目的:通过系统综述和 Meta 分析,评价和比较仿制与原研头孢哌酮-舒巴坦钠对临床感染患者疗效、安全性与成本-效果的差异,为临床合理用药与卫生决策提供循证依据。方法:系统检索中国知网、万方、维普、PubMed、Embase 和 Cochrane Library 数据库,收集自建库至 2024 年 9 月 30 日公开发表的关于仿制与原研头孢哌酮-舒巴坦钠治疗临床感染的相关文献,按照纳排标准进行文献筛选,对符合要求的文献进行数据提取和质量评价,然后使用 RevMan 5.4 版软件进行 Meta 分析,评价仿制与原研头孢哌酮-舒巴坦钠治疗临床感染的有效性、安全性与经济性差异。结果:通过数据库初次检索共获得 1 856 篇,经筛选,最终纳入的符合要求的文献有 15 篇,其中随机对照研究（randomized controlled trial,RCT）文献 10 篇、回顾性队列研究（retrospective cohort study,RCS）文献 5 篇;在临床疗效方面,整体上原研组的临床治疗有效率仅稍高于仿制组,其差异无统计学意义（P>0.05）;但 RCT 亚组的分析结果显示,原研组的临床有效率显著高于仿制组（P<0.05）;在细菌清除率方面,整体上原研组的细菌清除率显著高于仿制组（P<0.05）;但 RCT 和 RCS 两个亚组的分析结果显示,原研组和仿制组的细菌清除率差异并不具有统计学意义（P>0.05）;在安全性方面,无论是整体上,还是 RCT 和 RCS 两个亚组层面,原研组和仿制组的不良事件发生率差异均不具有统计学意义（P>0.05）;在经济性方面,所有结局指标均表明仿制头孢哌酮-舒巴坦钠较原研药具有更优的经济学价值。结论:整体上,仿制头孢哌酮-舒巴坦钠对临床感染患者的疗效、安全性与原研头孢哌酮-舒巴坦钠相当,但其具有更明显的经济性优势。

目的:分析医院骨科 Ⅰ 类切口手术患者围手术期抗菌药物的预防使用情况,为医院感染管理的精准监控与临床合理用药提供依据。方法:选取 2022 年 9 月—2024 年 9 月海军军医大学第三附属医院骨科收治的 2 237 例 Ⅰ 类切口手术患者作为研究对象,采集骨科手术患者的切口类型、手术名称、手术时长、抗菌药物使用情况等信息,依据相关权威资料对患者围手术期抗菌药物的使用进行合理用药点评,分析患者围术期抗菌药物的使用特点和合理用药情况。结果:2 237 例 Ⅰ 类切口手术患者中,有 1 181 例围手术期预防性使用了抗菌药物,预防使用率为 52.79%;其中,关节置换术和骨折复位内固定术患者的抗菌药物预防使用数和使用率均最高,分别为 90.60%（270/298） 和 89.61%（526/587）;1 181 例预防性使用抗菌药物的手术患者中,绝大多数（1 143 例,占 96.78%）选择了第 2 代头孢菌素头孢呋辛;在用药疗程方面,抗菌药物用药疗程≤24 h 的仅 201 例（占 17.02%）,而>72 h 者有 414 例（占 35.06%）;点评结果显示,1 181 例预防性使用抗菌药物的手术患者中,有 659 例存在不合理用药情况,其中以用药疗程过长为最多（580 例,占 88.01%）;2 237 例 Ⅰ 类切口手术患者中,发生术后切口感染的有 12 例,感染发生率为 0.54%。结论:医院骨科 Ⅰ 类切口手术患者围手术期抗菌药物的品种选择基本符合规范要求,但在用药疗程方面仍存在较多的不合理情况,对此医院相关管理部门应继续加强围术期抗菌药物预防使用的相关管理,以提高临床的合理用药水平。

Condyloma acuminatum is a sexually transmitted disease caused by human papillomavirus infection, characterized by a high recurrence rate. In traditional Chinese medicine (TCM), this disease is categorized under the scope of "warts" and "sao hou (pruritic condyloma)", and its core pathogenesis is believed to be deficiency of healthy Qi with excess of pathogenic factors, stagnation of damp-heat toxin. External application of TCM, such as fumigation and washing, smearing and rubbing, and soaking, serves as an important local treatment modality. It can be used alone or in combination with physical therapy or photodynamic therapy, all of which can achieve favorable clinical efficacy. This article reviews TCM understanding of condyloma acuminatum, as well as the therapeutic regimens, mechanisms and regularities based on external application of TCM, aiming to provide a reference for the radical treatment of condyloma acuminatum.

Severe pneumonia is a critical disease state resulting from the progressive deterioration of lung tissue inflammation induced by various etiologies or pathogenic bacteria. It has an acute onset, and may be life-threatening without timely and effective treatment. As a fourth-generation fluoroquinolone antibacterial drug, moxifloxacin possesses advantages such as high efficacy, broad-spectrum activity, low drug resistance rate, and few drug-drug interactions, making it widely used in the treatment of respiratory system infections. However, monotherapy with moxifloxacin may not fully meet the clinical treatment needs of severe pneumonia. Therefore, it is often combined with other antibacterial drugs, non-antibacterial drugs, and non-pharmacological treatments to achieve effective treatment outcomes. This article reviews and analyzes the combined use of moxifloxacin with other antibacterial drugs, non-antibacterial drugs, and non-pharmacological treatments for severe pneumonia, aiming to provide a reference for the effective clinical treatment of severe pneumonia.

Ginkgolide B is a terpenoid compound isolated from the leaves of Ginkgo biloba L., and it is the most biologically active component among ginkgolides. Ginkgolide B exerts a wide range of pharmacological effects, including inhibiting platelet aggregation, anti-atherosclerosis, anti-osteoporosis, antioxidation, neuroprotection, anti-inflammation, anti-tumor, as well as renal and cardiovascular protection. In particular, it has been extensively applied in the fields of neuroprotection and cardiovascular system protection, and its application prospects have attracted considerable attention. This article reviews the pharmacological effects and mechanism of action of ginkgolide B reported in the literature in recent years, so as to provide a theoretical basis for the development and clinical application of ginkgolide B.

Objective: To explore and optimize the formulation process of berberine liquid crystal cream, evaluate its physicochemical properties, sensory performance, therapeutic effect and potential mechanism for rabbit ear acne models, so as to provide theoretical basis for the development of new topical anti-acne preparations. Methods: Taking the dosages of emulsifiers (cetearyl glucoside, glyceryl monostearate and cetearyl alcohol) as key factors, the central composite design-response surface methodology (CCD-RSM) combined with analytic hierarchy process-inter-class correlation coefficient (AHP-ICC) composite weighting method was used to optimize the formulation. The comprehensive score of liquid crystal structure, stability and sensory performance was used as the evaluation index to determine the optimal formula. The oleic acid-induced rabbit ear acne model was established, and the animals were divided into a blank group, a model group, a low-dose berberine liquid crystal cream group, a medium-dose berberine liquid crystal cream group and a high-dose berberine liquid crystal cream group. After 3 weeks of intervention, the pathological changes of rabbit ear tissues were observed, and the levels of interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor-α (TNF-α) in the tissues were detected to evaluate the therapeutic efficacy. Results: After process optimization and screening, the optimal formulation of berberine liquid crystal cream was determined as follows: cetearyl glucoside 4 g, glyceryl monostearate 1.5 g, cetearyl alcohol 3 g. The prepared berberine liquid crystal cream was a pale yellow fine ointment with a pH value of 5.61, showing good heat resistance, cold resistance and centrifugal stability. Sensory evaluation indicated that it had strong moisturizing property, was easily absorbed, and non-sticky. Pharmacodynamic experiments showed that compared with the model group, all dose groups of berberine liquid crystal cream could improve epidermal hyperplasia, follicular keratotic plugging and inflammatory cell infiltration of rabbit ears to different extents, with the high-dose group showing the most significant effect. Moreover, it could significantly down-regulate the gene expression levels of IL-1β, IL-6, IL-8 and TNF-α in rabbit ear tissues. Conclusion: Berberine liquid crystal cream can significantly reduce follicular keratotic plugging and inflammatory cell infiltration, and its inhibitory effect on inflammatory factors such as IL-1β, IL-6, IL-8 and TNF-α in rabbit ear tissues is dose-dependent, with the high-dose group exhibiting the most prominent therapeutic effect.

Objective: To analyze the process of pharmaceutical care in anti-infective therapy of a patient with Pseudomonas aeruginosa infection after pancreatic surgery, and provide a reference for the anti-infective therapy of postoperative infections in patients undergoing clinical pancreatic surgery. Methodsand Results: The patient was admitted to the hospital due to long-term precordial pain, and was subsequently diagnosed with a pancreaticoduodenal mass after completing relevant examinations. Radical pancreaticoduodenectomy and cholecystectomy were performed, and cefodizime was administered during the perioperative period for infection prevention. On the 8th day after surgery, the patient presented with fever and abnormal infection indicators; subsequently, Gram-positive bacteria, Gram-negative bacteria, and fungal spores were detected by microscopic examination of abdominal drainage fluid, and teicoplanin plus voriconazole were added. The infection was once controlled, but fever and abnormal infection indicators recurred 12 days later, so cefodizime was adjusted to piperacillin-sulbactam sodium. Two days later, Pseudomonas aeruginosa was detected from the abdominal drainage fluid culture, and the susceptibility test results showed that the strain was sensitive to piperacillin, ceftazidime, imipenem, ciprofloxacin, and amikacin. However, the patient's infection was not effectively controlled after 20 days of treatment with piperacillin-sulbactam sodium, so piperacillin-sulbactam sodium was adjusted to imipenem-cilastatin sodium. After 6 days of treatment with imipenem-cilastatin sodium, the patient still had persistent fever. During a consultation, clinical pharmacists considered that although the latest susceptibility test of Pseudomonas aeruginosa indicated sensitivity to meropenem, imipenem, etc., literature data showed that the minimum inhibitory concentration (MIC) of meropenem against Pseudomonas aeruginosa was lower than that of imipenem. Therefore, it was recommended to adjust imipenem to meropenem and set the infusion time of meropenem to 3 hours. After the adjustment, the patient's fever improved rapidly, and the infection indicators also normalized soon. Conclusion: Pseudomonas aeruginosa is prone to causing refractory infections due to its inherent tendency to develop drug resistance. For such situation, clinical practice should involve refined interpretation of susceptibility test results and optimization of dosage regimens to achieve effective anti-infective therapy.

Tigecycline is an important clinical drug for the treatment of multidrug-resistant Gram-negative bacterial infections, and the spread of its drug resistance poses a severe challenge to clinical treatment. Currently, the main mechanisms underlying bacterial resistance to tigecycline include overexpression of efflux pump systems, drug inactivation mediated by modifying enzymes, alterations in ribosomal target sites, etc. Different drug resistance mechanisms may exhibit characteristics of diversification and synergism. This article reviews the distinct drug resistance mechanisms of bacteria to tigecycline, aiming to provide a reference for developing potential strategies to address tigecycline resistance, thereby guaranteeing its long-term clinical value in the treatment of multidrug-resistant Gram-negative bacterial infections.

Objective: To analyze the occurrence and pharmaceutical care process of hematuria caused by the interaction between amiodarone and rivaroxaban in a patient with non-valvular atrial fibrillation, and provide a reference for medication safety in similar clinical patients. Methodsand Results: The patient was admitted to the hospital due to recurrent chest pain without obvious inducement for 5 consecutive days. Based on the current examination results and the newly diagnosed non-valvular atrial fibrillation during the recent hospitalization due to acute cerebral infarction, clinicians preliminarily judged that the chest pain might be caused by non-valvular atrial fibrillation, and administered treatments such as load reduction, anticoagulation, and antiplatelet therapy. Two days later, considering that the patient's coagulation function, fecal occult blood test, urine routine, and platelet aggregation function were all normal, dalteparin sodium was replaced with oral anticoagulant rivaroxaban tablets. However, on the 2nd day of rivaroxaban administration, the patient developed frequent micturition, dysuria, dark tea-colored urine, and strongly positive urine occult blood (+++). During ward rounds, clinical pharmacists learned that the patient had experienced similar symptoms when taking rivaroxaban during the previous hospitalization, and had been receiving amiodarone for cardioversion before admission. Therefore, they highly suspected that the hematuria was an adverse drug reaction caused by rivaroxaban under the influence of amiodarone, and recommended discontinuing rivaroxaban. On the 3rd day after discontinuing rivaroxaban, the patient's urine color returned to normal, and urine occult blood turned weakly positive (+). Moreover, no bleeding events occurred after adjusting the anticoagulant regimen to dabigatran etexilate in the follow-up treatment. Conclusion: A clear pharmacokinetic interaction exists between rivaroxaban and amiodarone, which can increase the blood concentration of rivaroxaban, thereby significantly elevating the bleeding risk, especially in high-risk patients such as the elderly, those with a history of stroke, and those receiving combined antiplatelet therapy. Clinically, adequate assessment of bleeding risk should be conducted, appropriate therapeutic regimens should be formulated, and active medication safety monitoring should be performed after drug administration to ensure the safety and continuity of treatment.

Objective: To analyze the identification method, mechanism, influencing factors, preventive and management measures of QT interval prolongation induced by levofloxacin hydrochloride injection in a patient, and provide a reference for the rational use and safety of levofloxacin in clinical practice. Methodsand Results: The patient was admitted to Department of Respiratory and Critical Care Medicine of the hospital due to "acute bronchitis". After admission, empirical treatment with levofloxacin hydrochloride injection and other drugs was administered clinically. Clinical pharmacists considered that the patient's serum potassium level was 3.15 mmol/L on admission, and suggested supplementing potassium to correct hypokalemia and replacing the anti-infective drug, but the doctor did not adopt the suggestion. In the early morning of the 3rd day after admission, the patient developed symptoms such as palpitation and flustered feelings, and the bedside electrocardiogram indicated QTc interval prolongation. Clinical pharmacists considered that no QTc interval prolongation was observed in the patient's admission electrocardiogram, and preliminarily concluded that the adverse reaction was induced by levofloxacin. Therefore, it was recommended to replace levofloxacin with amoxicillin-clavulanate potassium and administer symptomatic treatment such as potassium supplementation. The doctor adopted the suggestion, and the patient's uncomfortable symptoms like palpitation and flustered feelings alleviated rapidly thereafter. Conclusion: The use of levofloxacin carries the risk of QT interval prolongation, which may progress to ventricular tachycardia in severe cases, thereby threatening the life safety of patients. Clinically, screening of high-risk patients should be strengthened, and monitoring of adverse drug reactions should be enhanced in patients receiving levofloxacin treatment to ensure the medication safety.

Objective: To investigate the in vitro antibacterial activity and mechanism of magnolol against enteric pathogenic bacteria, as well as its synergistic antibacterial effect with norfloxacin, and provide a reference for the development of new drugs for the treatment of bacterial intestinal infectious diseases. Methods: The microbroth double dilution method was used to determine the minimum inhibitory concentration (MIC) of magnolol and norfloxacin against Escherichia coli, Shigella flexneri, Shigella sonnei, Salmonella enteritidis and Vibrio parahaemolyticus. The checkerboard method was used to measure the fractional inhibitory concentration index (FICI) of the combination of magnolol and norfloxacin. Biochemical methods were used to determine the effects of magnolol on the extracellular nucleic acid and protein contents of pathogenic bacteria, and fluorescence spectrophotometry was employed to determine the membrane potential intensity, so as to analyze the antibacterial mechanism of magnolol against enteric pathogenic bacteria. Results: The MIC values of magnolol against Escherichia coli, Shigella flexneri, Shigella sonnei, Salmonella enteritidis and Vibrio parahaemolyticus ranged from 256 to 4 096 μg/mL, with the strongest antibacterial activity against Shigella flexneri. The FICI values of magnolol combined with norfloxacin were 0.375-1, indicating a synergistic or additive effect. After Shigella flexneri was treated with magnolol at the MIC for 6 hours, the extracellular nucleic acid level and protein content increased significantly (P<0.01), while the intracellular fluorescence intensity decreased significantly (P<0.01), suggesting that the cell membrane of Shigella flexneri was damaged or even ruptured to a certain extent. Conclusion: Magnolol has excellent antibacterial activity against enteric pathogenic bacteria, and its mechanism of action is related to the destruction of cell membrane integrity. Meanwhile, the combination of magnolol and norfloxacin can exert synergistic or additive antibacterial effects, which can provide a new strategy for the clinical treatment of bacterial intestinal infectious diseases.

Objective: To analyze the process of pharmaceutical care in anti-infective therapy of a patient with pulmonary mucormycosis complicated with severe community-acquired pneumonia caused by multidrug-resistant bacteria, and provide a reference for the anti-infective therapy of patients with complex severe pulmonary infections in clinical practice. Methodsand Results: The patient was admitted to our hospital due to "fever accompanied by fatigue, headache, cough, and expectoration" with poor therapeutic effect in another hospital. Based on the patient's symptoms, laboratory test results, and especially the next-generation sequencing (NGS) results of bronchoalveolar lavage fluid from the previous hospital indicating Haemophilus influenzae (sequence number: 44 235), Streptococcus pneumoniae (sequence number: 8 900), Staphylococcus aureus (sequence number: 5 923), Rhizopus oryzae (sequence number: 12 726), etc., a preliminary diagnosis of pulmonary mucormycosis complicated with severe community-acquired pneumonia was made. Empirical anti-infective therapy with amphotericin B cholesterol sulfate complex plus amoxicillin-clavulanate potassium was administered, followed by the addition of nebulized amphotericin B for injection. After 5 days of treatment, the patient still had persistent fever; considering the possible drug resistance of Staphylococcus aureus and the continuous elevation of creatinine level (potentially related to the use of amphotericin B cholesterol sulfate complex), linezolid was added, and amphotericin B cholesterol sulfate complex was adjusted to isavuconazole for injection. Subsequently, the patient's fever gradually subsided, and the creatinine level began to decrease. However, given the presence of a large amount of white necrotic tissue in the airway lumen detected by bronchoscopy, intraluminal instillation of amphotericin B for injection was added. On the 6th day of the new treatment regimen, NGS results of bronchoalveolar lavage fluid showed that the sequence number of Haemophilus influenzae was still as high as 48 332, suggesting that amoxicillin-clavulanate potassium had no significant anti-infective effect, so it was adjusted to piperacillin-tazobactam sodium. After that, the patient's condition improved gradually and was discharged from the hospital one week later. Oral sequential therapy with linezolid plus isavuconazole was continued after discharge. Conclusion: Both pulmonary mucormycosis and severe community-acquired pneumonia caused by multidrug-resistant bacteria are clinically complex severe infections. For such patients, clinical pharmacists should give full play to their professional expertise, actively participate in and assist doctors in formulating more individualized and precise anti-infective therapeutic regimens, and conduct whole-course pharmaceutical care to ensure the efficacy and safety of drug therapy.

Objective: To analyze the pharmaceutical practice process of clinical pharmacists participating in the treatment of a patient with drug-resistant Klebsiella pneumoniae intracranial infection using dual β-lactam combination therapy, and provide a reference for clinical treatment of such patients in the future. Methods and Results: A 58-year-old female patient was admitted to the hospital due to "fever for 2 days", diagnosed with "liver abscess, hepatic insufficiency, electrolyte disturbance, thrombocytopenia, hypertension and type 2 diabetes mellitus". On the 1st day after admission, blood samples of the patient were collected for microbial culture, and empirical anti-infective therapy with imipenem-cilastatin sodium was initiated. On the 3rd day, percutaneous ultrasound-guided puncture and drainage of the liver abscess was performed, and pus samples were sent for culture. On the 5th day, the pus culture result indicated Klebsiella pneumoniae (susceptible). On the 7th day, the patient presented with a body temperature of 38 ℃ and mental abnormalities, with persistently elevated blood routine and inflammatory indicators, and intracranial CT examination results showed no obvious abnormalities. Clinical pharmacists considered that the patient had developed imipenem-related central nervous system adverse reactions, and central nervous system infection could not be ruled out. Therefore, they suggested adjusting the anti-infective regimen to meropenem plus amikacin, which was adopted by the clinical team. On the 10th day after admission, the patient experienced bradycardia, hypotension, poor consciousness response and neck stiffness at night, and intracranial infection was suspected. On the 11th day, the metagenomic next-generation sequencing (mNGS) result confirmed Klebsiella pneumoniae with drug-resistant genes detected. After a hospital-wide consultation, the anti-infective regimen was adjusted to meropenem plus ceftazidime-avibactam sodium plus amikacin. On the 24th day, the patient's cerebrospinal fluid (CSF) examination results improved significantly compared with the previous data; re-examination CT showed partial reduction of multiple hepatic lesions, and amikacin was discontinued. On the 31st day, the patient's maximum body temperature reached 39 ℃ with persistently high inflammatory indicators; a repeat lumbar puncture revealed positive CSF Pandy's test and an increased nucleated cell count compared with the results on the 24th day, suggesting a possible recurrence of intracranial infection. Meropenem was then discontinued, and the regimen was changed to intravenous infusion of colistimethate sodium (CMS) plus ceftazidime-avibactam sodium, combined with one intrathecal injection of CMS. A second intrathecal injection of CMS was administered on the 32nd day, and the intravenous infusion of CMS plus ceftazidime-avibactam sodium was continued thereafter. On the 35th day, the patient's body temperature decreased to 37.2 ℃; lumbar puncture showed normal CSF properties, with a significant reduction in nucleated cell count compared with the previous data. Subsequently, three blood cultures turned negative, and the patient's body temperature gradually decreased. On the 48th day, the patient was afebrile, all infection indicators returned to normal range, and a repeat lumbar puncture showed normal CSF properties. Meanwhile, the mNGS result showed 1 sequence of Klebsiella pneumoniae with no drug-resistant genes detected. The patient's condition improved, and the intracranial infection was basically controlled. Ceftazidime-avibactam sodium was discontinued on the 52nd day, and CMS was discontinued on the 59th day, after which the patient was discharged from the hospital. Conclusion: In the treatment of a patient with central nervous system infection caused by carbapenem-resistant Klebsiella pneumoniae, clinical pharmacists contributed to the continuous adjustment and optimization of anti-infective regimens by integrating pharmacokinetics/pharmacodynamics knowledge and adverse drug reaction analysis. Eventually, the patient's condition was effectively controlled with a favorable prognosis. This case can provide a reference for clinical treatment of patients with invasive Klebsiella pneumoniae liver abscess complicated with metastatic central nervous system infection, and help improve the clinical treatment level.

目的:分析 2021—2023 年医院抗菌药物相关药物不良反应（adverse drug reactions,ADRs）的发生情况及其临床特点,为临床抗菌药物的用药安全提供参考。方法:选取 2021 年 1 月—2023 年 12 月万载县中医院收治的 75 610 例使用了抗菌药物治疗的患者作为研究对象,采集患者的年龄、性别、诊断,所用抗菌药物的品种、规格、用法用量,以及 ADRs 的发生情况、累及系统（或部位）、临床表现等信息,分析医院抗菌药物相关 ADRs 的发生情况及其临床特点。结果:75 610 例使用抗菌药物治疗患者的感染类型主要为尿路感染（37 535 例,占 49.64%）,其次为呼吸系统感染（20 315 例,占 26.87%）和术后感染（17 760 例,占 23.49%）;75 610 例使用抗菌药物治疗的患者中,发生 ADRs 的有 55 例,ADRs 的发生率为 0.07%;55 例发生抗菌药物相关 ADRs 的患者中,女性略多于男性（31 例 vs 24 例）,而在年龄方面,以≥60 岁者为最多,其次为≤20 岁者（9 例,占 16.36%）和 50~<60 岁者（7 例,占 12.73%）;55 例抗菌药物相关 ADRs 中,所涉药物品种以盐酸莫西沙星氯化钠注射液为最多（10 例,占 18.18%）,其次为左氧氟沙星氯化钠注射液（8 例,占 14.55%）,再次为注射用头孢唑林钠和注射用阿莫西林-克拉维酸钾（均为 5 例,各占 9.09%）;55 例抗菌药物相关 ADRs 中,药物的给药方式绝大多数为静脉滴注（51 例,占 92.73%）,其余均为口服（4 例,占 7.27%）;55 例抗菌药物相关 ADRs 的累及系统（或部位）以皮肤及其附件和全身为最多（均为 11 例,各占 20.00%）,其次为胃肠道（7 例,占 12.73%）。结论:医院抗菌药物相关 ADRs 的整体发生率较低,但临床仍要保持对抗菌药物相关 ADRs 的常态化监测,以保障患者用药安全。

Objective: To analyze the process of anti-infective therapy and pharmaceutical care for a patient with intracranial infection after ventriculoperitoneal shunt, and provide a reference for the treatment of such patients. Methods and Results: A patient was admitted to the hospital on March 2, 2024 due to "hypoxic-ischemic encephalopathy and more than 4 months after ventriculoperitoneal shunt", and relevant examinations were completed. The patient developed fever 3 days after admission; results of routine blood test, as well as routine and biochemical examinations of cerebrospinal fluid (CSF) indicated infection, but antibacterial therapy was temporarily withheld due to suspected central hyperthermia. The patient was diagnosed with intracranial infection definitely 8 days after admission, and empirical treatment with ceftriaxone-tazobactam sodium (2.0 g, q12h, intravenous infusion) was initiated, after which the infection indicators improved to some extent. Recurrence of infectious symptoms was observed in the patient 24 days after admission, and specimens including CSF were collected for etiological examination. The patient's condition deteriorated rapidly 27 days after admission, and Staphylococcus epidermidis was detected in the submitted specimens; the medication was adjusted to vancomycin (1.0 g, q12h, intravenous infusion) based on the drug susceptibility test results. The patient developed fever again with the progression of infection indicators 35 days after admission, suggesting the aggravation of intracranial infection. The patient's body temperature rose continuously with further progression of infection indicators 39 days after admission, and meropenem (2.0 g, q8h, intravenous infusion) was added. Pan-drug-resistant Pseudomonas aeruginosa was detected in the patient's CSF 44 days after admission. Based on the drug susceptibility test results, ciprofloxacin (0.4 g, q8h, intravenous infusion) and amikacin (30 mg, intrathecal injection) were added, vancomycin was discontinued, the patient's symptoms improved gradually and the intracranial infection was well controlled. Cranial CT suggested hydrocephalus in the patient 90 days after admission, and a secondary shunt surgery was then performed with anti-infective therapy maintained postoperatively. The patient's condition stabilized one week later and the patient was discharged from hospital. Conclusion: Clinical pharmacists assist in formulating safe and effective individualized therapeutic regimens through methods such as etiological early warning, pharmacokinetic/pharmacodynamic (PK/PD)-based administration optimization, innovative application of intrathecal drug delivery route and management of off-label drug use, which reflects the crucial value of pharmaceutical care in the treatment of severe infections.

Objective: To analyze the effect of the centralized volume-based procurement (CVP) policy for antibacterial drugs of the hospital on the efficacy, cost-effectiveness and safety of meropenem in the treatment of patients with severe community-acquired pneumonia (SCAP), and provide a reference for promoting clinical rational drug use. Methods: Patients with SCAP treated with meropenem in Tongren People's Hospital before the CVP of antibacterial drugs (January-December 2022, 44 cases) and after the CVP (January-December 2023, 66 cases) were selected as the research subjects. Information including age, gender and diagnosis of the patients was collected and statistically analyzed via the rational drug use monitoring system, and body temperature, laboratory test results and clinical outcomes of the patients were collected and statistically analyzed via the hospital information system. The general data and total clinical effective rate of SCAP patients treated with meropenem before and after the CVP were compared, the cost-effectiveness analysis was conducted, and the medication safety of meropenem before and after the CVP was evaluated. Results: There were no statistically significant differences in age, gender, comorbid underlying diseases, average length of hospital stay and duration of meropenem therapy between SCAP patients treated with meropenem before and after the CVP (P>0.05). The total clinical effective rates of meropenem in the treatment of SCAP patients before and after the CVP were 88.64% and 96.97% respectively, with no statistically significant difference (P>0.05) after comparison. The expenditure on antibacterial drugs, total drug treatment cost and total hospitalization cost of patients after the CVP were significantly lower than those before the CVP (P<0.05). The cost-effectiveness ratios (C/E) before and after the CVP were 67.48 and 20.74 respectively, and the incremental cost-effectiveness ratio (iCER) was –476.64. The sensitivity analysis results with a 15% reduction in drug costs showed that the iCER was –512.85. No adverse reactions were observed in SCAP patients treated with meropenem before the CVP, while adverse reaction occurred in one patient after the CVP, mainly manifested as rash and pruritus, and the difference between the two groups was not statistically significant (P>0.05). Conclusion: The implementation of the CVP policy has not only ensured the clinical efficacy and medication safety of meropenem, but also greatly alleviated the economic burden on patients.

目的:分析医院万古霉素超说明书用药的现状及其合理性,为临床万古霉素的规范超说明书用药提供参考。方法:选取 2023 年 1 月—2024 年 3 月西安国际医学中心医院的 268 份使用万古霉素患者的出院病历作为研究资料,以药品说明书为基础,结合国内外临床指南、专家共识和高质量文献等循证医学证据,对超说明书用药的类型、科室分布及其合理性进行系统评价。结果:268 份使用万古霉素的患者病历中,超说明书用药病历有 71 份（占 26.49%）,其中主要来自关节一科（29 份）、关节二科（19 份）和足踝外科（15 份）;71 份万古霉素超说明书用药病历中,万古霉素的超说明书类型均为超给药途径用药,其中主要的给药方式有复合骨水泥（30 份）、关节腔局部注射（15 份）、关节腔外用局部涂撒粉末（11 份）;对照万古霉素超说明书用药的评价标准,71 份万古霉素超说明书用药病历均为合理。结论:医院万古霉素存在一定比例的超说明书用药情况,其类型均为超给药途径用药,经评价这些超说明书用药均为有循证证据支持的合理用药,且均取得了较好的治疗效果和未发生严重药物不良反应,尽管如此临床仍应持续加强对超说明书用药的监测和管理,以保障患者的用药安全。

Objective: To analyze the pharmaceutical care process of postoperative intracranial infection treatment in a patient with intracranial space-occupying lesion, and provide a reference for clinical treatment. Methods and Results: A 45-year-old male patient was admitted to the hospital due to "left temporal lobe space-occupying lesion". On the 11th day after admission, he underwent resection of intracranial space-occupying lesion in the left frontotemporal region, and cefazolin was given for infection prevention before surgery. On the first day after surgery, the patient's body temperature was 37.4 ℃, with significant elevation in white blood cell (WBC) count and neutrophil (NEUT) count, and the medication was switched to ceftriaxone sodium. On the third day after surgery, the patient had low-grade fever (body temperature 37.8 ℃) with abnormal results of cerebrospinal fluid examination, and intracranial infection was considered. Clinical pharmacists conducted consultation, suggested discontinuing ceftriaxone sodium and switching to the combined regimen of vancomycin (loading dose 1.75 g, maintenance dose 1 g, intravenous drip, q12h) + vancomycin (20 mg, intrathecal injection, q24h) + meropenem (2 g, intravenous pump infusion for more than 3 hours, q8h). The proposal was not fully adopted by physicians, and the patient was treated with vancomycin (loading dose 1.75 g, intravenous drip, q12h) + vancomycin (40 mg, intrathecal injection, q24h) + meropenem (1 g, intravenous pump infusion for more than 3 hours, q8h). On the 6th day after surgery, the patient's body temperature rose to 3⁹.3 ℃. Pharmacists conducted consultation again and suggested adjusting the dosage of meropenem (2 g, intravenous drip, q8h) while continuing the combined use of vancomycin. On the 15th day after surgery, the patient still had occasional low-grade fever. Physicians invited clinical pharmacists for consultation, and pharmacists suggested discontinuing vancomycin and administering linezolid (600 mg, intravenous drip, q12h) while continuing the combined use of meropenem for anti-infective treatment. After that, the patient's symptoms further improved. On the 22nd day after surgery, the patient was conscious, had clear vision and normal body temperature, and was allowed to be discharged from hospital by physicians. Conclusion: Clinical pharmacists participate in the whole course of postoperative intracranial infection treatment in this patient with intracranial space-occupying lesion. Based on the changes of his condition, they put forward rational suggestions by combining pharmaceutical expertise with relevant guidelines and conducted pharmaceutical care. The patient has achieved good curative effect, which reflects the professional value of clinical pharmacists.

Objective: To analyze the treatment and pharmaceutical care for a patient with hemorrhagic stroke complicated with multiple comorbidities, and provide a reference for clinical pharmacists in conducting pharmaceutical care and formulating safe and rational medication regimens for patients with hemorrhagic stroke. Methods and Results: The patient was treated in another hospital 10 days ago due to "sudden severe headache accompanied by dyskinesia of the right limb, nausea and vomiting, and dysarthria", and was then transferred to our hospital for further treatment. After admission, mannitol was administered for dehydration and intracranial pressure reduction, combined with cefoperazone-sulbactam sodium for anti-infective therapy. In the early morning of the next day, the patient developed a decreased level of consciousness and somnolence, along with a blood pressure of 190/113 mmHg and a body temperature of 39.2 ℃. Cranial and thoracic computed tomography (CT) revealed hemorrhage in the vermis of the cerebellar hemisphere that ruptured into the fourth ventricle, dilatation and hydrops of the lateral and third ventricles, a small amount of subarachnoid hemorrhage, and inflammation of the right lower lobe of the lung. Serum tests showed abnormal infection indicators including white blood cell count, neutrophil percentage, high-sensitivity C-reactive protein, and procalcitonin. Therefore, the therapeutic regimen was adjusted to enhanced dehydration and intracranial pressure reduction with mannitol combined with human albumin injection and furosemide injection, blood pressure control with urapidil hydrochloride, and anti-infective therapy with imipenem-cilastatin sodium. Five days later, the patient suffered from sudden limb convulsion and loss of consciousness; considering the medical history of cerebral hemorrhage, an epileptic seizure was diagnosed, and concentrated valproate sodium injection (0.3 g) was given via intravenous pump infusion to relieve epileptic symptoms. Given the potential interaction between imipenem-cilastatin sodium and valproate sodium, the anti-infective agent was switched to piperacillin-tazobactam sodium (4.5 g, q8h). One day later, renal function test results showed urea nitrogen of 34.88 mmol/L and creatinine of 178.5 μmol/L with progressive elevation of creatinine, suggesting acute kidney injury. Therefore, mannitol was discontinued and replaced with concentrated sodium chloride injection (3 g, q12h) for dehydration and intracranial pressure reduction. Blood routine tests indicated improved infection indicators, and piperacillin-tazobactam sodium was then reduced to 4.5 g every 12 hours (q12h) for continued anti-infective therapy based on the renal function status. After nearly 10 days, the patient's symptoms and infection indicators were significantly improved, and the patient was discharged subsequently. Conclusion: Patients with hemorrhagic stroke are often complicated with pneumonia, epilepsy, kidney injury and other comorbidities. When formulating clinical dosage regimens, full consideration should be given to adverse drug reactions, drug-drug interactions and the rationality of administration routes, so as to improve the clinical therapeutic efficacy.

Objective: To analyze the clinical characteristics and prognosis of daptomycin-associated liver injury, and provide a reference for the clinical safe use of daptomycin. Methods: Domestic and foreign databases were systematically retrieved (up to July 23, 2024) to incorporate the case report literatures on daptomycin-induced liver injury. Data including patients' demographic characteristics, medication information, onset time of liver injury, clinical manifestations, treatment and outcomes were extracted for descriptive statistical analysis. Results: A total of 10 patients were enrolled, including 6 males, 3 females and 1 with unrecorded gender, aged 31 to 80 years with an average age of 53 years. The primary diseases were mainly bacteremia (5 cases) and osteomyelitis (4 cases), and all patients had underlying diseases. Off-label dosage was used in 6 cases (60%), and combined medication was administered in 8 cases (80%). The onset time of liver injury was 5 days to 5 weeks after medication administration (accounting for 80% within 5 to 14 days). The clinical types of liver injury included hepatocellular injury type (4 cases), mixed type (2 cases) and cholestatic injury type (1 case), while 3 cases failed to meet the diagnostic criteria. The main clinical manifestation was abnormal biochemical indicators, and only 4 cases had symptoms (such as abdominal pain, jaundice and fatigue). All 10 cases received intervention of daptomycin discontinuation. Liver function recovered within 5 days to 2 months after drug withdrawal in 8 cases (80%), 1 case died of hepatic encephalopathy, and the outcome of 1 case was unknown. Conclusion: Daptomycin-associated liver injury mostly occurs within 5 to 14 days after medication administration with atypical clinical manifestations, and most patients have a favorable prognosis after drug withdrawal. It is recommended to strengthen the monitoring of liver function during the medication period, with special attention to the rationality of dosage and the risk of drug-drug interactions.

Objective: To systematically evaluate the differences in clinical efficacy and safety between voriconazole and fluconazole in the treatment of fungal infections, and provide the evidence-based rationale for clinical selection of antifungal drugs. Methods: Computerized retrieval was conducted in PubMed, CNKI and Wanfang Database for case-control studies on voriconazole (intravenous sequential oral administration or full-course intravenous administration) versus fluconazole (full-course intravenous administration) in the treatment of fungal infections published from the establishment of each database to October 10, 2024. Two researchers independently performed literature screening, quality assessment (using the Newcastle-Ottawa Scale) and data extraction. Meta-analysis was conducted with RevMan 5.4.1 software. Results: A total of 9 studies involving 637 patients were finally included. The meta-analysis results showed that the clinical effective rate in the voriconazole group was significantly higher than that in the fluconazole group (OR=2.93, 95%CI=1.50-5.70, P=0.002), and the incidence rate of drug-related adverse reactions was lower in the voriconazole group (OR=0.54, 95%CI=0.33-0.87, P=0.01). In terms of antipyretic effect, the voriconazole group was significantly superior to the fluconazole group (OR=7.94, 95%CI=2.82-22.35, P<0.000 1). There was no statistically significant difference in the incidence rate of breakthrough fungal infections between the two groups (OR=1.42, 95%CI=0.55-3.68, P=0.47). Conclusion: Available evidences indicate that voriconazole has superior clinical efficacy and safety in the treatment of fungal infections, while its efficacy in preventing breakthrough infections is comparable to that of fluconazole.

目的:分析 1 例高血压性脑出血患者行开颅手术后并发多重耐药鲍曼不动杆菌肺部感染的抗感染治疗药学监护过程,以期为此类患者的抗感染治疗与药学监护提供参考。方法与结果：患者（男,81 岁）因洗澡时突发四肢无力后跌倒而入院,综合患者入院后的各项检查结果和既往病史,判定其为高血压性脑出血,随即进行了开颅手术治疗,围术期临床予头孢呋辛进行了感染预防;术后第 7 天,患者出现发热、肺部湿啰音、感染指标异常等情况,并且胸部 CT 提示存在两肺炎症,临床考虑其并发了肺部感染,遂经验性予哌拉西林-他唑巴坦钠治疗;治疗 6 d 后,患者的感染症状未见明显好转,且痰标本中两次检出碳青霉烯类耐药的鲍曼不动杆菌,临床结合药敏试验结果将抗感染治疗方案调整为头孢哌酮-舒巴坦钠+阿米卡星;新方案治疗 9 d 后,患者的感染症状仍未得到有效控制,临床药师综合相关资料,建议将阿米卡星调整为替加环素,并且替加环素的给药方案宜为“首剂 200 mg,维持剂量100 mg,q12h”,临床采纳了该建议;又治疗 7 d 后,患者体温恢复正常,感染指标明显降低,胸部 CT 亦提示两肺炎症较前好转。结论:高血压性脑出血患者术后容易发生肺部感染等并发症,而对于有基础疾病的老年患者,其病原菌为多重耐药的风险更高,对此临床应在综合病原学结果的基础上选择合适的抗菌药物,并在给药方案上进行个体化调整,以提高药物的治疗效果,同时临床还应做好药物的药物不良反应监测,以保障患者的用药安全。

目的:分析 2019—2023 年医院抗菌药物相关药物不良反应（adverse drug reactions,ADRs）的临床特征,并提出干预策略,为促进临床抗菌药物的用药安全提供参考。方法:选取 2019 年 1 月—2023 年 12 月苏州市立医院白塔院区上报至国家药品不良反应监测中心的 2 102 例 ADRs 报告作为研究资料,收集 ADRs 所涉患者的性别和年龄、所涉药品的名称和给药方式,以及 ADRs 的累及部位（或系统）和相关临床表现、严重程度和转归等信息,分析医院抗菌药物相关 ADRs 的临床特点。结果:2 102 例 ADRs 报告中,抗菌药物相关的 ADRs 有 434 例,其中报告类型为“一般”的有 348 例,“严重”的有 53 例,“新的一般”的有 30 例,“新的严重”的有 3 例;434 例抗菌药物相关 ADRs 报告所涉患者中,女性患者（235 例,占 54.15%）占比高于男性（199 例,占 45.85%）,患者的年龄集中在 0~20 岁（140 例,占 32.26%）和>60~80 岁（95 例,占 21.89%）;所涉药品的给药方式主要为静脉滴注（345 例,占 79.49%）和口服（66 例,占 15.21%）;所涉抗菌药物的主要种类为头孢菌素类（161 例,占 37.10%）、大环内酯类（137 例,占 31.57%）和喹诺酮类（66 例,占 15.21%）;累及部位/系统排名前 3 位的是皮肤及其附件（185 例,占 42.63%）、胃肠道（90 例,占 20.74%）和全身性反应（45 例,占 10.37%）,434 例 ADRs 报告中,411 例患者好转,3 例未好转,其余 20 例不详。结论:抗菌药物相关 ADRs 值得关注,除采取措施促进临床科学用药外,医院应加强临床培训并定期总结,提高监测水平,从而更好地保障患者用药的安全性与合理性。

Objective: To analyze the practice of clinical pharmacists participating in anti-infective pharmaceutical consultations and explore the value of clinical pharmacists in anti-infective drug therapy in combination with typical cases. Methods: A total of 49 inpatients who received anti-infective pharmaceutical consultations with the participation of clinical pharmacists in Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine from January to December 2024 were selected as the research subjects. Data including the patients' gender, age, department distribution, etiological examination results, clinical outcomes, consultation contents and adoption of consultation opinions were collected to analyze the characteristics of patients and their anti-infective treatment status. Results: 49 patients with anti-infective pharmaceutical consultations involving clinical pharmacists were mainly from Department of Urology (25 cases, 51.02%) and Department of Neurosurgery (12 cases, 24.49%). The number of male patients was higher than that of female patients (37 cases vs 12 cases), and most patients were aged above 15 to 60 years. Among 49 patients, 35 had positive microbial test results, with a total of 35 pathogenic bacteria strains detected, including 24 strains of Gram-positive bacteria (68.57%, mainly Streptococcus and Staphylococcus aureus), 10 strains of Gram-negative bacteria (28.57%) and 1 strain of fungi. The main contents of consultations were assisting in adjusting medication regimens (29 cases, 59.18%) and adjusting the dosage and administration of drugs (15 cases, 30.61%). In 49 patients, the consultation opinions for 44 cases were adopted; 40 cases achieved cure or improvement in treatment outcomes, and 4 cases had aggravated conditions or ineffective treatment. Conclusion: The active participation of clinical pharmacists in anti-infective pharmaceutical consultations has gained clinical recognition. Clinical pharmacists not only provide personalized medication recommendations, but also play a positive role in the treatment of infectious diseases and improve the therapeutic level.

作为深化医药卫生体制改革的关键举措,国家药品集中采购（集采）已开展七批。本文按照第 2 版《中国国家处方集》（以下简称《处方集》）中各系统疾病的用药分类,总结《处方集》中 20 章系统疾病与用药中被纳入 7 批集采药品的数量与品种,对其被纳入的适宜性进行分析,进一步探究国家药品集中采购的趋势与合理性。经分析,前 7 批集采的 288 种药品（去除重复剂型后为 253 个品种）中,高达 236 种（93.3%） 被第 2 版《中国国家处方集》收录,凸显集采药品遴选与核心临床需求高度契合。除第六批（胰岛素制剂）、第四批外,每批次集采药品数量呈增加趋势,药品治疗疾病系统以感染性、心血管、内分泌代谢等疾病为主。建议医疗机构将中选药品纳入院内处方集,通过系统分析品规以满足多样化用药需求;同时可参考《处方集》中集采药品的分布特征,建立量化、常态化的院内集采药品使用考核体系,在保障合理用药的前提下完成合同用量目标。本研究为评估集采政策与临床需求的匹配度及优化医疗机构执行策略提供了参考。

Methenamine is an important drug for the prevention of lower urinary tract infections. It can hydrolyze into formaldehyde in an acidic urine environment (pH≈6.5) and exerts a broad-spectrum bactericidal effect. The U.S. Food and Drug Administration has approved methenamine hippurate(MH) for the prevention of recurrent urinary tract infections in patients aged 6 years or older. This article reviews the epidemiological status and challenges in the prevention and treatment of MH, and systematically elaborates on the research progress in the prevention and treatment of urinary tract infections with MH, aiming to provide a reference for the more rational and effective clinical application of MH in this field.

目的: 分析骨科 Ⅰ 类切口手术患者围术期预防性使用抗菌药物的合理性,为临床上此类患者的合理用药提供参考。方法: 选取 2023 年 12 月—2024 年 5 月昆山市中医医院骨科收治的 1 857 例 Ⅰ 类切口手术患者作为研究对象,采集患者的一般资料和抗菌药物的科室分布、品种选择等,对其围术期抗菌药物的预防使用情况进行合理性评价。结果: 骨科 1 857 例 Ⅰ 类切口手术患者围术期的抗菌药物预防使用率为 78.14%（1 451/1 857）,不同科室的抗菌药物使用情况存在差异;预防性使用抗菌药物的药物选择较为合理,主要选用头孢唑林和头孢尼西;共计 1 428 例患者的给药时机在术前 0.5~1 h,符合预防用药的最佳时机;不合理用药情况共 506 例（占 34.87%）,主要涉及无指征用药（34 例,占 6.72%）、品种选择不合理（74 例,占 14.62%）、给药时机不合理（23 例,占 4.55%）、用药疗程不合理（375 例,占 74.11%）。结论: 医院骨科 Ⅰ 类切口手术患者围术期预防性使用抗菌药物在预防使用率、品种选择和疗程等方面仍存在一定问题,临床需进一步加强对围术期抗菌药物的使用管理,规范、合理用药。

目的:分析医院住院患者糖皮质激素的使用情况及其不合理用药原因,并提出针对性干预措施,为提高临床糖皮质激素的合理用药水平提供参考。方法:借助医院信息系统,随机抽取 2024 年1—12 月徐州市中医院的 1 200 份使用了糖皮质激素的住院患者归档病历作为研究资料,采集患者的年龄、性别、诊断、所在科室,以及所用糖皮质激素的品种、规格、用法用量等信息,然后依据相关权威资料对糖皮质激素进行合理用药点评,分析医院住院患者糖皮质激素的使用特点和不合理用药原因。结果:1 200 例使用糖皮质激素的患者共来自 24 个科室,其中前 5 位的科室依次为呼吸科（238 例,占 19.83%）、皮肤科（115 例,占 9.58%）、肾内科（92 例,占 7.67%）、骨科（90 例,占 7.50%）与肿瘤科（88 例,占 7.33%）;1 200 例患者的疾病类型主要为呼吸系统疾病（340 例,占 28.33%）、过敏性疾病（285 例,占 23.75%）和风湿免疫性疾病（196 例,占 16.33%）;患者所用的糖皮质激素共涉及 12 个品种,其中主要品种为注射用甲泼尼龙琥珀酸钠（300 例,占 25.00%）、地塞米松磷酸钠注射液（270 例,占 22.50%）和吸入用布地奈德混悬液（178 例,占 14.83%）;合理用药点评结果显示,1 200 份病历中有 204 份存在糖皮质激素不合理使用情况,不合理发生率为 17.00%;其中,不合理用药的主要原因为给药途径不适宜（95 例,占 46.57%）、适应证不适宜（42 例,占 20.59%）。结论:医院住院患者的糖皮质激素使用存在较多的不合理用药情况,对此相关管理部门应加强对临床合理用药的培训与管理,以提高其合理用药水平,进而保障患者的用药安全。

目的:分析 1 例糖尿病患者并发全身感染的抗感染治疗与药学监护过程,为临床糖尿病合并全身感染的抗感染治疗提供参考。方法与结果：患者因发热和感染指标（降钙素原、尿白细胞阳性）异常得不到有效控制而入院治疗;入院后,临床综合患者的检查结果和糖尿病病史,初步判断其为糖尿病合并尿路感染,伴全身炎症反应综合征,遂经验性予哌拉西林-他唑巴坦钠治疗;治疗 3 d 后,患者仍反复发热,并且血培养检出人葡萄球菌,药敏结果提示其对青霉素、苯唑西林等耐药,而对万古霉素、利奈唑胺、利福平等敏感,临床药师会诊后建议将抗感染治疗方案调整为万古霉素;新方案治疗 3 d 后,患者感染指标水平进一步下降,并且精神状况、乏力、纳差等情况也较前好转,但仍反复发热;临床药师考虑患者入院初期使用哌拉西林-他唑巴坦钠治疗后感染指标曾有所下降,认为患者可能为混合感染,故在会诊时建议加用哌拉西林-他唑巴坦钠,医生采纳了该建议;之后,患者的体温和感染指标水平逐渐恢复正常,血培养结果也转为阴性。结论:糖尿病患者易继发局部和全身感染,其抗感染治疗方案的制定应尽量基于微生物学检查和药敏试验结果,然而在实际临床工作中患者的个体化给药常需根据实际情况进行动态调整,从而更好地保障患者的治疗效果。

目的:分析医院门急诊抗菌药物的使用情况,为提高临床抗菌药物的合理用药水平提供参考。方法:选取 2022—2024 年苏州市广济医院门急诊的 151 张含抗菌药物的处方作为研究资料,采集门急诊抗菌药物处方中患者的年龄、性别、诊断,以及所用抗菌药物的品种、用法用量等信息,依据药品说明书、相关指南和专家共识等权威资料,对其中的抗菌药物使用进行合理用药点评,分析医院门急诊抗菌药物的用药特点和不合理原因。结果:医院门急诊 151 张抗菌药物处方主要来自预防保健科（104 张,占 68.87%）和精神科（30 张,占 19.87%）;门急诊 151 张抗菌药物处方所涉患者在年龄上主要集中于>60 岁者（72 例,占 47.68%）和>40~60 岁者（43 例,占 28.48%）;151 张门急诊抗菌药物处方共涉及 7 个品种,其中以头孢呋辛（93 张,占 61.59%）和头孢克洛（25 张,占 16.56%）为主;处方点评结果显示,151 张门急诊抗菌药物处方中共有 45 张存在不合理用药情况,不合理发生率为 29.80%;而不合理用药的主要原因类型为用法用量不适宜（17 张,占 37.78%）、药物选用不适宜（13 张,占 28.89%）和无适应证用药（11 张,占 24.44%）。结论:医院门急诊抗菌药物存在较多的不合理用药情况,其常见原因有用法用量不适宜、药物选用不适宜和无适应证用药,对此医院相关管理部门应加强对临床抗菌药物合理使用的培训和考核管理,以提高其抗菌药物的合理使用水平。

目的: 分析 1 例氯吡格雷与瑞格列奈联用致严重低血糖的病例,并结合文献复习,为临床合理用药与风险防范提供参考。方法与结果: 患者,老年女性,因 2 型糖尿病长期口服瑞格列奈治疗,经皮冠脉介入术后加用氯吡格雷抗血小板治疗,联用第 2 天患者发生严重低血糖,且停用瑞格列奈后仍反复发作,经积极葡萄糖干预后缓解;同时检索并复习相关文献发现,氯吡格雷可强效抑制 CYP2C8 酶,显著升高瑞格列奈血药浓度,从而增强并延长其降糖作用,导致低血糖风险显著增加。结论: 氯吡格雷与瑞格列奈联用存在明确的药物相互作用,可显著增加低血糖风险,临床应避免联合使用。建议选用替代降糖方案,用药过程中加强血糖监测,以保障患者用药安全。

Objective: To analyze the pharmaceutical care process of a patient with Candida parapsilosis bloodstream infection, explore the risk factors, diagnostic methods and treatment regimens of the infection, and provide a reference for improving clinicians' and pharmacists' understanding of the disease and their collaborative diagnosis and treatment capabilities. Methods and Results: A 67-year-old male patient had undergone stent implantation for the anterior descending branch and circumflex branch of the coronary artery in another hospital due to "chest tightness for 5 years, aggravated for more than 2 months", and took secondary prevention drugs for coronary heart disease regularly after surgery, but still suffered from intermittent chest tightness and anhelation. He was transferred to Guizhou Provincial People's Hospital on November 20, 2023. On admission, electrocardiography showed third-degree atrioventricular block, and dual-chamber permanent pacemaker implantation was performed. After surgery, the patient suddenly lost consciousness, suffered from respiratory and cardiac arrest, and was immediately given tracheal intubation and invasive mechanical ventilation. Echocardiography showed a small amount of pericardial effusion, and central venous catheterization was performed. Considering the patient had hemorrhagic cardiac tamponade, thoracotomy and hemostasis exploration were carried out immediately. Postoperatively, the patient was in moderate to severe coma with no response to pain stimulation. On December 6, the patient underwent tracheotomy and was transferred to the Coronary Care Unit after surgery. From December 14 to 15, fungal spores were detected in the patient's blood cultures (aerobic + anaerobic) for two consecutive times, and caspofungin acetate for injection was administered for antifungal treatment. On December 17, the blood culture results indicated Candida parapsilosis (the strain was sensitive according to drug susceptibility test results). On December 18, the patient's clinical symptoms and signs still showed no significant improvement. Based on his condition and evidence-based data, clinical pharmacists suggested combined use of amphotericin B for injection and formulated an individualized dosage regimen. On December 26, the clinical team adopted the pharmacists' suggestion, titrated the dose of amphotericin B for injection to 45 mg per day, and successfully removed the right internal jugular vein catheter under strict aseptic technique. Through the above interventions and full-course pharmaceutical care, the patient's infection was gradually controlled, clinical symptoms were significantly improved, and the treatment achieved favorable efficacy. Conclusion: Effective management of Candida parapsilosis bloodstream infection is a systematic project integrating accurate etiological diagnosis, rational application of antifungal drugs, complete elimination of infection sources and comprehensive pharmaceutical care throughout the treatment process. Clinical pharmacists play an important role in optimizing anti-infective treatment regimens.

目的: 分析 2020—2022 年兴国县人民医院门急诊抗菌药物处方点评结果,总结其不合理用药特征,为促进临床合理用药提供参考。方法: 通过美康系统随机抽取门急诊抗菌药物处方 10 256 张,参照《抗菌药物临床应用指导原则》《医院处方点评管理规范（试行）》和药品说明书等规范进行点评,采用 Excel 软件统计不合理处方的类型、科室分布等。结果: 10 256 张处方中,抗菌药物使用频率排名前 4 位的科室依次为呼吸与消化内科（占 24.96%）、普外科（占 18.16%）、皮肤科（占 16.25%）,以及妇科（占 12.64%）;2020—2022 年门急诊抗菌药物处方不合理率为 2.51%（257/10 256）,其中 2020 年为 3.59%（102/2 839）、2021 年为 2.45%（83/3 389）、2022 年为 1.79%（72/4 028）,各年度不合理率呈下降趋势;不合理处方的季节分布按降序排名为冬季（占 32.30%）、春季（占 31.91%）、秋季（占 20.62%）、夏季（占 15.18%）;不合理类型以用药不适宜为主（占 82.88%）,主要原因为适应证不适宜（占 33.85%）、用法用量不适宜（占 26.46%）、无指征超“急三慢七”（占 11.67%）;涉及抗菌药物中,头孢菌素类占比最高（占 62.98%）,其次为喹诺酮类（占 13.15%）。结论: 医院门急诊抗菌药物不合理使用现象主要涉及头孢菌素类药物,表现为适应证把握不当、给药方案欠规范与疗程管理缺陷,需通过加强培训和动态监管持续改进。

目的: 评价信息化管控在 Ⅰ 类切口手术围手术期预防使用抗菌药物中的应用效果,以促进临床抗菌药物合理使用。方法: 通过规范科室预防用药目录、限定 Ⅰ 类切口手术预防用药时间、增加原则上不预防用药手术的限定、改变预防用药申请流程等多维度构建信息化管控体系,比较 2019 年 1—6 月（信息化管控前）和 2022 年 1—6 月（信息化管控后） Ⅰ 类切口手术预防用药率、术后 24 h 内停药率、手术部位感染发生率等。结果: 实施信息化管控后,全院 Ⅰ 类切口预防使用抗菌药物比例由 30.70% 下降至 24.54%,其中疝修补术预防用药比例下降显著,由 54.52% 下降至 2.13%; Ⅰ 类切口手术后 24 h 内停药率由 13.78% 升高至 96.96%,差异具有统计学意义（P<0.05）;疝修补术患者管控前平均住院天数为（6.52±2.71）d,管控后为（5.45±2.34）d,差异具有统计学意义（P<0.05）;管控前患者手术部位感染发生率为 0.50%,管控后为 0.48%,差异不具有统计学意义（P>0.05）。结论: 实施信息化管控后 Ⅰ 类切口手术围手术期预防使用抗菌药物比例明显降低,术后 24 h 内停药率显著提高,且未增加患者手术部位感染发生率,疝修补术患者的住院时间明显缩短;信息化管控可有效提升 Ⅰ 类切口手术预防用药的规范性,促进了抗菌药物合理使用。

目的:分析医院发热门诊自助药房的构建与应用效果,为智慧药房的建设与发展提供参考。方法:上海市浦东新区人民医院发热门诊定制和引进了 Pharm-care-A02P /Pharm-care-A01P 型双通道自助发药机,并于 2022 年 7 月 19 日正式启用,分析和比较发热门诊自助药房启用前后的发药差错率、调配时间、患者等待时间、患者满意度等指标。结果:自助药房发药和人工发药的发药差错率均为 0.00%,但自助药房的单张处方调配时间明显短于人工发药（35 s vs 65 s）,并且其单张处方的患者等候时间亦明显短于人工发药（45 s vs 90 s）;此外,自助药房发药的患者满意度高于人工发药（98.00% vs 95.80%）。结论:发热门诊自助药房可以做到发药零差错,并且相较于人工发药可以极大地提高发药效率,展现了自助药房这种智慧药房形态的巨大优势。

目的:分析医院呼吸内科下呼吸道感染（lower respiratory tract infection,LRTI）患者标本中病原菌的分布特征及其耐药特点,为临床 LRTI 患者的抗感染治疗提供参考。方法:选取 2023 年 1 月—2024 年 6 月资溪县人民医院呼吸内科收治的 110 例 LRTI 患者作为研究对象,采集患者的痰液、支气管肺泡灌洗液等呼吸道标本进行微生物培养和药敏试验,分析患者标本中病原菌的分布特征及其耐药情况。结果:110 例 LRTI 患者标本中共检出 121 株病原菌,其中革兰阴性菌 66 株（占 54.55%,主要为大肠埃希菌、铜绿假单胞菌和肺炎克雷伯菌）、革兰阳性菌 45 株（占 37.19%,主要为金黄色葡萄球菌、表皮葡萄球菌和肺炎链球菌）和真菌 10 株（占 8.26%,均为白假丝酵母）;药敏结果显示,大肠埃希菌、铜绿假单胞菌和肺炎克雷伯菌对亚胺培南、美罗培南、阿米卡星、头孢哌酮、妥布霉素、复方磺胺甲噁唑、哌拉西林的耐药率均低（<25.00%）,而对头孢呋辛、头孢唑林、阿莫西林、氨苄西林、环丙沙星、氨曲南、左氧氟沙星、头孢他啶、氨苄西林的耐药率均较高（>70.00%）;金黄色葡萄球菌、表皮葡萄球菌和肺炎链球菌对替加环素、磷霉素、氯霉素、利福平、万古霉素、利奈唑胺、替考拉宁的耐药率均较低（<15.00%）,而对左氧氟沙星、苯唑西林、青霉素、克林霉素、阿莫西林的耐药率均较高（>60.00%）。结论:医院呼吸内科 LRTI 的致病菌以大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌和表皮葡萄球菌为主,其对常用的非限制使用级、限制使用级抗菌药物有着较高的耐药率,为此临床应尽量根据其药敏试验结果合理选用抗菌药物,以保障患者的抗感染治疗效果。

目的: 分析 2024 年医院药学会诊的病例特征,总结临床药师参与会诊的经验,为提升药学服务质量和临床合理用药提供参考。方法: 选取 2024 年 1—12 月衡阳市中医医院临床药师参与的药学会诊病例作为研究对象,系统分析患者的基本信息、病原学检测结果、会诊意见采纳情况和治疗转归等情况。结果: 92 例患者共申请药学会诊 109 例次,申请会诊的科室以心病科为最多（42 例次,占 38.53%）,其次为骨伤科（23 例次,占 21.10%）;送检的患者标本中共检出病原菌 80 株,其中革兰阳性菌 23 株、革兰阴性菌 38 株、真菌 19 株;医师申请会诊的目的排名前 3 位的是“细菌/真菌培养阳性选定抗菌药物”“前期方案不佳调整用药”“制定抗菌药物初始治疗方案/抗菌药物使用指征”医师未采纳会诊意见 6 例、部分采纳 3 例、采纳 100 例,采纳的会诊意见中治疗有效率为 77.00%（77/100）。结论: 临床药师的会诊意见采纳率较高,但需进一步提升会诊建议的有效性,建议加强会诊后随访机制建设并推进中药临床药学实践。

目的:分析 PDCA 循环法在老年住院患者抗菌药物管理中的应用成效,为保障老年住院患者抗菌药物的合理用药和用药安全提供参考。方法:随机抽取 PDCA 干预前（2022 年 7—12 月）使用抗菌药物治疗的老年住院患者作为研究对象,依据相关权威资料对其中的抗菌药物使用进行合理用药点评,运用 PDCA 循环法对抗菌药物的不合理使用进行原因分析,并制定整改措施,然后再随机抽取 PDCA 干预后（2023 年 7—12 月）使用抗菌药物治疗的老年住院患者,同样进行抗菌药物的合理用药点评,比较 PDCA 干预前后老年住院患者抗菌药物不合理使用的改善情况。结果:干预前组患者抗菌药物的合理率使用为 76.25%,干预后组患者抗菌药物的合理使用率为 93.12%,二者差异有统计学意义（P<0.001）;PDCA 循环法干预后,老年住院患者抗菌药物的合理率达到目标值 90%,比干预前提高 16.87%。结论:药师运用 PDCA 循环法参与老年住院患者抗菌药物管理,可有效提高老年住院患者抗菌药物的合理使用率,确保老年患者的用药安全,提升药学服务水平。

Objective: To analyze the adverse reaction identification and management process of rash induced by oral vancomycin in the treatment of Clostridium difficile (CD) infection in a patient with ulcerative colitis, and provide a reference for improving drug safety information, optimizing clinical treatment regimens and ensuring the medication safety of patients. Methods and Results: A female patient was admitted to the hospital for the treatment of "ulcerative colitis". On the first day of admission, she was given symptomatic treatment with mesalazine enteric-coated tablets, live combined Bacillus subtilis and Enterococcus faecium enteric-coated capsules, ceftriaxone sodium for injection, etc. On the third day of admission, colonoscopy and laboratory tests indicated that the patient was complicated with CD infection. Therefore, ceftriaxone sodium was discontinued, and oral vancomycin was administered. Symmetric rashes appeared on the medial sides of both wrists and the elbows 3-4 hours after the first dose of vancomycin, which subsided spontaneously about 1 hour later without any intervention. However, rashes recurred after subsequent administrations of vancomycin, with the interval between medication intake and rash onset gradually shortened, and all rashes subsided spontaneously. Therefore, the rash was preliminarily identified as a vancomycin-related adverse reaction. On the following day, vancomycin was discontinued and replaced with metronidazole tablets, and no recurrence of rash was observed thereafter. Conclusion: Based on literature review, it is considered that the rash may be caused by the absorption of vancomycin into the blood. During the treatment of patients with CD infection, it is necessary to be alert to the adverse reactions of oral vancomycin, especially for patients with high risk factors, and monitoring and evaluation should be enhanced.

随着医疗服务的需求持续增长,编外人员已成为公立医院人力资源的重要组成部分,其管理模式直接影响医院的运行效率与服务质量。该文以苏州市中医医院为例,通过系统分析编外人员的结构特征与管理现状,客观比较人事代理制与合同制两种模式的利弊,总结转型过程中面临的挑战与应对策略,以期为同类公立医院创新人力资源管理模式、实现人员结构优化与管理制度升级提供实证参考与理论借鉴。