Berberine is a widely used bioactive compound with diverse pharmacological effects, including anti-inflammation, antioxidation, cytoprotection, broad-spectrum antibacterial and antiviral activities, as well as antitumor, antidiarrheal, antiarrhythmic, antihypertensive, hypoglycemic and lipid-regulating functions. Its pharmacological activities involve multiple systems and metabolic fields such as the digestive system, central nervous system, cardiovascular system and respiratory system. Although berberine has been used clinically for more than 60 years, its officially approved oral indications in China are still limited to intestinal infections, which fails to fully reflect its extensive pharmacological potential. The authors have previously reviewed the research progress in cerebral protection, cognitive impairment, Parkinson's disease, depression, antitumor, antiviral and hypoglycemic effects of berberine. In this article, the clinical research progress in prevention and treatment of berberine against hyperglycemia is further reviewed, so as to provide a reference for clinicians, promote the expansion of its clinical applications and give full play to its potential therapeutic value.

Objective: To comprehensively assess the clinical comprehensive value of four domestically marketed neurokinin-1 (NK-1) receptor antagonists (Aprepitant Capsules, Aprepitant Injection, Fosaprepitant Dimeglumine for Injection, Netupitant and Palonosetron Hydrochloride Capsules) in preventing and treating chemotherapy-induced nausea and vomiting (CINV), so as to provide a reference for individualized patient therapy and drug selection in medical institutions. Methods: Based on the evaluation framework established in the Rapid Guidelines for Drug Evaluation and Selection in Chinese Medical Institutions (2nd Edition), quantitative scoring and comprehensive evaluation were performed on the above drugs in terms of pharmaceutical properties, effectiveness, safety, economy, and other attributes. Results: All four NK-1 receptor antagonists achieved a comprehensive score above 70, meeting the criteria of ''strongly recommended'' or suggested to be retained in the guidelines. The scores ranked in descending order: Netupitant and Palonosetron Hydrochloride Capsules (78.40), Aprepitant Capsules (76.53), Aprepitant Injection (74.36), and Fosaprepitant Dimeglumine for Injection (73.38). Netupitant and Palonosetron Hydrochloride Capsules performed outstandingly in pharmaceutical properties and economy; Fosaprepitant Dimeglumine showed therapeutic advantages in acute-phase CINV control; Aprepitant Capsules had more sufficient evidence for pediatric use. Conclusion: The selection and evaluation based on the Rapid Guidelines for Drug Evaluation and Selection in Chinese Medical Institutions (2nd Edition) can support drug selection in medical institutions and promote scientific, rational and safe medication. All four NK-1 receptor antagonists exhibit satisfactory clinical utility in preventing and treating CINV and are eligible for recommendation into drug supply catalogs.

Objective: To analyze the implementation status and causes of disparities of national medical insurance negotiated antibacterial drugs (hereinafter referred to as "national negotiated antibacterial drugs") in typical regions, and put forward targeted strategies to improve the clinical accessibility and rational use of antibacterial drugs. Methods: Based on the National Catalog of Drugs for Basic Medical Insurance, Work-related Injury Insurance and Maternity Insurance issued by the National Healthcare Security Administration, basic information on national negotiated antibacterial drugs within the agreement period from 2017 to 2024 was collected. Data on the provision of relevant drugs in medical institutions at all levels in Jiangsu Province, Shandong Province and Shanghai Municipality were retrieved through the "Query of List of Institutions Equipped with National Medical Insurance Negotiated Drugs" database on China Healthcare Security Service Platform APP. Meanwhile, national negotiated monoclonal antibodies and antibody-drug conjugate antitumor drugs in the same period were selected as the control group. Results: The total number of national negotiated antibacterial drugs increased from 2 to 20 during 2017-2024, among which β-lactam antibacterial drugs were dominant (50%). Significant differences were observed in the average provision ratio of national negotiated antibacterial drugs in medical institutions in Jiangsu, Shandong and Shanghai, with the highest ratio in Shanghai (0.45%) and the lowest in Shandong (0.02%). The provision ratio in primary medical institutions was even lower. The average provision ratio of national negotiated antibacterial drugs was significantly lower than that of 23 antitumor drugs in the same period (0.18% in Jiangsu, 0.08% in Shandong and 0.57% in Shanghai). Conclusion: Although the number of national negotiated antibacterial drugs shows a fluctuating growth trend, there are still problems such as slow progress in antibacterial drug research and development, obvious disparities in drug provision across regions and varieties, and insufficient accessibility in primary medical institutions. In the future, coordinated efforts should be made in encouraging antibacterial drug research and development, exploring diversified innovative paths, and incentivizing medical institutions to equip and use innovative antibacterial drugs, so as to promote the implementation and rational application of national negotiated antibacterial drugs.

目的: 探讨根本原因分析（root cause analysis,RCA）在医院门急诊药房调剂差错中的应用效果,提出针对性防范策略,为提升药房服务质量,保障患者用药安全提供参考。方法: 选取 2021 年 1 月—2022 年 12 月（整改前）和2023 年 1 月—2024 年 12 月（整改后）南阳市第一人民医院门急诊药房药品调剂差错数据作为研究资料,统计整改前药品调剂差错类型,采用 RCA 法分析其根本原因,调整药品管理措施,比较整改前后药品调剂差错率、类型分布、药师工作满意度和患者满意度。结果: 整改前收集调剂药品数据 4 510 例,出现调剂差错 115 例,调剂差错发生率为 2.55%（115/4 510）,整改后收集调剂药品数据 5 638 例,出现调剂差错 86 例,调剂差错发生率为 1.53%（86/5 638）,整改后调剂差错发生率明显低于整改前（χ²=13.547,P<0.001）;整改后,名称相似、包装相似、用法用量错误是导致门急诊药房调剂差错的主要类型,发生率分别为 0.35%、0.28%、0.23%;整改后,药师对工作环境、工作流程、设备支持、职业认同感、心理支持满意度均高于整改前（P<0.05）;患者对药品发放准确性、药师服务态度、等候时间、用药指导满意度均高于整改前（P<0.05）。结论: 应用 RCA 可有效识别门急诊药房调剂差错的系统性原因,通过实施针对性改进措施能显著降低差错发生率,优化药品管理流程,并同步提升药师与患者满意度,对促进用药安全具有重要实践价值。

Objective: To analyze the adjustment of anti-infective treatment regimen and pharmaceutical care process of a pediatric patient with non-typhoidal Salmonella sepsis, so as to provide a reference for rational clinical medication in pediatric Salmonella sepsis. Methods and Results: A pediatric patient was admitted due to "fever for 4 days, diarrhea for 2 days and bloody stool for 1 day". Combined with clinical manifestations and laboratory findings, the child was initially diagnosed with infectious diarrhea and moderate dehydration, and received symptomatic and supportive treatments including anti-infection with cefoperazone-sulbactam sodium and fluid rehydration. On the 3rd day of admission, both blood culture and stool culture indicated Salmonella typhimurium, confirming the diagnosis of Salmonella sepsis; drug susceptibility results indicated sensitivity to ceftriaxone. Although procalcitonin was lower than that at admission, the pediatric patient still presented persistent high fever. Based on the pharmacological properties that Salmonella is an intracellular pathogen and azithromycin can be highly concentrated in phagocytes, clinical pharmacists recommended adding azithromycin for combined anti-infective therapy. The pediatric patient's body temperature returned to normal and diarrhea was relieved on the second day after azithromycin was administered. On the 7th day of admission, the pediatric patient developed abnormal coagulation function, which was considered an adverse reaction induced by cefoperazone-sulbactam sodium. Clinical pharmacists suggested discontinuing this agent, de-escalating to ceftriaxone according to the drug susceptibility results, and intramuscular injection of vitamin K₁ to correct coagulation function. On the 13th day of admission, the pediatric patient's coagulation function returned to normal, infection indicators met the discharge criteria, and the patient was discharged with stable condition. Conclusion: In the treatment of pediatric non-typhoidal Salmonella sepsis, if monotherapy with third-generation cephalosporins shows unsatisfactory efficacy, azithromycin can be combined based on the intracellular parasitic characteristics of the pathogen. Meanwhile, it is necessary for close monitoring of coagulation dysfunction potentially induced by agents such as cefoperazone. The participation of clinical pharmacists in the formulation of individualized regimens and whole-course pharmaceutical care is a key measure to guarantee the efficacy and safety of medication in children.

Objective: To analyze the pharmaceutical care process of a patient with arrhythmia induced by voriconazole, explore its underlying mechanism and pharmaceutical care strategies, so as to provide a reference for safe and rational clinical medication. Methods and Results: A 71-year-old female patient, weighing 38.5 kg, was hospitalized due to "pulmonary aspergillosis" half a month ago. After discharge, she presented recurrent nausea, vomiting and anorexia during oral voriconazole therapy. On October 25, 2023, she was admitted due to "recurrent loss of consciousness for 2 days", with admission diagnoses including cardiogenic syncope, pulmonary aspergillosis and hypokalemia. Clinical pharmacists participated in the consultation and inferred that the manifestations were probably multiple adverse reactions induced by voriconazole. It was recommended to implement electrocardiographic monitoring and blood oxygen saturation monitoring immediately, discontinue voriconazole tablets, and administer potassium chloride injection and potassium chloride sustained-release tablets to correct hypokalemia. On October 27, the patient still suffered from dizziness, cough and expectoration, with improved appetite. Clinical pharmacists re-evaluated in the consultation and confirmed that the patient developed arrhythmia, hypokalemia and gastrointestinal adverse reactions after voriconazole administration. Considering the insufficient antifungal treatment course, persistent respiratory symptoms and pulmonary shadows shown on chest CT, continued antifungal therapy was required. It was recommended to reduce the dose of voriconazole tablets to 100 mg twice daily under continuous electrocardiographic monitoring, which was adopted by the physician. On October 28, the patient complained of nausea after voriconazole administration, and esomeprazole enteric-coated capsules (40 mg, q24h, oral) were prescribed for acid suppression and gastric protection. During ward rounds, clinical pharmacists identified potential drug interaction between voriconazole and esomeprazole, and suggested reducing the dose of esomeprazole to 20 mg once daily, which was accepted by the physician. On October 30, the patient reported relieved nausea after voriconazole administration and was discharged after evaluation. Conclusion: Voriconazole tends to induce severe arrhythmia mediated by gastrointestinal reactions and hypokalemia in elderly patients with low body weight. Through active monitoring, correlation analysis and individualized dosage adjustment, clinical pharmacists effectively manage such complex adverse reactions while ensuring antifungal efficacy, highlighting the key role of pharmaceutical care in guaranteeing medication safety.

Objective: To analyze the pharmaceutical care process for a patient with refractory peritoneal dialysis-associated peritonitis, and provide a reference for anti-infective therapy and medication safety in such patients. Methods and Results: The patient was admitted to the hospital due to turbid ascites for 9 days and diagnosed with refractory peritoneal dialysis-associated peritonitis based on the patient's recent examination results and previous anti-infective treatment. Empirical anti-infective therapy with teicoplanin plus levofloxacin was given. On the second day after admission, next-generation sequencing of ascites indicated Acinetobacter baumannii, and the therapeutic regimen was adjusted to cefoperazone-sulbactam sodium plus tigecycline. After 5 days of treatment, abnormal coagulation parameters including prothrombin time, activated partial thromboplastin time and fibrinogen were observed. After evaluation, clinical pharmacists considered that the abnormalities were most likely induced by cefoperazone-sulbactam sodium combined with tigecycline, and recommended switching the anti-infective regimen to colistimethate sodium plus meropenem. However, the patient developed severe dyspnea immediately after the first intravenous administration of colistimethate sodium. Clinical pharmacists attributed it to colistimethate sodium, and suggested immediate drug discontinuation and hemodialysis to promote drug elimination. The patient's dyspnea gradually improved on the next day. On the 5th day of meropenem treatment, the patient's infectious symptoms and inflammatory markers were significantly relieved, and peritoneal dialysis catheter removal was performed. Conclusion: The treatment of refractory peritoneal dialysis-associated peritonitis is complex and prolonged. Clinical pharmacists should timely optimize and individualize the anti-infective regimen according to the patient's condition and laboratory results to ensure effective treatment, and strengthen the monitoring of adverse drug reactions to guarantee medication safety.

Objective: To analyze the clinical pharmaceutical care process of a patient with mixed infection of Raoultella planticola and Staphylococcus capitis after cerebral hemorrhage surgery, so as to provide a reference for optimizing anti-infective regimens and improving medication rationality in such postoperative mixed infection patients. Methods and Results: The patient presented with persistent fever and markedly elevated infection indicators after cerebral hemorrhage surgery. Empirical treatment with ceftriaxone was initiated but achieved unsatisfactory efficacy. On the 5th day of admission, sputum culture results identified Raoultella planticola; based on drug susceptibility results, clinical pharmacists recommended discontinuing ceftriaxone and switching to levofloxacin for targeted anti-infective therapy. On the 8th day of admission, Staphylococcus capitis was detected by epidural drainage tube culture. Given the features of mixed infection, clinical pharmacists suggested switching to piperacillin-tazobactam sodium combined with vancomycin for intensified anti-infective treatment. On the 19th day of admission, the patient's infection was effectively controlled. In accordance with the Guiding Principles for Clinical Application of Antibacterial Agents (2015 Edition), clinical pharmacists recommended timely deescalation therapy and gradual withdrawal of antibacterial drugs. Following standardized treatment and wholecourse pharmaceutical care, the patient's body temperature and infection indicators returned to normal, bilateral pulmonary infectious lesions resolved, and the condition stabilized. The patient was discharged and transferred to a rehabilitation hospital for further rehabilitation. Conclusion: Patients after cerebral hemorrhage surgery are susceptible to mixed infections due to surgical trauma, invasive procedures and other factors. By interpreting etiological test results, optimizing anti-infective regimens according to the patient's conditions, and providing wholecourse pharmaceutical care, clinical pharmacists can enhance the effectiveness and safety of anti-infective therapy, reduce the emergence of drug-resistant bacteria and adverse drug reactions, and consequently improve patient prognosis.

Objective: To analyze the anti-infective treatment and pharmaceutical care process of a patient with severe pneumonia complicated by empyema caused by Tropheryma whipplei, so as to provide a reference for the clinical treatment and safe and rational drug use of this rare infection. Methods and Results: A patient was admitted due to ''chest pain, hemoptysis and fever for half a day'', and diagnosed with severe pneumonia with left pleural effusion. After admission, the patient received empirical anti-infective therapy with piperacillin sodium-tazobactam sodium combined with moxifloxacin. During treatment, the patient presented persistent hypokalemia and prolonged QT interval(QTc 490 ms). Tropheryma whipplei (sequence number: 108) was detected by metagenomics next-generation sequencing (mNGS) of bronchoalveolar lavage fluid. Based on the etiological examination results and drug susceptibility characteristics, the clinical pharmacist recommended switching to doxycycline combined with meropenem. After left thoracentesis and drainage, the infection was well controlled. The clinical pharmacist suggested deescalation of antibacterial drugs to ceftriaxone plus doxycycline for sequential therapy. After nearly 4 weeks of hospitalization, the patient's clinical symptoms were significantly relieved, body temperature returned to normal, infection indicators decreased remarkably, and imaging showed absorption of pulmonary lesions. The patient was discharged with continued doxycycline treatment. Conclusion: Through participation in the individualized treatment process of a patient with Tropheryma whipplei pneumonia complicated by empyema, clinical pharmacists have implemented whole-process pharmaceutical care to help optimize the anti-infective regimen and ensure medication safety, reflecting their professional value in the multidisciplinary treatment of rare pathogen infections.

Objective: To analyze the anti-infective therapy and pharmaceutical care process of a patient with cerebral hemorrhage complicated by pulmonary infection, so as to provide a reference for the clinical diagnosis and treatment of such patients. Methods and Results: A 21-year-old male patient was admitted due to ''dizziness accompanied by recurrent convulsions for more than 8 hours''. Emergency cranial CT revealed cerebral hemorrhage in the right frontal lobe and left parietal lobe. The patient was given nasal feeding of a prescription for acute stroke stage (Banxia Baizhu Tianma Decoction combined with blood-activating and stasis-resolving traditional Chinese medicine) to dispel wind, resolve phlegm, activate blood and unblock collaterals, together with symptomatic treatments such as dehydration to reduce intracranial pressure and seizure control. ''Craniotomy with hematoma evacuation, decompressive craniectomy and tracheotomy'' were performed on day 2, and ''total cerebral angiography via the aortic arch'' on day 4 after admission. Postoperatively, the patient developed fever with a peak temperature of 39 ℃, and lung CT suggested infection. Empirical anti-infective therapy with ceftriaxone, antipyretic treatment and resuscitation with Suhexiang Pills were administered. On day 13 after admission, the patient still had persistent high fever (40.6 ℃) with elevated infection indicators, accompanied by flushed face, red tongue with yellow and greasy coating, wiry and rapid pulse, and excessive phlegm. Modified Zhengan Xifeng Decoction was added, and a clinical pharmacist of traditional Chinese medicine was consulted. The pharmacist recommended discontinuing Suhexiang Pills and switching to Angong Niuhuang Pills, and adjusting the anti-infective regimen to moxifloxacin combined with cefoperazone-sulbactam sodium, which was adopted by the physician. On day 14, the imaging manifestations of pulmonary infection deteriorated, accompanied by liver dysfunction (considered to be related to sodium valproate). The pharmacist suggested upgrading the anti-infective drug to meropenem, adjusting the antiepileptic regimen to levetiracetam combined with topiramate, switching traditional Chinese medicine to modified Qingying Decoction, and performing next-generation sequencing (NGS) of alveolar lavage fluid and blood, which was adopted by the physician. On day 16, NGS results indicated Ureaplasma urealyticum and human herpesvirus type 1, so doxycycline and acyclovir were added. After comprehensive intervention, infection indicators gradually improved, liver function recovered, and the patient was transferred back to his native place for rehabilitation after his condition stabilized. Conclusion: Cerebral hemorrhage complicated by pulmonary infection or even bloodstream infection is clinically complex. Etiological evidence should be obtained as early as possible on the basis of empirical anti-infective therapy. Individualized treatment with integrated traditional Chinese and Western medicine should be implemented combined with liver and kidney function and changes in individual syndromes. Synergistic management of syndrome-based Chinese medicine selection and Western medicine safety is essential to improve efficacy and ensure medication safety.

目的：基于“体（湿热质）-病（术后便秘）-证（肠道积热证）”三位一体模式,探究隔大黄灸联合穴位敷贴在预防混合痔术后便秘中的临床应用效果。方法：选取 2024 年 6—11 月苏州市中医医院肛肠科 300 例混合痔患者作为研究对象,将肛肠一科的 150 例患者设为对照组,肛肠二科的 150 例患者设为观察组;对照组术后给予常规医疗护理方案,观察组在常规基础上,自术后第 1 天起加用隔大黄灸联合穴位敷贴治疗,连续 3 d;比较 2 组患者术后便秘发生率、首次排便时间、住院时间,以及术后第 3 天和第 7 天的大便性状、单次排便时间、排便费力程度和生活质量等指标。结果：与对照组相比,观察组术后便秘发生率显著降低（P<0.05）,首次排便时间和住院时间明显缩短（P<0.05）;术后第 3 天和第 7 天,观察组大便性状改善更明显（P<0.05）,每次排便时间更短（P<0.05）,排便费力程度更轻（P<0.05）,生活质量显著提高（P<0.05）。结论：隔大黄灸联合穴位敷贴能有效预防湿热质、肠道积热证混合痔患者术后便秘的发生,优化术后排便状况,促进康复,提高术后生活质量。

目的: 分析 1 例结核硬脂酸棒状杆菌所致附睾炎患者的临床诊疗过程,为临床此类罕见菌感染的诊断和治疗提供参考。方法与结果: 患者 4 月前在无明显诱因情况下发现右侧阴囊部肿胀、疼痛,在当地医院治疗期间检测出结核菌素试验阳性,怀疑可能结核分枝杆菌感染转入我院;入院第 3 天,予患者行超声引导下右侧睾丸病灶穿刺活检术,病理检查提示肉芽肿性炎,遂经验性给予左氧氟沙星抗感染治疗;第6 天,患者穿刺组织宏基因组二代测序回报结核硬脂酸棒状杆菌（序列数 630）,综合患者病情,考虑为附睾炎,由于无明显活动性结核依据,遂停用左氧氟沙星而改为哌拉西林-他唑巴坦钠;第 10 天,患者出现腹泻,每日约 4~5 次,偶见水样便,临床药师考虑其很可能与药物有关,遂停用哌拉西林-他唑巴坦钠,而改用利奈唑胺,并予止泻、改善肠道菌群等对症治疗;第 16 天,患者腹泻、腹部不适症状消失,右侧阴囊肿痛较前明显缓解,肿胀改善,遂准予出院,但嘱其出院后继续使用利奈唑胺治疗。结论: 结核硬脂酸棒状杆菌是皮肤常见定植菌,但其所致感染的情况较为少见,并且传统病原学检查很难检测到该菌,导致临床对其缺乏充分的了解,从而使得其所致感染常常被误诊或延迟诊断;对此,临床可在感染的病原学诊断遇到困难时积极探索使用新兴检测手段,以尽快明确诊断,从而为患者制定更有针对性的治疗,进而保证患者获得有效的治疗。

目的: 探讨药学科普干预对 2 型糖尿病（type 2 diabetes mellitus,T2DM）患者注射用降糖药认知度与治疗依从性的影响,为促进临床合理用药提供依据。方法: 选取 2024 年 4—12 月在苏州市市立医院就诊的 150 例 T2DM 患者作为研究对象,将其随机分为 2 组,每组 75 例;对照组患者接受医院药师提供的常规药学服务,观察组在对照组基础上接受结构化的药学科普干预方案,采用针对糖尿病患者用药依从性的调查问卷评估其用药依从性,采用自行设计的调查问卷评估患者对胰岛素和胰岛素类似物正确使用的知识掌握程度;测量并记录 2 组患者在干预前、干预后 3 个月和干预后 6 个月的空腹血糖值;采用参考糖尿病管理自我效能量表修订形成的调查问卷评估自我管理能力。结果: 150 例患者中,男性多于女性（92 例 vs 58 例）;患者年龄为 42~71 岁,平均年龄为（57.46±7.67）岁;112 例（占 74.67%）患者与家人同住,38 例（占 25.33%）患者为独居状态;干预后,观察组患者的用药依从率显著高于对照组（90.67% vs 78.67%,P<0.001）,患者的认知良好率高于对照组（92.00% vs 76.00%,P<0.05）;干预后 3 个月和 6 个月,观察组患者的空腹血糖水平均低于对照组（P<0.05）;干预后 6 个月,观察组患者的自我管理效能评分高于对照组（P<0.05）。结论: 对使用注射类降糖药的 2 型糖尿病患者实施结构化的药学科普干预,可有效提升其药物知识水平、治疗依从性与自我管理效能,并有助于实现更优的血糖控制;以患者教育为核心的药学干预是糖尿病综合管理中值得推广的重要环节。

Objective: To analyze one case of methotrexate (MTX)-induced liver injury, collect adverse events of MTX-induced liver injury from the FDA Adverse Event Reporting System (FAERS) database and analyze the onset time, so as to provide a reference for clinical individualized medication. Methods and Results: A 38-year-old female patient diagnosed with ectopic pregnancy received conservative treatment with MTX (87 mg, single deep intramuscular injection in both buttocks). On the 4th day after drug withdrawal, serum human chorionic gonadotropin (HCG) was 441 mIU/mL; on the 7th day after drug withdrawal, serum HCG was 426 mIU/mL, with only a 3% decrease compared with that on the 4th day after MTX treatment. Liver function test results showed alanine aminotransferase (ALT) 144 U/L and aspartate aminotransferase (AST) 102 U/L, suggesting drug-induced liver injury. The patient was given Glutathione for Injection and Monoammonium Glycyrrhizinate and Cysteine and Sodium Chloride Injection for liver protection, combined with surgical treatment. Laparoscopic salpingectomy of the affected side was performed on the 8th day after drug withdrawal. On the 11th day after drug withdrawal, liver function was improved (ALT 75 U/L, AST 54 U/L). On the 13th day after drug withdrawal, the patient was discharged with stable condition, continued to take diammonium glycyrrhizinate enteric-coated capsules for liver protection, and was scheduled for reexamination of liver function and serum HCG one week later. On the 22nd day after drug withdrawal, liver function test results showed ALT 46.9 U/L and negative serum HCG. Meanwhile, based on relevant data from the FAERS database, with indication limited to ectopic pregnancy and study period from 2004 to 2024, a total of 56 adverse events related to liver injury were screened. The system organ classes included hepatobiliary diseases and various examinations, and the preferred terms for liver function injury in examinations mainly included abnormal liver function test, elevated liver enzymes, elevated serum bilirubin, etc. The onset time of MTX-induced liver injury ranged from 2 days to 30 days. Conclusion: Clinical attention should be paid to MTX-induced liver dysfunction. Liver function test should be carried out as early as the 2nd day after medication, and the period within 30 days is the key monitoring window.

Scrub typhus is a natural focal disease caused by infection with Orientia tsutsugamushi. In recent years, the incidence of this disease has shown an upward trend in the AsiaPacific region. Delayed therapeutic efficacy and even drug resistance have been observed in clinical practice, which poses a severe challenge to the effective prevention and treatment of scrub typhus. This article systematically reviews the current clinical application and drug resistance trends of antiscrub typhus agents, the molecular basis of drug resistance mechanisms in scrub typhus, as well as the research directions and challenges for the development of novel antiscrub typhus drugs. It aims to provide a reference for the research and development of new antiscrub typhus agents and the subsequent exploration of therapeutic strategies against scrub typhus.

Objective: To investigate the quantitative value transfer law of flavonoid components during the preparation of the reference sample of Wendan Decoction, a classical famous Chinese formula, and provide a scientific basis for the establishment of its specifications and development of its preparations. Methods: The reference sample of Wendan Decoction was prepared by the traditional water decoction process. A high-performance liquid chromatography (HPLC) method was established for the simultaneous determination of naringin, hesperidin and neohesperidin (the key flavonoid components), and systematic methodological validation was performed. The content changes of the three components (naringin, hesperidin and neohesperidin) and the extract yield in each preparation step were determined, the component transfer rates were calculated, and the quantitative value transfer characteristics were analyzed. Results: Naringin, hesperidin and neohesperidin presented absorption peaks at 30.115, 32.633 and 36.851 min, respectively. The water decoction of complete Wendan Decoction formula showed identical absorption peaks for the three components, with good baseline separation and no interference peaks. Through linear regression processing and standard curve plotting, it was found that the three components exhibited good linearity within their respective concentration ranges (r>0.999). The relative standard deviations (RSDs) of precision, stability and repeatability tests were all less than 2%, and the spiked recoveries met the required criteria. The extract yield of three batches of water decoction ranged from 11.96% to 14.59% (average 13.09%), and that of the three batches of concentrated solution ranged from 9.57% to 11.13% (average 10.31%). The transfer rate experiment showed that, the transfer rates of naringin, hesperidin and neohesperidin from herbal pieces to water decoction were 11.98%-13.00%, 20.00%-27.82% and 13.00%-17.00%, respectively; those from water decoction to concentrated solution were 81.99%-96.84%, 86.93%-100.00% and 82.91%-100.47%, respectively; and those from concentrated solution to lyophilized powder were 85.84%-114.69%, 89.86%-102.66% and 102.94%-104.92%, respectively. Conclusion: The established HPLC method for simultaneous determination of multi-index components of Wendan Decoction is accurate and reliable. Naringin, hesperidin and neohesperidin can be transferred completely through the process of "water decoction-concentrated solution-lyophilized powder", indicating that flavonoid components are effectively preserved without obvious loss during preparation.

目的: 分析医院门急诊抗菌药物的合理用药情况,为提高临床抗菌药物的合理用药水平提供参考。方法: 通过合理用药软件,选取 2023 年 2—12 月昆山市第五人民医院门急诊的 15 309 张抗菌药物处方作为研究资料,依据相关权威资料对处方中的抗菌药物开展专项点评,分析医院门急诊抗菌药物的不合理用药特点。结果: 处方点评结果显示,15 309 张抗菌药物处方中不合理处方共有 167 张,不合理率为 1.09%,即合理率为 98.91%;167 张不合理抗菌药物处方主要来自急诊内科（60 张,占 35.93%）和皮肤科（43 张,占 25.75%）,其次为妇科（17 张,占 10.18%）和急症外科（11 张,占 6.59%）;167 张不合理抗菌药物处方中,主要的不合理原因类型为适应证不适宜（94 张,占 56.29%）、用法用量不适宜（31 张,占 18.56%）和遴选药品不适宜（21 张,占 12.57%）。结论: 医院门急诊抗菌药物的使用整体较为合理,但仍存在部分不合理用药情况,对此管理部门应持续加强对临床的合理用药宣教和培训,以进一步提高其抗菌药物的合理用药水平,从而保证患者的疗效和用药安全。

目的: 分析成人破伤风患者的临床特点与死亡的危险因素,为临床诊疗提供参考。方法: 选取 2017 年 1 月—2024 年 9 月郑州市第六人民医院收治的 126 例破伤风成人患者的临床资料作为研究对象,收集患者的一般资料、基础疾病、受伤部位、潜伏期、致伤因素、临床表现及其并发症、治疗和预后情况等,按预后情况将患者分为死亡组（n=37）与非死亡组（n=89）,分析患者的临床特点,采用单因素、多因素 Logistic 回归分析成人破伤风患者死亡的危险因素。结果: 126 例成人破伤风患者的主要受伤部位为下肢（69 例,占 54.76%）、上肢（40 例,占 31.75%）和头部（7 例,占 5.56%）,主要致伤因素为铁钉、铁丝、刀、犁、镰刀外伤（43 例,占 34.13%）,树枝、草根、玻璃、竹制品外伤（35 例,占 27.78%）,以及车祸、挤压伤、重物砸伤（33 例,占 26.19%）,平均潜伏期为（9.31±2.54）d;发生全身性破伤风 107 例（占 84.92%）、局限性破伤风 19 例（占 15.08%）,发生并发症 73 例（占 57.94%）、自主神经功能障碍 14 例（占 11.11%）;患者 Ablett 分级为 Ⅰ、Ⅱ、Ⅲ、Ⅳ 级的分别为 23 例（占 18.25%）、26 例（占 20.63%）、64 例（占 50.79%）和 13 例（占 10.32%）,Ablett 分级为 Ⅲ、Ⅳ 级的患者（77 例,占 61.11%）均入住 ICU;基础疾病为冠心病、高血压,潜伏期、抗毒素用量、急性生理学和慢性健康状况评价（acute physiology and chronic health evaluation,APACHE）Ⅱ 评分,并发喉痉挛致窒息、心律失常,以及自主神经功能障碍、Ablett 分级为患者死亡的相关因素（P<0.05）;多因素 Logistic 回归分析结果显示,抗毒素用量、APACHE Ⅱ 评分,并发喉痉挛致窒息、心律失常,以及 Ablett 分级为 Ⅲ、Ⅳ 级是成人破伤风患者死亡的危险因素（P<0.05）。结论: 临床诊治成人破伤风患者需注重分析其临床特点,抗毒素用量、APACHE Ⅱ评分,并发喉痉挛致窒息、心律失常,以及 Ablett 分级为 Ⅲ、Ⅳ 级是成人破伤风患者死亡的危险因素,临床治疗时需给予重点关注。

Klebsiella pneumoniae (KP) can be classified into classic Klebsiella pneumoniae (cKP) and hypervirulent Klebsiella pneumoniae (hvKP) according to phenotypic characteristics and genetic markers. Epidemiological data indicate that hvKP infections are more prevalent among healthy community-dwelling adults, and its epidemic region has expanded from the Asia-Pacific region to a global scale. To better characterize hvKP, this article systematically reviews the biological and epidemiological features, virulence factors, drug resistance and related mechanisms of hvKP. This review aims to provide a reference for in-depth understanding of the pathogenic and drug-resistant nature of hvKP, as well as for the development of novel diagnostic and therapeutic strategies.

Objective: To analyze the anti-infective and anticoagulant treatment process of a patient with Listeria monocytogenes (LM) bloodstream infection complicated by meningitis and lower extremity deep vein thrombosis, explore the key points of pharmaceutical care in treatment of complex infections provided by clinical pharmacists, and provide a reference for rational clinical medication. Methods and Results: A 53-year-old male patient was admitted with fever and confusion. Piperacillin-tazobactam sodium was initially administered for empirical anti-infective treatment. The patient's condition then deteriorated, presenting with impaired consciousness and elevated intracranial pressure. LM was identified in both blood culture and cerebrospinal fluid culture, confirming the diagnosis of LM meningitis and sepsis. Owing to ampicillin shortage and the minimum inhibitory concentration (MIC) approaching the resistance breakpoint, clinical pharmacists recommended adjusting to a triple anti-infective regimen of meropenem (2.0 g, q8h) + amikacin (7.5 mg/kg, q12h) + compound sulfamethoxazole (0.8 g, q12h) based on guidelines and literature. After treatment, the patient's body temperature declined, cerebrospinal fluid parameters improved, and blood culture turned negative. During hospitalization, the patient developed lower extremity deep vein thrombosis. The anticoagulant regimen was switched from prophylactic to therapeutic dosage of low-molecular-weight heparin, followed by bridging therapy with rivaroxaban (15 mg, q12h initially; sequential 20 mg, q24h). Thrombosis was controlled with no bleeding events. After 34 days of treatment, both infection and thrombosis were effectively controlled. The patient was discharged on oral amoxicillin + rivaroxaban for consolidation therapy and recovered favorably during outpatient follow-up. Conclusion: LM bloodstream infection complicated by meningitis and lower extremity deep vein thrombosis is a complex condition requiring simultaneous anti-infective and anticoagulant treatment. Based on drug susceptibility results, pharmacokinetic/pharmacodynamic (PK/PD) properties and individual patient factors, clinical pharmacists contribute to optimizing anti-infective regimens and providing whole-course monitoring of anticoagulant therapy, playing a critical role in ensuring therapeutic efficacy and medication safety, reducing complications and improving patient prognosis.

目的: 分析老年股骨骨折患者术后并发肺部感染的影响因素,为老年股骨骨折患者术后感染的预防提供参考。方法: 选取 2020 年 3 月—2024 年 3 月平顶山市中医医院收治的 80 例老年股骨骨折患者作为研究对象,采集所有患者的年龄、性别、婚姻状况、吸烟史、饮酒史、基础疾病、手术时长、手术类型、住院时长等信息,以及老年股骨骨折患者术后肺部感染的发生情况,分析发生术后肺部感染的影响因素。结果: 80 例患者术后共有 16 例（占 20.00%）发生肺部感染;单因素分析结果显示,年龄、糖尿病史、低蛋白血症、意识障碍、吞咽障碍、住院时长、入住 ICU、侵入性操作与老年股骨骨折患者术后发生肺部感染相关（P<0.05）;Logistic 回归分析结果显示,年龄>75 岁（OR=3.413,95%CI 为 1.093~10.657）、有糖尿病史（OR=11.074,95%CI 为 2.818~43.517）、有低蛋白血症（OR=3.413,95%CI 为 1.093~10.657）、有意识障碍（OR=6.600,95%CI 为 1.893~23.012）、有吞咽障碍（OR=5.211,95%CI 为 1.593~17.048）、住院时长≥2 周（OR=4.200,95%CI 为 1.295~13.617）、入住 ICU（OR=4.385,95%CI 为 1.273~15.101）、有侵入性操作（OR=3.922,95%CI 为 1.212~12.686）为老年股骨骨折患者术后发生肺部感染的独立危险因素（P<0.05）。结论: 年龄>75 岁、有糖尿病史、有低蛋白血症、有意识障碍、有吞咽障碍、住院时长≥2 周、入住 ICU、有侵入性操作为老年股骨骨折患者术后发生肺部感染的危险因素,临床需据此制定相关预防措施。

Objective: To analyze the correlation between the drug resistance rate of Klebsiella pneumoniae (KP) and antibiotics use density (AUD) in a hospital from 2019 to 2024, so as to provide a basis for optimizing antibacterial drug management and empirical medication. Methods: Etiological results of all submitted specimens from inpatient wards and corresponding antibacterial drug use data in The First People's Hospital of Tianmen in Hubei Province from January 1, 2019 to December 31, 2024 were selected as research data. The data of Gram-negative bacteria and KP isolated from submitted specimens in inpatient wards were counted, and strain identification and drug susceptibility testing were carried out for the isolated strains. Results: A total of 21556 strains of Gram-negative bacteria were detected over the six years, including 3 755 strains of KP; the detection rate of KP in Gram-negative bacteria showed an overall upward trend. The proportion of extended-spectrum β-lactamase (ESBL)-producing strains decreased from 42.10% to 18.10%. The overall drug resistance rates of KP to ampicillin-sulbactam sodium, cefazolin, cefuroxime, ceftriaxone and compound sulfamethoxazole showed a decreasing trend (P<0.05), while the drug resistance rate to tigecycline remained 0.00%. The AUD of antibacterial drugs presented structural changes: the AUD of cefoperazonesulbactam sodium decreased significantly (P<0.01), while the AUD of piperacillin, cefazolin, cefotaxime, amikacin and tigecycline showed an increasing trend (P<0.05). Pearson correlation analysis showed no significant correlation between the drug resistance rate of each antibacterial drug and its own AUD (P>0.05). Fullmatrix correlation analysis revealed that the detection rate of ESBL producing strains was highly positively correlated with the AUD of cefoperazonesulbactam sodium (r=0.97, P<0.01) and cefoxitin (r=0.88, P<0.05). The drug resistance rate of compound sulfamethoxazole was significantly negatively correlated with the AUD of cefotaxime, amikacin and tigecycline (r<–0.85, P<0.05). Conclusion: There is a complex correlation between the structural change of antibacterial drug use and the evolution of drug resistance spectrum, but the correlation between the drug resistance rate of a single drug and its use density is limited. Strengthening medication monitoring and multidimensional correlation analysis will help formulate more precise antibacterial drug management strategies.

目的：分析 2021—2024 年郑州市第二人民医院左氧氟沙星相关药物不良反应（adverse drug reactions,ADRs）的发生情况与临床特征,为促进临床安全、合理用药提供参考。方法：选取 2021 年 1 月 1 日—2024 年 12 月 31 日郑州市第二人民医院上报至国家药品不良反应监测系统的 70 例左氧氟沙星相关 ADRs 患者作为研究对象,采集左氧氟沙星相关 ADRs 所涉患者的性别、年龄、原患疾病,累及的器官系统或部位及其临床表现、转归和严重 ADRs 的临床特点,以及左氧氟沙星相关 ADRs 所涉药品的品规、给药途径、用法用量,分析左氧氟沙星相关 ADRs 发生情况与临床特征。结果：70 例左氧氟沙星相关 ADRs 所涉患者的性别主要为女性（占 74.29%）,年龄主要为>20~45 岁（占 38.57%）,所涉患者的原患疾病主要为消化系统感染（占 34.29%）;所涉药品的品规主要为左氧氟沙星氯化钠注射液（占 68.57%）,给药途径主要为静脉滴注（占 97.14%）,用法用量主要为“0.5 g,q24h,静脉滴注”（占 85.71%）;严重 ADRs 有 9 例（占 12.86%）,左氧氟沙星相关 ADRs 累及的主要器官系统或部位为皮肤及其附属器（占 72.86%）,其次为消化系统（占 17.14%）和心血管系统（占 14.29%）;经对症处理,61 例一般 ADRs 所涉患者中 30 例好转（占 49.18%）、30 例治愈（占 49.18%）,9 例严重 ADRs 中 5 例好转（占 55.56%）、4 例治愈（占 44.44%）。结论：左氧氟沙星相关 ADRs 多见于罹患消化系统感染的中青年女性患者,且大部分报告与静脉给药方式有关,累及的器官系统或部位以皮肤及其附属器为主;临床应重点关注高危人群与给药方式,加强用药监测以确保患者安全、合理用药。

Chemotherapy for malignant tumors often gives rise to prominent systemic toxic and side effects due to lack of drug targeting capability. Biomimetic drug delivery systems, constructed on the basis of living cells with innate targeting capacity, can overcome complex physiological barriers in vivo and represent an effective strategy for precise drug delivery. With inherent phagocytic function, excellent tumor tropism, potent immunomodulatory activity and distinctive vascular penetration properties, macrophages are ideal carriers for the construction of tumor-targeted delivery systems. Macrophage-based biomimetic drug delivery systems have exhibited promising application prospects in tumor therapy. This article systematically reviews the construction strategies of macrophage-biomimetic drug delivery systems and their application progress in tumor therapy, and discusses the future development directions in this field, aiming to provide a reference for designing more efficient and intelligent macrophage-biomimetic drug delivery systems and facilitate their clinical translation.

目的：分析某院 2018—2023 年全身用抗菌药物相关药物不良反应（adverse drug reactions,ADRs）的发生情况与临床特点,为临床抗菌药物的合理使用提供参考。方法：选取 2018 年 1 月—2023 年 12 月南京医科大学附属无锡人民医院上报至国家药品不良反应监测系统的 1 264 例全身用抗菌药物相关 ADRs 报告作为研究资料,采集报告类型、所涉患者的年龄和性别、所涉药物品种和剂型,以及累及器官（或系统）等信息。结果：1 264 例抗菌药物相关 ADRs 的报告中,报告类型主要为“一般”（1 056 例,占 83.54%）,关联性评价结果主要为“可能”（1 072 例,占 84.87%）;ADRs 所涉患者以男性居多（641 例,占 50.7%）,年龄分布以≥64 岁年龄组为主（377 例,占 29.8%）;给药途径以静脉给药（1 104 例,占 87.34%）为主,排名前 3 位的药物种类分别是头孢菌素类（含酶抑制剂）（291 例,占 23.02%）、喹诺酮类（270 例,占 21.36%）和青霉素类（含酶抑制剂）（242 例,占 19.15%）;ADRs 主要累及皮肤及其附件（587 例,占 46.44%）,其次为消化系统（262 例,占 20.73%）和神经系统（145 例,占 11.47%）;患者经处置后绝大多数好转（892 例,占 70.57%）或痊愈（313 例,占 24.76%）。结论：抗菌药物引起的 ADRs 多见于老年患者,主要涉及头孢菌素类（含酶抑制剂）、喹诺酮类和青霉素类抗菌药物,给药途径以静脉给药居多,多累及皮肤及其附件,临床对相关患者应加强监护和管理,以保障用药安全。

Objective: To analyze the anti-infective therapy and pharmaceutical care process of a patient with liver abscess complicated by pulmonary infection, and provide a reference for the clinical treatment of such patients. Methods and Results: A patient was admitted with headache, generalized soreness, cough and expectoration, nausea, vomiting, abdominal pain, high fever and chills. The admitting diagnoses were ''pulmonary infection'' and ''acute bronchitis'', and cefotaxime sodium was used for initial anti-infective therapy. As the infection continued to aggravate during treatment, the medication was adjusted to cefoperazone-sulbactam sodium (cefoperazone: sulbactam = 1:1, 3 g, q12h, intravenous infusion) after pharmacist consultation. On the 5th day of admission, the patient's symptoms still did not improve and infection indicators increased; after communication between pharmacists and physicians, the anti-infective therapeutic regimen was adjusted to cefoperazone-sulbactam sodium (cefoperazone: sulbactam = 2:1, 3 g, q8h, intravenous infusion) plus levofloxacin injection. On the 8th day of admission, the patient suffered from severe epigastric pain. Contrast-enhanced abdominal CT revealed a space-occupying lesion in the left hepatic lobe, highly suggestive of liver abscess. The clinical diagnosis of ''liver abscess'' was added, and percutaneous puncture and catheter drainage of the liver abscess was performed on the same day, without adjustment of the anti-infective therapeutic regimen. On the 13th day of admission, the patient developed bitter mouth, dry mouth, abdominal distension, abdominal pain, chest tightness and shortness of breath, and was given domperidone tablets, phloroglucinol injection and Zhichuanling Injection for symptomatic treatment. On the first day of this treatment, the patient presented with involuntary hand movement, restlessness, hallucination and impulsive behavior. After correlation analysis of adverse drug reactions, the pharmacist recommended discontinuing domperidone tablets, Zhichuanling Injection and levofloxacin and sodium chloride injection; the neurological symptoms resolved completely after drug withdrawal. On the 22nd day of admission, the patient's symptoms and laboratory findings improved significantly, and discharge was approved. The clinical pharmacist provided discharge medication advice, recommending amoxicillin-clavulanate potassium tablets plus metronidazole tablets. Conclusion: Through participation in the treatment and medication monitoring of a patient with liver abscess complicated by pulmonary infection, clinical pharmacists have adjusted anti-infective agents, identified and managed adverse drug reactions in a timely manner, thereby improving therapeutic efficacy and ensuring medication safety.

目的: 分析 2023 年苏州市第九人民医院上报药物不良反应（adverse drug reactions,ADRs）的流行病学特征,为临床安全合理用药提供参考。方法: 选取 2023 年 1—12 月苏州市第九人民医院上报至国家药品不良反应监测系统的 612 例 ADRs 报告作为研究资料,对报告类型、患者性别和年龄、涉及药物类别与剂型、累及器官（或系统）等数据进行统计分析。结果: 612 例 ADRs 报告中,报告类型以“一般”为主（440 例,占 71.90%）,其后依次为“严重”（101 例,占 16.50%）、“新的一般”（65 例,占 10.62%）和“新的严重”（6 例,占 0.98%）;ADRs 报告所涉女性患者（311 例,占 50.82%）略多于男性患者（301 例,占 49.18%）;患者年龄以>65 岁居多（289 例,占 47.22%）,其次为>45~65 岁（203 例,占 33.17%）;ADRs 所涉主要的药物类别为抗感染药物（196 例,占 32.03%）和抗肿瘤药物（124 例,占 20.26%）;所涉药物的剂型主要为注射剂（345 例,占 56.37%）和粉针剂（138 例,占 22.55%）;ADRs 最常累及器官（或系统）为皮肤及其附件（201 例,占 32.84%）,其次为消化系统（165 例,占 26.96%）。结论: 医院 2023 年上报的 ADRs 具有老年患者多发、抗感染与抗肿瘤药物风险突出、静脉给药为主要风险途径、累及器官（或系统）以皮肤及其附件和消化系统为主等特征;建议加强对老年患者和重点药物的用药监护,规范静脉给药操作,并持续强化对“新的”和“严重”ADRs 的监测与上报,以提升用药安全水平。

目的: 分析医院静脉用药调配中心（pharmacy intravenous admixture service,PIVAS）不合理医嘱的发生情况与相关特点,为临床静脉用药的安全、合理用药提供参考。方法: 选取 2023 年 9 月—2025 年 8 月宜兴市人民医院 PIVAS 接收的 448 630 条医嘱作为研究资料,采集医嘱中药品的名称、剂型、用法用量、所用溶媒,以及医嘱所涉科室等信息,依据权威资料,对医嘱进行合理用药点评,分析 PIVAS 不合理医嘱的发生情况与相关特点。结果: 医嘱点评结果显示,医院 PIVAS 448 630 条医嘱中共发现不合理医嘱 681 条（不合理发生率为 1.52‰）,其中 2023—2025 年的医嘱不合理发生率分别为 2.95‰、1.23‰、1.31‰,总体呈下降态势;在 PIVAS 的 681 条不合理医嘱中,前 5 位来源科室分别为肿瘤科（92 条,占 13.51%）、消化内科（71 条,占 10.43%）、肝胆胰腺外科（54 条,占 7.93%）、骨科中心（38 条,占 5.58%）和血液科（37 条,占 5.43%）;PIVAS 的 681 条不合理医嘱共涉及 18 类 110 种药品,帕累托图分析结果显示,维生素和肠内外营养药等（178 条,占 26.14%）、消化系统用药（118 条,占 17.33%）、中药注射剂（111 条,占 16.30%）、抗菌药物（54 条,占 7.93%）,以及调节水、电解质和酸碱平衡的药物（48 条,占 7.05%）是不合理医嘱的主要涉及品类;在 110 种药品中所涉不合理医嘱数≥10条的药品有 11 种,其中前 3 位分别为维生素 C 注射液（122 条,占 17.91%）、注射用间苯三酚（61 条,占 8.96%）、苦黄注射液（40 条,占 5.87%）;681 条不合理医嘱不合理的原因有 11 种,其中溶媒选择不适宜（180 条,占 26.43%）、联合使用不适宜（164 条,占 24.08%）、浓度不适宜（137 条,占 20.12%）是主要的原因类型;54 条与抗菌药物相关的不合理医嘱共涉及抗菌药物 16 种,其中前 3 位的依次为注射用替考拉宁（15 条,占 27.78%）、奥硝唑注射液（9 条,占 16.67%）、亚胺培南-西司他丁钠（8 条,占 14.81%）,其所涉的不合理原因主要为溶媒选择不适宜（24 条,占 44.44%）、浓度不适宜（13 条,占 24.07%）、给药剂量不适宜（9 条,占 16.67%）;164 条联合使用不适宜的医嘱中,有 115 条（占 70.12%）与胰岛素有关,典型案例为维生素 C 注射液+胰岛素注射液（90 条,占 54.88%）。结论: 医院 PIVAS 的不合理医嘱发生率总体处于较低水平,但不合理医嘱所涉的药物品类和原因类型呈现相对集中的特点,对此医院管理部门可对临床针对性地开展相关培训和考核,以提高其合理用药的水平,进而保障患者的用药安全。

目的: 分析 PDSA 在降低住院患者抗菌药物使用强度（antibiotics use density,AUD）中的效果,为临床抗菌药物的合理应用与管理提供参考。方法: 选取 2024 年 1—12 月医院住院患者抗菌药物使用情况作为研究资料,将 2024 年 1—3 月实施 PDSA 前的资料设为实施前组,2024 年 4—12 月的设为实施后组,分析实施 PDSA 前后全院各科室 AUD 达标情况和抗菌药物使用率的变化情况。结果: 实施 PDSA 的持续改进项目后,临床科室 AUD 未达标数量呈下降趋势,不达标率最低降至 7.14%;全院 28 个临床科室中 21 个科室 AUD 较实施前降低;医院住院患者 AUD 也有所下降,2024 年 4 月下降至 38.03,整体 AUD 均在目标值以下,最低为 28.66;2024 年全年 AUD 为 33.94,较 2023 年度 AUD 值 35.91 下降 5.49%;医院住院患者抗菌药物使用率下降明显,始终维持在目标值以内,最低降至 42.13%。结论: 通过实施 PDSA 显著降低住院患者 AUD 和抗菌药物的使用率,均达到国家三级公立医院的标准,促进了抗菌药物的临床合理应用。

目的: 分析医院 2020—2024 年所上报的中药制剂相关药物不良反应（adverse drug reactions,ADRs）的流行病学特点,为临床合理用药提供参考。方法: 选取 2020—2024 年苏州市中西医结合医院上报至国家药品不良反应监测中心的 171 例中药制剂相关的 ADRs 报告作为研究资料,收集 ADRs 的报告类型,ADRs 报告所涉患者性别和年龄、中药制剂种类、给药途径,以及 ADRs 累及器官（或系统）和临床表现,分析中药制剂相关 ADRs 的流行病学特点。结果: 2020—2024 年,医院上报的中药制剂相关 ADRs 报告类型为“一般”的 83 例（占 48.54%）,为“严重”的 56 例（占 32.75%）;所涉患者男性与女性数量相当（88 例 vs 83 例）;患者年龄以>60 岁为主（63 例,占 36.84%）,其次为>45~60 岁（51 例,占 29.82%）;所涉中药制剂按功效分类,主要为活血类（87 例,占 49.15%）,其次为清热类（41 例,占 23.16%）;所涉药品品种主要为注射用血栓通（冻干）（18 例,占 10.17%）、舒肝宁注射液（17 例,占 9.60%）,以及参麦注射液（13 例,占 7.34%）;所涉中药制剂的给药方式主要为静脉给药（105 例,占 59.32%）,其次为口服给药（50 例,占 28.25%）;ADRs 以累及皮肤及其附件的发生率最高（100 例,发生率 58.48%）,其次为心血管系统（30 例,发生率 17.54%）。结论: 患者年龄、给药途径、药品种类等方面有着较明显的特点,临床应加强对中老年、有过敏史或肝肾功能异常患者的用药监护与教育,并完善 ADRs 监测体系,以提升用药安全水平。

Objective: To mine and analyze adverse drug events (ADEs) of four antibacterial drugs (vancomycin, linezolid, teicoplanin and daptomycin) used for treating pediatric methicillin-resistant Staphylococcus aureus (MRSA) infections in the real world based on the U.S. FDA Adverse Events Reporting System (FAERS) database, so as to provide evidence for safe and rational clinical medication. Methods: By using "vancomycin", "linezolid", "teicoplanin" and "daptomycin" as keywords, ADEs with these drugs as the suspected drugs from January 1, 2004 to June 30, 2024 were searched in the FAERS database, and related information on ADEs was collected to analyze the clinical characteristics of the associated ADEs. Results: After screening in the FAERS database, the numbers of eligible ADE reports for vancomycin, linezolid, teicoplanin and daptomycin were 3 707, 1 004, 460 and 196 respectively, and the numbers of included ADE signals were 285, 115, 77 and 29 respectively. Among the included ADEs, reports of linezolid, teicoplanin and daptomycin were mainly from Europe, including 416 cases (41.43%), 357 cases (77.61%) and 157 cases (80.10%) respectively, while vancomycin reports were predominantly from the United States (1 253 cases, 33.80%) and Europe (1 242 cases, 33.50%). Regarding age distribution, vancomycin recipients were concentrated at 0 to less than 6 years (1 498 cases, 40.41%); linezolid users showed a relatively balanced age distribution; teicoplanin was mostly used in patients aged 12 to less than 18 years (199 cases, 43.26%); daptomycin was mainly administered to those aged 6 to less than 12 years (137 cases, 69.90%). For gender distribution (excluding unknown or unclear cases), males outnumbered females in all groups, with male-to-female ratios of 1.24 (vancomycin), 1.60 (linezolid), 1.09 (teicoplanin) and 2.70 (daptomycin) respectively. Positive ADE signal reports and signals of the four drugs were classified by system organ class (SOC). Vancomycin involved 23 SOCs (the most diverse), followed by linezolid (20), teicoplanin (15) and daptomycin (11). "Infections and infestations" and "systemic diseases and administration site conditions" were among the top 5 SOCs for all four agents, while other involved SOCs differed. ADEs of the four antibacterial drugs all showed strong associations with "infections and infestations". In terms of Preferred Terms (PT), vancomycin presented a strong signal and high report count for "vancomycin infusion reaction"; linezolid showed a prominent signal strength in "nervous system diseases", such as "toxic neuropathy" and "dysdiadochokinesia". For teicoplanin, ADE signals including "ventricular thrombosis", "myocardial injury" and "ankylosis" each had only 3 reports but showed strong correlation, and were not documented in the package insert. For daptomycin, apart from "delayed therapeutic response" and "non-responder to treatment", its ADE signals were mostly concentrated in "metabolism and nutrition disorders", consistent with its high-frequency ADE profiles. Conclusion: There are both similarities and differences in SOCs involved in ADEs of the four antibacterial drugs, which can guide the clinical selection of appropriate antibacterial drugs to maintain therapeutic efficacy while improving medication safety in pediatric patients.

Objective: To analyze the diagnosis and anti-infective treatment process of a patient with Cryptococcus gattii pneumonia, and provide a reference for the early identification and standardized treatment of Cryptococcus gattii infection. Methods and Results: The patient was admitted to the hospital due to cough and expectoration for 1 week. Based on the patient's symptoms, laboratory findings and chest CT results, the patient was initially diagnosed with pulmonary infection and received empirical therapy with moxifloxacin, which was later switched to piperacillin-sulbactam sodium. On the 8th day after admission, the patient's fever, cough and expectoration showed no obvious improvement, and Pseudomonas aeruginosa was detected by sputum culture; the antiinfective regimen was then adjusted to biapenem according to the etiological results. On the 11th day after admission, the patient still had fever, and metagenomic nextgeneration sequencing of bronchoalveolar lavage fluid detected Cryptococcus gattii VG Ⅰ with a sequence count of 20. Despite the low sequence count, clinicians identified Cryptococcus gattii as the pathogenic bacterium in combination with the patient's clinical manifestations and response to antiinfective therapy. After thorough evaluation by physicians and pharmacists, antifungal therapy with liposomal amphotericin B plus flucytosine was initiated. The patient's body temperature returned to normal after 3 days of antifungal therapy. After 2 weeks of antifungal therapy, fever and cough were significantly relieved, and chest CT showed resolution of bilateral pulmonary lesions. Conclusion: Different from Cryptococcus neoformans, which mainly infects immunocompromised individuals, Cryptococcus gattii primarily targets immunocompetent people. Moreover, Cryptococcus gattii rarely causes pulmonary infection and mostly presents with atypical clinical manifestations, leading to easy misdiagnosis or neglect. Therefore, high clinical vigilance should be paid to immunocompetent patients with poor response to empirical treatment. Advanced molecular biological detection techniques are recommended for auxiliary diagnosis to achieve early definite diagnosis and targeted therapy, thereby promoting patient recovery.

Objective: To investigate the in vitro antibacterial activity and mechanism of ethyl gallate against common clinical pathogenic bacteria, and provide a reference for the development of clinical drugs for bacterial infections. Methods: The broth microdilution method was used to determine the minimum inhibitory concentrations (MICs) of ethyl gallate against Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Shigella flexneri and Salmonella, so as to evaluate its in vitro antibacterial activity against pathogenic bacteria. Biochemical methods were used to measure the contents of extracellular alkaline phosphatase, nucleic acids and proteins in bacteria, so as to explore the antibacterial mechanism of ethyl gallate. Results: Ethyl gallate showed the strongest activity against Staphylococcus aureus, Streptococcus pneumoniae and Shigella flexneri (MIC = 256.0 μg/mL), followed by Escherichia coli and Salmonella enterica (MIC = 512.0 μg/mL), and the weakest activity against Klebsiella pneumoniae and Pseudomonas aeruginosa (MIC = 1 024.0 μg/mL). Compared with the blank group, the extracellular levels of alkaline phosphatase, nucleic acids and proteins in Staphylococcus aureus and Shigella flexneri were significantly increased after 6 h of treatment with 256.0 μg/mL ethyl gallate (P<0.01). Conclusion: Ethyl gallate exhibits favorable broad-spectrum antibacterial activity against common clinical pathogenic bacteria, and its antibacterial mechanism may be related to destroying the integrity of the bacterial cell wall and cell membrane.

目的: 探究喘息性疾病患儿监护人居家雾化用药安全风险知信行（knowledge-attitude-practice,KAP）现状及其影响因素,为居家雾化安全用药科普干预内容、方法的设置和促进治疗的有效开展提供依据。方法: 采用方便抽样法,选取焦作、郑州、开封、周口、南阳、信阳、新乡等市 18 岁以下喘息性疾病患儿的主要监护人为研究对象,以“问卷星”平台和现场发放问卷的形式对居家雾化用药进行 KAP 情况调查,分析受访者的接受度、用药 KAP 现状及其风险点,并采用单因素方差分析、多重线性回归等方法分析其影响因素。结果: 共纳入问卷 666 份,接受居家雾化吸入治疗的有 493 人,接受率为 74.02%;监护人用药知识、态度和行为的平均得分均处于良好水平;单因素分析显示不同的监护人年龄、居住地、教育程度、职业、来医院单程时间、患儿医保和诊断情况在监护人用药知识得分中的差异具有统计学意义（P<0.05）,不同的监护人年龄、居住地、教育程度、职业、来医院单程时间、患儿的年龄和诊断情况在监护人用药态度得分中的差异具有统计学意义（P<0.05）,不同的监护人与孩子的关系、年龄、居住地、教育程度、职业、来医院单程时间,以及患儿年龄、医保情况和诊断情况在监护人用药行为得分中的差异具有统计学意义（P<0.05）;多重线性回归分析结果显示,影响居家雾化用药知识得分的因素是监护人年龄、居住地、教育程度、来医院单程时间和患儿医保情况（P<0.05）,影响居家雾化用药态度得分的因素有监护人年龄、居住地、教育程度、来医院单程时间和患儿的诊断（P<0.05）,影响居家雾化用药行为得分的因素有居住地、职业和来医院单程时间（P<0.05）。结论: 河南地区喘息性疾病患儿监护人对居家雾化治疗的接受度较高,多数监护人对安全用药知识、态度与行为的掌握情况良好;未来健康宣教应重点关注老年人、低学历和自由职业者等群体,实施个性化干预以提升居家雾化用药安全。

Objective: To analyze the virulence characteristics of clinical Klebsiella pneumoniae (KP) isolates and their correlation with drug resistance, and provide a reference for the clinical prevention and treatment of KP infections. Methods: A total of 121 KP strains isolated from specimens of inpatients in various clinical departments of Zhenjiang Hospital of Integrated Traditional Chinese and Western Medicine from January to October 2024 were selected as the research materials. The mucoid phenotype, capsular serotypes (K1, K2, K5, K20, K54 and K57) and virulence genes (rmpA, magA, wcaG, fimH, kfu and Aero) of KP were detected by mucus thread formation test and polymerase chain reaction (PCR). Drug resistance of the KP isolates was determined using the VITEK 2 Compact automatic microbial identification and drug susceptibility analyzer. Finally, the virulence characteristics of clinical KP isolates and their correlation with drug resistance were analyzed. Results: Capsular serotyping of KP showed that all six capsular serotypes were detected, among which K2 was the most prevalent (29 strains, 23.97%), followed by K1 (19 strains, 15.70%) and K57 (12 strains, 9.92%); 48 strains (39.67%) were untyped. Virulence gene detection revealed that, all six virulence genes were detected, with the highest detection rate for fimH (102 strains, 84.30%), followed by rmpA (77 strains, 63.64%) and Aero (77 strains, 63.64%). The magA gene was exclusively detected in K1 strains (19 strains, 15.70%), and wcaG only in K1 and K54 strains (23 strains, 19.01%). The mucus thread formation test showed that, among the 121 isolates, 71 (58.68%) were hypermucoviscous (HV) phenotype and 50 (41.32%) were non-hypermucoviscous (non-HV). The HV isolates were dominated by K1 (16 strains, 22.54%), K2 (24 strains, 33.80%) and K57 (12 strains, 16.90%), whereas 40 (80.00%) non-HV isolates were untyped, with no K5 or K57 detected. Statistical analysis showed significant differences in capsular serotype distribution between HV and non-HV strains (P<0.05). The detection rates of Aero, rmpA and fimH in 71 HV isolates were all above 70.00%, while only fimH showed a high detection rate (92.00%) in 50 non-HV isolates. Significant differences were found in the detection rates of rmpA, wcaG and Aero between the two phenotypes (P<0.05). Drug susceptibility test showed, both phenotypes exhibited 100.00% resistance to ampicillin. HV isolates showed low resistance (less than 10.00%) to all tested antibacterial drugs other than ampicillin, whereas non-HV isolates had resistance rates of less than 10.00% only to meropenem and minocycline. Statistical analysis revealed significant differences in resistance rates between HV and non-HV strains against cefuroxime, ceftriaxone, ceftazidime, cefepime, cefoxitin, piperacillin-tazobactam sodium, gentamicin, amikacin, compound sulfamethoxazole, ciprofloxacin, levofloxacin and imipenem (all P<0.05). Drug-resistant enzyme detection showed that, among the 121 isolates, 27 produced extended-spectrum β-lactamases (ESBLs) and 5 were carbapenem-resistant Klebsiella pneumoniae (CRKP). ESBL-producing/CRKP isolates showed significantly lower detection rates of HV phenotype and common capsular serotypes than non-ESBL-producing/CRKP isolates (9.38% vs 76.40%, P<0.05; 12.50% vs 77.53%, P<0.05). In terms of virulence genes, the detection rates of Aero, rmpA, wcaG and magA were also significantly lower in ESBL-producing/CRKP strains (P<0.05). Conclusion: Clinical HV KP isolates generally display high expression of virulence genes and specific capsular serotypes, but exhibit lower resistance to most antibacterial drugs than non-HV isolates.

目的：分析结核性胸膜炎患者并发胸膜结核瘤的危险因素,为该并发症的临床防治提供参考依据。方法：选取 2023 年 6 月—2024 年 6 月扬州市第三人民医院收治的 120 例结核性胸膜炎患者作为研究对象,采集患者的临床特征（如初治或复治、胸腔积液部位和积液量）和治疗措施（是否胸腔内注入尿激酶、是否使用糖皮质激素等）等信息,统计患者胸膜结核瘤的发生情况,采用单因素分析和多因素 Logistic 回归分析,明确并发胸膜结核瘤的独立危险因素。结果：120 例结核性胸膜炎患者中,并发胸膜结核瘤的有 50 例;单因素分析结果显示,结核性胸膜炎并发胸膜结核瘤与胸腔积液量、是否注入尿激酶和是否使用糖皮质激素有关（P<0.05）;多因素分析结果显示,大量胸腔积液（OR>1 且 P<0.05）是胸膜结核瘤发生的危险因素,胸腔内注入尿激酶（OR<1 且 P<0.05）和使用糖皮质激素（OR<1 且 P<0.05）为胸膜结核瘤发生的保护因素。结论：大量胸腔积液是结核性胸膜炎患者并发胸膜结核瘤的独立危险因素,而胸腔内注入尿激酶和使用糖皮质激素可能具有保护作用;临床实践中应重视对大量胸腔积液患者的监测与管理,并在评估获益与风险的基础上,考虑合理使用尿激酶和糖皮质激素,以降低胸膜结核瘤的发生风险。

目的: 分析院科两级管理模式对 ICU 患者呼吸机相关性肺炎（ventilator-associated pneumonia,VAP）的防控成效,为临床住院患者 VAP 的防范提供参考。方法: 选取 2023 年 1—6 月（468 例,设为干预前组）与 2024 年 1—6 月（502 例,设为干预后组）韶关市第一人民医院 ICU 收治的住院患者作为研究对象,干预前组患者使用呼吸机时采取传统管理模式,而干预后组患者使用呼吸机时采取院科两级管理模式,比较 2 组患者的VAP 防控措施执行率、有创机械通气率和 VAP 发生密度差异。结果: 干预后组的正确执行手卫生、床头抬高 30°~45°、加强口腔护理、每日拔管评估和整体防控措施的执行率均显著高于干预前组（P<0.01）,但在吸痰无菌操作、每周更换呼吸机管路、湿化器用无菌水且每日更换的执行率方面与干预前组无显著差异（P>0.05）;2 组患者的呼吸机有创机械通气率经比较其差异无统计学意义（P>0.05）;干预后组患者的 VAP 发生密度显著低于干预前组（3.595‰ vs 6.438‰,P<0.05）。结论: 院科两级管理模式可有效提升 ICU 的 VAP 防控措施执行率,并降低患者的 VAP 发生密度。

Objective: To analyze the pharmaceutical care process of an elderly patient with multiple comorbidities complicated with candidemia, and explore the role of clinical pharmacists in individualized anti-infective therapy. Methods and Results: A patient was admitted due to "poor appetite and fatigue for 1 month and fever for 1 day", and was diagnosed with infectious fever and right ureteral calculi with hydronephrosis, followed by ureteral stent placement. The patient's postoperative infection deteriorated, and Enterococcus faecium (vancomycin-sensitive) and Candida albicans were successively detected. Clinical pharmacists assisted in adjusting the anti-infective regimen to fluconazole plus vancomycin plus meropenem. In view of the patient receiving continuous venovenous hemofiltration (CVVH), pharmacists suggested increasing the dosage of fluconazole from 0.2 g/d to 0.4 g/d to ensure effective plasma concentration. When infection indicators improved and fungi were confirmed as the predominant pathogen, pharmacists promptly recommended discontinuing vancomycin and meropenem and carrying out de-escalation therapy. During treatment, pharmacists monitored and managed drug interactions between fluconazole and atorvastatin, metoprolol, etc., preventing potential adverse drug reactions. After 4 weeks of antifungal treatment, the patient became afebrile with improved infection indicators, and oral fluconazole was prescribed for consolidation therapy after discharge. Conclusion: For patients with complex candidemia, clinical pharmacists participate in dosage adjustment, de-escalation decision-making, drug interaction management and whole-course monitoring, which markedly reduces pharmacotherapy risks while ensuring therapeutic efficacy, reflecting the core value of pharmaceutical expertise in multidisciplinary collaboration.

目的: 分析苏州地区妊娠晚期妇女 B 族链球菌（group B Streptococcus,GBS）的感染情况,并探讨不同年龄、血型、阴道环境对妊娠晚期孕妇 GBS 感染的影响,为该地区孕妇 GBS 感染的早期预防和高危人群筛查提供循证依据。方法: 选取 2018 年 1 月—12 月在医院产科门诊产检的 7 769 例妊娠晚期妇女作为研究对象,采集其阴道下 1/3 分泌物和直肠分泌物,采用 GBS 专用选择性显色培养基进行培养鉴定,分析孕妇年龄、血型、阴道环境与 GBS 阳性率的关系。结果: 共纳入 7 769 例孕妇,其中 GBS 阳性者 620 例,总阳性率为 7.98%;按年龄段分析结果显示,>39 岁年龄段孕妇 GBS 阳性率最高（12.12%）,其次为>29~34 岁年龄段（8.62%）,各年龄段 GBS 阳性率差异无统计学意义（χ²=3.92,P=0.42）;按血型分析结果显示,A 型、B 型、AB 型、O 型血孕妇 GBS 阳性率分别为 7.64%、8.64%、6.67%、8.31%,Rh 阳性、阴性血型孕妇 GBS 阳性率分别 8.01%、3.70%,不同血型的孕妇 GBS 阳性率差异无统计学意义（P>0.05）;阴道微生态和炎症指标分析结果显示,阴道分泌物检出霉菌的妊娠晚期妇女 GBS 阳性率显著高于未见霉菌者（10.57% vs 7.82%,P=0.04）;妊娠晚期妇女 GBS 感染与阴道分泌物滴虫、白细胞计数、上皮细胞计数和阴道清洁度均无相关性（均 P>0.05）。结论: 妊娠晚期妇女 GBS 感染与阴道霉菌感染相关,孕妇在备孕和怀孕期间应该严格注意阴道清洁卫生,尤其注意避免霉菌感染。

目的: 分析和评价多黏菌素 B 联合不同抗菌药物对耐多黏菌素 B 革兰阴性杆菌的体外抗菌效果,为临床耐多黏菌素 B 革兰阴性杆菌感染患者的抗感染治疗提供参考。方法: 选取 2021 年 11 月—2024 年 8 月前海人寿南宁医院重症医学科和呼吸内科患者中获得的 32 株非重复耐多黏菌素 B 革兰阴性杆菌作为研究资料,采用微量肉汤稀释法检测多黏菌素 B 与 11 种不同抗菌药物对耐多黏菌素 B 革兰阴性杆菌的最低抑菌浓度（minimal inhibit concentration,MIC）,另采用棋盘法测定多黏菌素 B 与多种抗菌药物联合的抑菌作用,并以联合抑菌指数（fractional inhibitory concentration index,FICI）判断多黏菌素 B 与不同抗菌药物的联合抗菌效果。结果: 菌种鉴定结果显示,32 株耐多黏菌素 B 革兰阴性菌中肺炎克雷伯菌有 12 株,大肠埃希菌有 4 株,鲍曼不动杆菌有 16 株;并且,有 14 株携带碳青霉烯酶基因,其中 10 株携带 bla_KPC,2 株携带 bla_NDM,2 株携带 bla_IMP;32 株革兰阴性菌中,MIC₅₀ 和 MIC₉₀ 最低的药物是多黏菌素 B（其值分别为 4 和 64 mg/L）,其次是替加环素和头孢他啶-阿维巴坦钠（其 MIC₅₀ 和 MIC₉₀ 值分别为 8 和 128 mg/L）;根据药敏折点,32 株革兰阴性菌对多黏菌素 B 和替加环素的耐药率最高（均为 100.00%）,同时对美罗培南、头孢他啶、头孢吡肟、氨曲南也有着极高的耐药率（均>90.00%）;对于肺炎克雷伯菌和大肠埃希菌,多黏菌素 B 与阿维巴坦联合具有较好的协同作用,而与其他 β-内酰胺酶抑制剂联合时不表现出任何相互作用;对于鲍曼不动杆菌,多黏菌素 B 与舒巴坦或阿维巴坦联合具有较好的协同作用,而与其他 β-内酰胺酶抑制剂联合时不表现出任何相互作用;FICI 测定结果显示,多黏菌素 B+美罗培南-阿维巴坦钠对大肠埃希菌、肺炎克伯菌和鲍曼不动杆菌均表现为协同作用,而多黏菌素 B+替加环素、多黏菌素 B+头孢他啶-阿维巴坦钠、多黏菌素 B+头孢吡肟-阿维巴坦钠对大肠埃希菌、肺炎克伯菌和鲍曼不动杆菌表现为协同或相加作用。结论: 多黏菌素 B 联合美罗培南-阿维巴坦钠对耐多黏菌素 B 革兰阴性杆菌具有较好的体外协同抗菌作用,可能可以成为临床治疗耐多黏菌素 B 革兰阴性杆菌感染的潜在选择。