

Objective: To analyze the correlation between the detection rate of methicillin-resistant Staphylococcus aureus (MRSA) and the antibiotics use density (AUD) in inpatient wards of a hospital from 2012 to 2021, and provide reference for the prevention and control of antimicrobial resistance and the rational use of antibacterial drugs. Methods: The etiological results and antibacterial drug use data of specimens sent from inpatient wards of Yulin First People's Hospital from January 2012 to December 2021 were selected as research data. The detection data of Gram-positive bacteria and Staphylococcus aureus (SA) and the resistance rates of SA to various antibacterial drugs were statistically analyzed, the AUD of each antibacterial drug over the years was calculated, and the correlation between the detection rate of MRSA and the AUD was analyzed. Results: From 2012 to 2021, the detection rates of SA in Gram-positive bacteria in inpatient wards of the hospital increased from 26.70% to 50.70%, with a significant change (P<0.01); the detection rates of MRSA in SA fluctuated between 38.20% and 57.04%, with an average detection rate of 48.27%. The drug susceptibility test results showed that the resistance rates of SA against ciprofloxacin, compound sulfamethoxazole, erythromycin, clindamycin, tetracycline, and gentamicin decreased year by year, with significant changes (P<0.01). In addition, the resistance rates of SA against vancomycin and linezolid were always 0.00%. From 2012 to 2021, the AUDs of penicillin, cefazolin, erythromycin, clindamycin, levofloxacin and total quinolones showed a decreasing trend (P<0.05), while the AUDs of ampicillin-sulbactam sodium, piperacillin-tazobactam sodium, vancomycin, linezolid, tigecycline and moxifloxacin showed an increasing trend (P<0.05). The correlation analysis showed that the detection rate of MRSA was positively correlated with the AUDs of penicillin, cefuroxime, erythromycin, azithromycin, levofloxacin and total quinolones (P<0.05) and negatively correlated with the AUDs of ampicillin-sulbactam sodium, ciprofloxacin, vancomycin, linezolid and tigecycline (P<0.05). The linear regression analysis results showed that the coefficient of determination R2 of the correlation between the detection rate of MRSA and the AUDs of azithromycin, levofloxacin, ciprofloxacin and total quinolones was greater than 0.7, which was clinically significant. Conclusion: The detection rates of MRSA in the hospital maintain at a high level all year round and are closely related to the use of azithromycin, levofloxacin, ciprofloxacin and total quinolones. Therefore, the use habits of such highly correlated drugs should be adjusted appropriately during clinical anti-infection treatment to reduce the occurrence of MRSA.

Objective: To analyze the pharmaceutical care process of anti-infection treatment in patients with neck multi-space infection and chest wall abscess induced by Pediococcus pentosaceus, and provide a reference for the diagnosis and treatment of patients with Pediococcus pentosaceus infection in clinical practice. Methods and Results: A patient went to the hospital's emergency department due to "sore throat for 6 days, accompanied by expectoration, fever, dysphagia, and restriction of mouth opening". After examination, the doctor considered it to be neck multi-space infection with chest wall abscess, then the patient was admitted to the otolaryngology department; on the first day of admission, abscess incision and drainage was performed and a drainage tube was placed to drain the pus. The pus was used for microbial culture, and cefoperazone-sulbactam sodium + ornidazole were given empirically. On the fifth day, Pediococcus pentosaceus was cultured in the pus. After referring to related data, the clinical pharmacist suggested adjusting the anti-infection treatment regimen to ampicillin; on the eighth day, the patient's left chest wall was still swollen, so a second operation was performed and a drainage tube was placed to drain the pus; in the following 3 weeks, the patient's abscess gradually disappeared, the wound surface gradually recovered, and no bleeding, redness and swelling were observed, and the patient was basically cured. Conclusion: The infection with Pediococcus pentosaceus is relatively rare in clinical practice; in addition, a serious abscess was formed for the patient. Therefore, doctors and pharmacists should attach importance to it and take internal medicine and surgical methods to ensure the treatment effect.