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 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.

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.

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.

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。

目的：基于帕累托图分析法,分析医院门诊不合理处方的主要原因类型,并对典型案例进行剖析,为促进临床合理用药提供参考。方法：选取 2021 年 1 月—2022 年 12 月上高县中医院门诊处方点评工作中发现的 682 张不合理处方作为研究资料,梳理每张处方的不合理原因类型,采用帕累托图分析法分析引发不合理用药的主要原因特点。结果：682 张不合理处方中,以用药不适宜处方为最多（538 张,占 78.89%）,其次为不规范处方（113 张,占 16.57%）,超常处方最少（31 张,占 4.54%）;538 张用药不适宜处方中,用法用量不适宜（355 张,占 65.99%）和适应证不适宜（142 张,占 26.39%）是主要的原因类型;113 张不规范处方中,诊断或证候类型未写明或书写不全（57 张,占 50.44%）和“处方未表明正当理由超说明书使用,或中药饮片处方药物未按‘君臣佐使’排序,或未标明药物调剂、特殊用法等”（32 张,占 28.32%）;31 张超常处方中,无适应证用药（15 张,占 48.39%）和无正当理由超说明书用药（11 张,占 35.48%）是主要的原因类型。结论：医院门诊处方主要的不合理原因类型为用药不适宜,其中又以用法用量不适宜和适应证不适宜表现最为突出,对此临床可针对性加强相关管理和培训,以提高临床的合理用药水平,从而保证患者用药的安全性和有效性。

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.

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

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.

Objective: To analyze the epidemiological characteristics of adverse drug reactions related to tenofovir disoproxil fumarate (TDF) based on the US FDA Adverse Event Reporting System (FAERS) database, and provide a reference for the clinical medication safety of TDF. Methods: By using "tenofovir disoproxil fumarate" as a key word, all information on TDF-related adverse drug events (ADEs) from January 1, 2004 to December 31, 2022 was searched in the FAERS database, to analyze the epidemiological characteristics of the TDF-related adverse drug reactions. Results: A total of 69 352 cases of TDF-related ADEs were searched from the FAERS database, of which the number gradually increased from 584 in 2004 to 5 329 in 2019, and then sharply increased to 20 997 in 2020, and then decreased rapidly. Among the 69 352 cases of TDF-related ADEs, the reporting country was mainly the United States (47 050 cases, 67.84%), the reported severity was mainly "serious" (57 989 cases, 83.62%), the sex of patients involved was mainly male (43 746 cases, 63.08%), and their ages were mainly in the range of 18-64 years old (38 802 cases, 55.95%). The 69 352 ADEs involved 113 ADE positive signals and 19 system organ classes. The top three reported ADEs were renal and urinary disorders (24 168 cases), musculoskeletal and connective tissue disorders (23 432 cases), and psychiatric disorders (11 305 cases). In addition, among the 69 352 ADEs, 37 ADE signals were not mentioned in the TDF package insert, of which the top three ADEs were osteonecrosis (10 286 cases), miscarriage (1 043 cases), and vitamin D deficiency (880 cases), and the top five signal intensities were abnormal total protein, osteonecrosis, mitochondrial poisoning, abnormal ultrasound prenatal screening, and increased β₂ microglobulinuria. Conclusion: Most TDF-related ADEs are serious. For ADEs that involve a large number of patients, especially those with positive signals not described in the TDF package insert, safe medication monitoring should be strengthened clinically, and active preventive and therapeutic measures should be taken to ensure the safe medication of patients.

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

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

Objective: 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.

Berberine is a plant extract monomer with a wide range of pharmacological effects, including anti-inflammatory, antimicrobial, antiviral, anticancer, hypoglycemic, hypolipidemic, neuroprotective, and immunomodulatory properties. In this article, the inhibitory effects of berberine on mouse Lewis lung cancer cells, human non-small cell lung adenocarcinoma cells, human giant cell lung carcinoma cells, human large cell lung adenocarcinoma cells, and human squamous cell lung carcinoma cells are reviewed to give a detailed explanation of the pharmacological effect and mechanism of berberine against lung cancer and provide reference for its clinical development in lung cancer treatment.

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

Objective: To analyze the anti-infective treatment and pharmaceutical care process of a patient with Mycobacterium gordonae infection complicated with lung cancer, and provide reference for the clinical anti-infective treatment of such rare infectious diseases. Methods and Results: The patient was admitted for treatment due to persistent cough, expectoration and hemoptysis for more than two years. On the 11th day, next-generation sequencing results of the patient's alveolar lavage fluid indicated Mycobacterium gordonae, leading to the initiation of treatment with clarithromycin, rifampicin and moxifloxacin. However, two days later, the patient's bilirubin levels significantly increased. The clinical pharmacist identified this as liver damage caused by rifampicin and moxifloxacin, and recommended adjusting the treatment regimen to clarithromycin, linezolid and levofloxacin. After two days, the patient's bilirubin levels deceased to normal. During this period, a liquid-based thin-preparation cytologic test of the alveolar lavage fluid revealed atypical cells, suggesting non-small cell lung cancer. After anti-infective treatment for over three months, the patient's lung CT scan showed partial absorption and reduction of lung lesions, with near-complete absorption of bilateral pleural effusion. Considering the prolonged treatment course for non-tuberculous mycobacterial lung infection, the patient was advised to continue regular medication. Conclusion: Mycobacterium gordonae infection is relatively rare in clinical practice, so there is limited experience in clinical treatment of such cases. Clinical pharmacists should actively participate in the development of treatment regimens, monitor drug efficacy and medication safety, and ensure the effectiveness and safety of patient treatment.

目的：分析医院药学门诊的儿童用药教育服务模式建立与实践,为后续针对儿童的药学服务水平的提升,患儿用药安全和疗效的保障提供参考。方法：选取 2020 年 12 月—2022 年 12 月至医院药学门诊进行用药咨询的患儿及其家属作为研究对象,以及 2021 年 6 月—2022 年 3 月从到药学门诊接受用药教育的患儿家属那回收到的 100 份针对儿童用药教育的药品种类及其内容需求调查问卷作为研究资料,分析儿童用药教育的主要特点和需求。结果：2020 年 12 月—2022 年 12 月出诊药师共对 683 例患儿及其家属开展了用药教育,涉及 126 种药品,主要为祛痰、止咳、平喘药共（19 种,占 15.08%）,抗菌药物（16 种,占 12.70%）,感冒药（14 种,占 11.11%）,消化系统用药物（14 种,占 11.11%）,和维生素、微量元素（13 种,占 10.32%）;针对各类药物,开展用药教育共 1 004 次,其中祛痰、止咳、平喘药频次最多（469 次,占 46.71%）,其次为感冒药（192 次,占 19.12%）、消化系统用药（91 次,占 9.06%）、抗菌药物（88 次,占 8.76%）;在用药教育方面,出诊药师对 683 例患儿的基本教育做到了全覆盖,对绝大多数（562 例,占 82.28%）特殊剂型、装置药品或其特殊用法也进行用药教育;调查结果显示,患儿家属对上呼吸道感染用药和退热药的了解需求最高（达 85.00%）,其次对维生素和微量元素、腹泻药、皮肤科用药的了解需求也较高（分别为 44.00%、39.00%、35.00%）;患儿家属对药品用法用量、药物不良反应和儿童用药安全的了解需求均较高。结论：医院儿科药学门诊上上呼吸道疾病用药的药学咨询量是最多的,并且上呼吸道疾病用药的用法用量和用药安全知识也是患儿家属的需求热点,对此门诊药师应针对性增加和完善用药教育材料,从而更好地满足患儿及其家属的用药教育需求。

目的: 通过挖掘国家专利数据,探究中药复方外用治疗痤疮的用药规律,为临床痤疮的治疗提供参考。方法： 在国家知识产权局数据库中检索时至 2024 年 3 月的外用治疗痤疮的中药复方专利,统计其中中药的品种、频次等信息,分析各中药的性、味、归经、功效、归类、适宜组合等规律。结果： 经检索、筛选,共得到 255 件外用治疗痤疮的中药复方专利,其中涉及中药 425 味,累计频次为 2 003 次,其中出现频次前 3 位的依次为黄芩、大黄和白芷;所涉中药在性味上以寒（1 127 次,占 56.27%）、苦（1 179 次,占 58.86%）为主,在归经上以归肝经为主（1 109 次,占 55.37%）,而在功效上以清热药的味数（130 味,占 30.59%）和频次（778 次,占 38.84%）最多;关联规则分析结果显示,核心药物为黄芩、丹参、黄柏、苦参、大黄、白芷;聚类分析结果显示,黄芩、丹参、大黄、白芷、黄连、黄柏、苦参、金银花、冰片、蒲公英、皂角刺、连翘、赤芍、茯苓可归于一类。结论： 外用治疗痤疮的中药复方专利中,中药的性味以苦、寒为主,且多归肝经,此外复方中黄芩、丹参、黄柏、苦参、大黄、白芷为核心药物。

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

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

Objective: To analyze the occurrence and treatment process of allergic shock induced by cefazolin in a patient with threatened premature labor and negative skin test, and provide reference for clinical medication safety of patients, particularly pregnant women. Methods and Results: :The patient (female, 26 years old) was hospitallized due to "36 weeks of gestation and 3 hours of vaginal leakage". The physical examination revealed fetal membrane rupture. To prevent infection with Streptococcus agalactiae, cefazolin was prophylactically administered (negative skin test). However, after intravenous infusion for 30 seconds, the patient developed symptoms of allergic shock, including numbness in hands and feet, chest tightness, shortness of breath, difficult breathing, vomiting, and cyanosis. Cefazolin was immediately discontinued, and emergency resuscitation was initiated. During this period, the fetal heart rate dropped from 110 beats per minute to 60-80 beats per minute, indicating fetal distress, and the cesarean section was performed immediately. Subsequently, the newborn and the mother were transferred to the pediatric department and ICU separately for further treatment. Several days later, both the newborn and the mother fully recovered and were discharged. Following the event, based on the evaluation criterion for adverse drug reaction association, the association between cefazolin and allergic shock was considered "highly likely". Conclusion: Although cefazolin is considered a relatively safe antibacterial drug and rarely causes severe adverse drug reactions like allergic shock, its medication risk remains. Therefore, clinical medication safety should be monitored, especially for special populations such as pregnant women, so as to ensure the medication safety for patients.

目的：分析 2021—2023 年郑州市儿童流行性感冒（简称流感）的流行病学特征,为临床儿童流感的防控提供参考。方法：选取 2021 年 1 月—2023 年 12 月在郑州人民医院就诊的 1 021 例流感患儿作为研究对象,采集患儿的年龄、性别、发病时间、临床表现、实验室指标等信息,分析流感患儿的流行病学特点。结果：1 021 例流感患儿中,乙型流感患儿有 795 例（占 77.86%）,其余均为甲型流感（226 例,占 22.14%）;乙型流感和甲型流感患儿在年龄、发病季节和发病年份上存在显著差异（P<0.05）,但在性别分布上并无明显差异（P>0.05）;乙型流感和甲型流感患儿在呼吸道症状、消化道症状和并发症方面存在显著差异（P<0.05）,而在发热和全身症状方面无明显差异（P>0.05）;乙型流感和甲型流感患儿在呼吸道症状、消化道症状和并发症方面存在显著差异（P<0.05）,而在发热和全身症状方面无明显差异（P>0.05）;乙型流感和甲型流感患儿的红细胞计数、血小板计数、血红蛋白、白细胞计数、淋巴细胞计数、中性粒细胞计数、C 反应蛋白等指标的水平存在显著差异（P<0.05）,而其单核细胞计数、淋巴细胞百分比、中性粒细胞百分比等指标的水平无明显差异（P>0.05）。结论：郑州市儿童流感病毒类型以乙型流感病毒株为主,其流行高峰在秋冬季,此外乙型流感和甲型流感在临床表现和部分主要指标方面存在较明显的差异,临床在诊断时应多加鉴别,以便后续针对性治疗的开展。

目的：分析质控管理干预在静脉用药调配中心（pharmacy intravenous admixture service,PIVAS）质控管理中的成效,为临床的用药安全提供参考。方法：基于医院 PIVAS 现有的质控管理体系,挖掘当前存在的问题,并采取针对性的质控管理干预,分析干预前（2023 年 6 月）和干预后（2023 年 12 月） PIVAS 的质控评分和输液配置差错情况。结果：通过质控检查,发现当前 PIVAS 质控管理体系存在 7 个类别、14 个具体问题,对此质控组针对性提出了 18 条质控措施;实施质控管理干预后 PIVAS 的质控评分明显高于干预前（96.8 分 vs 89.5 分）,其中在耗材管理、病区送药和 5S 检查方面的改善最为明显,但在混合调配环节的评分不升反降;质控管理干预后 PIVAS 的输液调配差错率明显低于质控管理干预前（0.017% vs 0.036%,P<0.05）。结论：质控管理干预的实施有效提高了医院 PIVAS 的质控管理能力,减少了 PIVAS 的输液调配差错,从而保证了临床患者的输液安全。

Objective: To identify substances with anti-Klebsiella pneumoniae activity based on multi-omics technology and validate them with molecular docking technology, and provide reference for the clinical development of drugs against Klebsiella pneumoniae. Methods: Whole-genome data of Klebsiella pneumoniae was obtained from the NCBI database. Data on human proteomes, bacterial essential proteomes, bacterial virulence factors, and drug molecules was collected from databases such as UniProt, DEG, VFDB, ChEMBL. A bacterial pan-genome analysis tool was used to analyze the pan-genome of Klebsiella pneumoniae. BLASTp tool was then used to screen out non-human homologous core proteins and identify potential drug targets. Active sites of proteins were predicted and drug molecules were optimized with related tools. Finally, batch molecular docking was conducted to validate the results and obtain the most promising active substances. Results: The pan-genomic analysis results showed that the genome of Klebsiella pneumoniae contained 3 454 core genes, 5 260 accessory genes, and 2 106 unique genes. The core genome of Klebsiella pneumoniae contained 2 608 essential proteins, 22 virulence factors, and 2 404 non-human homologous proteins. Through comparison of these three sets, 14 shared proteins were obtained, of which Gene2502 protein was considered as a potential target against Klebsiella pneumoniae. Molecular docking was performed with Gene2502 protein as the receptor, in the top nine compounds with the strongest docking scores, paromomycin was identified with antibacterial activity and may be a potential compound against Klebsiella pneumoniae. Conclusion: Multi-omics technology and molecular docking technology provide new ideas for screening and designing substances with anti-Klebsiella pneumoniae activity.

Objective: To analyze and compare the cardiac toxicity risks of anthracyclines such as doxorubicin, mitoxantrone, epirubicin, daunorubicin, and idarubicin based on real-world data, and provide reference for clinical medication safety of anthracyclines. Methods: Using the search terms "doxorubicin (L01DB01)", "mitoxantrone (L01DB07)", "epirubicin (L01DB03)", "daunorubicin (L01DB02)" and "idarubicin (L01DB06)", adverse drug events (ADEs) related to cardiac toxicity were retrieved from the USA FDA Adverse Event Reporting System (FAERS) database between January 2004 and September 2023, with the above five anthracyclines as primary suspected drugs, and the epidemiological characteristics of cardiac toxicity associated with these five anthracyclines were analyzed. Results: A total of 3 159 ADE reports involving cardiac toxicity for the five anthracyclines were found in the FAERS database, including 2 215 reports for doxorubicin, 265 for mitoxantrone, 422 for epirubicin, 197 for daunorubicin, and 60 for idarubicin. For 2 215 reports of doxorubicin, 2 392 ADEs were involved with cardiac toxicity, with 62 preferred terms (PTs); the top 3 pts in terms of the quantity of ADE items were cardiac toxicity (387 cases), heart failure (354 cases), and cardiomyopathy (311 cases). For 265 reports of mitoxantrone, 663 ADEs were involved with cardiac toxicity, with 32 PTs; the top 3 pts in terms of the quantity of ADE items were tachycardia (146 cases), cardiomyopathy (103 cases), and pericardial effusion (56 cases). For 422 reports of epirubicin, 367 ADEs were involved with cardiac toxicity, with 28 PTs; the top 3 pts in terms of the quantity of ADE items were heart failure (94 cases), cardiac toxicity (36 cases), and atrial fibrillation (29 cases). For 197 reports of daunorubicin, 257 ADEs were involved with cardiac toxicity, with 25 PTs; the top 3 pts in terms of the quantity of ADE items were heart failure (31 cases), tachycardia (27 cases), and atrial fibrillation (26 cases). For 60 reports of idarubicin, 67 ADEs were involved with cardiac toxicity, with 14 PTs; the top 3 pts in terms of the quantity of ADE items were heart failure (10 cases), myocarditis (9 cases), and cardiomyopathy (7 cases). Using the reporting odds ratio (ROR) method, analysis results revealed that for doxorubicin-related ADEs, PTs with ROR above 50 included cardiac toxicity, acute cardiomyopathy, and toxic cardiomyopathy; for mitoxantrone-related ADEs, PTs with ROR above 50 included myocardial hemorrhage; for epirubicin-related ADEs, PTs with ROR above 50 included right atrial dilation and myocardial edema; no PTs with ROR above 50 were found for daunorubicin-related ADEs; for idarubicin-related ADEs, PTs with ROR above 50 included left ventricular dilation. Seven cardiac toxicity related SMQ signals were detected in the Standardised MedDRA Query (SMQ) analysis, with cardiomyopathy and heart failure as common positive signals for all five anthracyclines. Conclusion: Cardiac toxicity caused by anthracyclines is commonly associated with cardiomyopathy and heart failure. The cardiac toxicity risk intensity varies among different anthracyclines. Clinically, drugs with a lower risk of cardiac toxicity should be prioritized, and careful monitoring of cardiac toxicity related ADEs should be implemented.

Objective: To analyze the diagnosis and anti-infective treatment process of a patient with Chlamydia psittaci pneumonia, and provide reference for clinical diagnosis and anti-infective treatment of such atypical pneumonia. Methods and Results: The patient was admitted to Department of Respiratory and Critical Care Medicine due to fever and cough for 8 days. Infection indicators, including white blood cell count, neutrophil count, neutrophil percentage, and C-reactive protein, were significantly abnormal. Chest CT showed bilateral pulmonary inflammation. After admission, empiric treatment with Piperacillin-tazobactam sodium and moxifloxacin was initiated. Metagenomic next-generation sequencing of the patient's bronchoalveolar lavage identified Chlamydia psittaci. Considering the patient's history of pigeon contact, a diagnosis of Chlamydia psittaci pneumonia was made. As the therapeutic effect with moxifloxacin was unsatisfactory, the original anti-infection regimen was adjusted to omadacycline. One week later, the patient's symptoms and indicators basically returned to normal, and the patient was discharged after recovery. Conclusion: Chlamydia psittaci, as an atypical pathogen, is not easily detected by conventional pathogen detection methods. In such cases, new testing technologies like metagenomic next-generation sequencing can be considered. Clinically, treatment regimens should be adjusted based on the actual therapeutic effect of drugs to ensure effective therapeutic effect for patients.

目的: 分析路径化管控对医院耳鼻喉科抗菌药物合理使用的成效,为临床抗菌药物的合理使用提供参考。方法： 针对医院耳鼻喉科抗菌药物使用强度（antibiotics use density,AUD）严重超标的情况,在业务院长牵头、多科室协同下分析 AUD 超标的主要原因,并建立路径化管控工作模式,比较实施路径化管控前后耳鼻喉科的 AUD、抗菌药物使用金额和抗菌药物的合理用药改善情况。结果： 实施路径化管控后,耳鼻喉科的 AUD 快速从 99.80 降至 62.68,最低至 37.68;实施路径化管控后,耳鼻喉科的抗菌药物使用金额快速从 10 万元以上降至 5 万元左右,最低至 4.68 万元;点评结果显示,在实施路径化管控后科室手术患者围术期抗菌药物的给药时机合理率、药物选用合理率和预防用药疗程合理率较前均有明显提高（P<0.01）。结论： 开展路径化管控可以显著改善耳鼻喉科手术患者围术期抗菌药物的合理用药状况,从而减少非必要的抗菌药物使用,进而提高临床的抗菌药物合理用药水平。

Objective: To analyze the clinical characteristics of adverse drug reactions (ADRs) related to antibacterial drugs reported by the hospital from 2019 to 2023, and provide a reference for further improving the clinical medication safety of antibacterial drugs. Methods: A total of 239 reports of antibacterial drug-related ADRs reported to the National Adverse Drug Reaction Monitoring System by Affiliated Jiangsu Shengze Hospital of Nanjing Medical University from January 2019 to December 2023 were selected as the research data. The information such as patients' age and sex, types and dosage forms of involved drugs, and clinical manifestations and outcomes of ADRs was collected to analyze the epidemiological characteristics of antibacterial drug-related ADRs. Results: Among the 239 reports of antibacterial drug-related ADRs, the number of female patients involved was slightly more than that of male patients (126 cases vs 113 cases), and the age distribution was overall balanced; a total of 245 cases with antibacterial drugs were involved among the 239 ADRs, of which, cephalosporins involved were most common (129 cases), followed by quinolones (62 cases); the drugs were mostly administered by intravenous drip (223 cases); the antibacterial drug-related ADRs mainly involved the skin and its appendages, followed by the digestive system. In terms of types of ADRs, most ADRs were "general" (183 cases) and "new and general" (42 cases), and only 12 cases and 2 cases of ADRs were "serious" and "new and serious" respectively. After treatment, the vast majority (235 cases, 98.33%) of patients were cured or alleviated. Conclusion: Most of the ADRs related to antibacterial drugs are caused by cephalosporins and quinolones in the hospital, and are not serious and have good outcomes. However, it is still necessary to strengthen the clinical monitoring of patients' medication to ensure the safe medication of patients.

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

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

Objective: To analyze the clinical characteristics of adverse drug reactions (ADRs) related to anti-infective drugs in the hospital and provide reference for the clinical safe use of anti-infective drugs. Methods: The anti-infective drug related ADR reports of 107 patients reported by Anyang District Hospital of Puyang City from January 2022 to December 2023 were selected as research data. The information such as patient age, gender, type of ADR reports, type and dosage form of drugs, organs involved and clinical manifestations was collected to analyze the clinical characteristics of anti-infective drug related ADRs. Results: Among the ADR reports of 107 cases, the report type was mainly "general" (97 cases, 60.65%), and the reports of "new and general" and "serious" types only involved 6 cases and 4 cases respectively. In terms of gender, the number of male patients with ADRs was slightly more than that of female patients (56 cases vs 51 cases); in terms of age, most patients were over 50 years old (71 cases, 66.36%). In terms of drug types, the drugs involved in ADRs were mainly quinolones (48 cases, 44.86%) and cephalosporins (20 cases, 18.69%); in terms of dosage forms, the main drugs were injections (53 cases, 49.53%) and powder injections (53 cases, 49.53%); the main organs involved were skin and its appendages (54 cases, 50.47%), followed by the gastrointestinal system (14 cases, 13.08%) and injection sites (10 cases, 9.35%). Conclusion: Anti-infective drug related ADRs mostly occur in the middle-aged and elderly individuals; the main drug types are quinolones and cephalosporins, and the dosage forms are basically injection preparations. Therefore, it is required to strengthen the relevant clinical monitoring to ensure the safe medication for patients.

目的: 分析医院剖宫产产妇发生产褥感染的病原学特征和危险因素,为临床产妇产褥感染的防治提供参考。方法： 选取 2022 年 1 月—2023 年 1 月兴国县人民医院收治的 180 例剖宫产产妇作为研究对象,采集产妇的年龄、文化程度、孕周、孕史、基础疾病、用药史、白蛋白水平、剖宫产时机、产后出血,以及产褥感染的发生和病原学检查结果等信息,采用 Logistic 回归分析法分析产妇发生产褥感染的影响因素。结果： 180 例剖宫产产妇中发生产褥感染的有 12 例,感染发生率为 6.67%;12例并发产褥感染的剖宫产产妇标本中共检出病原菌 24 株,其中革兰阴性菌 15 株（占 62.50%）、革兰阳性菌 7 株（占 29.17%）和真菌 2 株（占 8.33%）;单因素分析结果显示,剖宫产产妇发生产褥感染与白蛋白水平、瘢痕子宫与否、有无产前生殖道感染、有无胎膜早破、剖宫产时机、产后出血与否具有相关性（P<0.05）;多因素 Logistic 回归分析结果显示,白蛋白<35 g/L、产后出血、瘢痕子宫、产前生殖道感染、第二产程剖宫产、胎膜早破是剖宫产产妇发生产褥感染的独立危险因素（P<0.05）;接受者操作特征曲线显示,6 个独立危险因素联合构建的预测曲线的曲线下面积最大,为 0.823（95% CI 为 0.778~0.866）。结论： 剖宫产产妇发生产褥感染与白蛋白水平、瘢痕子宫与否、有无产前生殖道感染、有无胎膜早破、剖宫产时机、产后出血与否密切相关,并且这些因素联合可以较好地预测感染的发生与否,对此临床应积极开展风险排查,对高风险产妇要加强监护,以减少感染的发生。

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

目的: 分析医院处方前置审核系统的实践成效,为临床患者用药的安全性、合理性、经济性提供参考。方法： 选取常州市妇幼保健院部署处方前置审核系统前 5 个月（2023 年 1—5 月）的相关指标数据（设为对照组）,和处方前置审核系统部署完成后 5 个月（2023 年 9 月—2024 年 1 月）的相关指标数据（设为观察组）,比较处方前置审核系统部署前后处方/医嘱合格率、医疗控费指标、调配差错的变化情况。结果： 部署处方前置审核系统后,门急诊处方和住院医嘱的人工审核率由之前的均为 100.00% 降至 0.85% 和 0.77%;合理用药点评结果显示,观察组的处方合格率高于对照组（99.48% vs 98.28%,P<0.01）,而其医嘱合格率亦高于对照组（99.04% vs 98.18%,P<0.01）;部署处方前置审核系统后,全院药占比由 21.31% 下降至 20.13%,门诊患者的次均药费由 107.75 元下降至 94.62 元,住院患者的次均药费由 1181.51 元下降至 985.02 元,而药师调配差错量和患者投诉量均明显减少。结论： 处方前置审核系统的部署对医院的医疗效率、医疗质量、医疗安全等方面均有较明显的改善作用,还可降低患者的药品费用支出。

Objective: To analyze the practice of pediatric clinical pharmacists participating in anti-infection consultation and provide a reference for the safe and rational use of drugs in clinically infected children. Methods: Four typical cases of anti-infection consultation participated by pediatric clinical pharmacists were selected as the research objects, the anti-infection treatment of the four children was analyzed and the experiences were summarized. Results: In the anti-infection consultation, clinical pharmacists provided suggestions on individualized medication from such aspects as new use of old drugs, off-label use of drugs, drug combination, and drug adverse reaction monitoring based on the special pathophysiological characteristics of children and the etiological examination results, so that the four children with difficult infections were ultimately cured and discharged from the hospital. Conclusion: Clinical pharmacists should actively analyze and summarize typical cases in the clinical practice in addition to completing their routine works, to consolidate their professional knowledge, and provide better clinical services and enable patients to receive safer and more effective treatment.

近年来传染病的总体发病率和死亡率显著降低。但是,“旧”传染病的重新出现与“新”传染病的不断涌现,使得传染病学教学面临重大挑战。通过探索将医防融合贯穿到传染病教学过程中的方法,培养医防融合的医学教育师资队伍,实现教学资源整合和教学改革的创新,最大限度地提高传染病学课程的教学质量,培养优秀的传染病防治和管理人才。

目的：分析医院集采前后临床抗菌药物的使用动态,为完善集采背景下的抗菌药物管理体系提供实证依据。方法：借助医院信息系统,采集 2020—2022 年河池市人民医院的抗菌药物相关数据指标,分析医院执行集采过程中抗菌药物相关指标的变化情况。结果：2020—2022 年,门诊患者抗菌药物使用率、急诊患者抗菌药物使用率、住院患者抗菌药物使用率、住院患者抗菌药物使用强度、抗菌药物使用前的微生物送检率、I 类切口手术抗菌药物预防使用率均符合抗菌药物临床应用管理评价要求,且有持续向好趋势,而抗菌药物的销售金额占比则呈下降趋势;从 2020 年末医院开始执行集采后,2021 年、2022 年分别有 5 种和 6 种集采抗菌药物进入销售金额前 10 位的抗菌药物中,2021 年、2022 年分别有 4 种和 5 种集采抗菌药物进入 DDDs 前 10 位的抗菌药物中,2021 年、2022 年分别有 3 种和 6 种集采抗菌药物进入 DDDc 前 10 位的抗菌药物中。结论：集采后医院的抗菌药物临床应用管理指标在本就达标的基础上持续向好,临床应持续做好集采工作,同时持续完善医院的抗菌药物管理。