Berberine, a natural isoquinoline alkaloid, is clinically used primarily for the treatment of intestinal infections caused by sensitive organisms. It exhibits a wide range of pharmacological effects, including anti-inflammatory, antibacterial, antiviral, anticancer, antihypertensive, hypoglycemic, and hypolipidemic activities. With the deepening of studies, researchers have found that berberine has a cerebral protection effect. This article reviews and summarizes the protective effect, action mechanism, and clinical applications of berberine in brain injury, so as to provide a reference for the further clinical application development of berberine.

目的：分析基层医院门诊抗菌药物的使用情况,为提升基层医院抗菌药物的合理用药水平提供参考。方法：随机选取 2023 年 7 月—2024 年 6 月习水县杉王街道社区卫生服务中心门诊的 1 200 张抗菌药物处方（每月 100 张）作为研究资料,采集处方中的前记、正文、后记中的所有信息,然后依据相关权威资料对其中的抗菌药物进行专项的合理用药点评,分析医院门诊抗菌药物的使用情况和不合理用药原因。结果：1 200 张门诊抗菌药物处方涉及的前 5 位口服抗菌药物分别为阿莫西林克拉维酸钾片（181 张）、阿奇霉素片（153 张）、头孢呋辛酯片（109 张）、左氧氟沙星片（95 张）和头孢克肟颗粒（76 张）,而前 5 位的注射用抗菌药物分别为注射用头孢呋辛钠（104 张）、注射用头孢他啶（62 张）、注射用青霉素钠（61 张）、左氧氟沙星氯化钠注射液（57 张）和甲硝唑氯化钠注射液（54 张）;医院门诊处方中,抗菌药物以单用为主（1 084 张,占 90.33%）,联用处方仅有 116 张,且均为二药联用;处方点评结果显示,1 200 张门诊抗菌药物处方中有 237 张存在不合理用药情况,不合理发生率为 19.75%;前 3 位的抗菌药物不合理使用原因分别为无指征用药（51 张,占 21.52%）、用法用量不规范（48 张,占 20.25%）和品种选择不当（46 张,占 19.41%）。结论：当前医院门诊抗菌药物的使用仍存在较多的不合理使用情况,医院应加强对医生、药师的抗菌药物相关培训和管理,以提高医院抗菌药物的合理用药水平。

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

Daptomycin is a novel cyclic lipopeptide antibacterial drug with potent antibacterial activity against Gram-positive bacteria but no antibacterial activity against Gram-negative bacteria. In China, its approved indications are limited to complicated skin and soft tissue infections and Staphylococcus aureus-induced bloodstream infections. However, clinical practice has revealed that daptomycin also demonstrates favorable clinical efficacy in off-label indications, such as left-sided infective endocarditis caused by Staphylococcus aureus, prosthetic joint infections and osteomyelitis caused by Staphylococcus aureus and Enterococcus species, and infections due to vancomycin-resistant Enterococcus. This article reviews the type of off-label use of daptomycin and relevant medication management, aiming to provide a reference for the rational clinical use of daptomycin.

目的：分析 1 例血液透析患者使用头孢唑林致抗菌药物相关性脑病的诊疗过程,为临床头孢唑林的用药安全提供参考。方法与结论：1 例常规行血液透析的患者因“左面部红肿疼痛 11 d”而入院治疗;通过检查,临床判断患者左面部红肿疼痛为面部坏死性筋膜炎,遂予头孢唑林抗感染治疗;次日,患者出现上肢抽搐、胡言乱语等症状,CT 检查则提示存在脑梗塞情况,临床在排除其他可能原因后考虑可能为抗菌药物相关性脑病,遂立即停用头孢唑林,并予丙戊酸钠,以及行血液透析联合血液灌流治疗;第 2 天,临床将抗感染治疗方案调整为哌拉西林-他唑巴坦钠,并再次行血液灌流治疗,当天患者未再出现胡言乱语、上肢抽搐等症状,并且之后的 2 周也均未再出现上述症状。结论：对于血液透析患者,由于其自身肾功能较差,临床应尽量避免对此类患者使用主要经肾脏排泄的 β-内酰胺类抗菌药物,如确需使用,应务必做好用药安全监测,以便抗菌药物相关性脑病风险发生时及时采取救治措施,从而保障患者的用药安全。

Objective: To analyze the identification and management process of adverse drug reactions (ADRs) in a case of delirium induced by levofloxacin, and provide a reference for the safe use of levofloxacin in clinical practice. Methods and Results: The patient was admitted to the hospital with symptoms such as nausea, vomiting, and diarrhea. Combined with abnormal indicators such as neutrophil percentage and C-reactive protein, the clinical diagnosis was acute gastroenteritis, and levofloxacin was given for anti-infective therapy. In the early morning of the 4th day, the patient developed mental symptoms such as restlessness, delirium, and confused speech. Experts from Department of Encephalopathy were consulted. The experts learned that the patient had no history of neuropsychiatric diseases or related family history. Combined with the current medication, they initially judged that these symptoms might be caused by levofloxacin, recommended discontinuing levofloxacin and giving symptomatic treatment. After discontinuing levofloxacin, the patient did not experience restlessness, delirium, confused speech or other symptoms again. Subsequent Naranjo Scale scoring showed that the association between levofloxacin and mental symptoms such as delirium was "probable". Conclusion: As a commonly used antibacterial drug in clinical practice, levofloxacin has the risk of causing central nervous system adverse reactions. Clinicians should strengthen medication monitoring during patient medication to ensure medication safety of patients.

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

目的：分析 2021—2023 年医院常见革兰阴性菌的检出情况及其耐药性变迁情况,为临床抗菌药物的合理使用提供参考。方法：选取 2021 年 1 月—2023 年 12 月抚州市第一人民医院住院患者各种送检标本中分离的病原学检查结果作为研究资料,统计革兰阴性菌（尤其是大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、奇异变形杆菌和阴沟肠杆菌）的检出情况及其耐药率,分析 3 年间这些常见革兰阴性菌检出率和耐药率的变化情况。结果：2021—2023 年医院住院患者标本中共分离到非重复革兰阴性菌 1 961 株,其中检出率最高的 6 种革兰阴性菌依次为大肠埃希菌（746 株,占 38.04%）、肺炎克雷伯菌（389 株,占 19.84%）、铜绿假单胞菌（308 株,占 15.71%）、鲍曼不动杆菌（126 株,占 6.43%）、奇异变形杆菌（67 株,占 3.42%）和阴沟肠杆菌（57 株,占 2.91%）;药敏结果显示,2021—2023 年大肠埃希菌对氨苄西林-舒巴坦钠、阿莫西林-克拉维酸钾、哌拉西林-他唑巴坦钠、头孢唑林、头孢呋辛、头孢他啶、头孢曲松、氨曲南、庆大霉素、妥布霉素和左氧氟沙星的耐药率发生了显著变化（P<0.05）,其整体趋势均为耐药率下降;2021—2023 年肺炎克雷伯菌对厄他培南、亚胺培南、美罗培南、庆大霉素、妥布霉素和复方磺胺甲噁唑的耐药率发生了显著变化（P<0.05）,其中对厄他培南、亚胺培南、美罗培南的耐药率呈上升趋势,而对庆大霉素、妥布霉素和复方磺胺甲噁唑的耐药率则呈下降趋势;2021—2023 年奇异变形杆菌仅对头孢呋辛的耐药率发生了显著变化（P<0.05）,呈上升趋势;而 2021—2023 年铜绿假单胞菌、鲍曼不动杆菌、阴沟肠杆菌对所有常用抗菌药物的耐药率均未发生显著变化（P>0.05）;在多重耐药菌株中,2021—2023 年产 ESBLs 肺炎克雷伯菌和耐碳青霉烯类肺炎克雷伯菌的检出率发生了显著变化（P<0.05）,前者呈下降趋势,而后者呈上升趋势;此外,3 年间产 ESBLs 菌株中产 ESBLs 大肠埃希菌的检出数最多（343 株）,且检出率也最高（为 45.98%）;耐碳青霉烯类菌株中耐碳青霉烯类肺炎克雷伯菌的检出数最多（112 株）,而检出率最高的则为耐碳青霉烯类鲍曼不动杆菌（为 70.63%）。结论：医院 2021—2023 年住院患者中所检出的革兰阴性菌以大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌为主,其中大肠埃希菌和肺炎克雷伯菌是临床检出最多的多重耐药菌,对此临床应持续加强对这些常见病原菌的病原学监测,以促进抗菌药物的合理使用,同时强化院感防控措施,以遏制耐药菌的传播。

Objective: To analyze the diagnosis and treatment process of a patient with diarrhea caused by Clostridium difficile infection (CDI), and provide a reference for etiological diagnosis and precise treatment of clinical diarrhea patients. Methods and Results: The patient was admitted to Orthopedics Department due to "28 days after coronary artery bypass grafting, 23 days after fasciotomy for right lower extremity osteofascial compartment syndrome with muscle necrosis of right lower extremity". Before admission, the patient had long-term use of piperacillin-tazobactam sodium and proton pump inhibitors/H2 receptor antagonists. On the day of admission, right lower extremity amputation was performed, and piperacillin-tazobactam sodium and omeprazole were given postoperatively. The patient stopped taking piperacillin-tazobactam sodium after 9 days, but severe diarrhea occurred 2 weeks after discontinuation, which did not improve with multiple antidiarrheal drugs. Clinical pharmacists were consulted and considered a high possibility of CDI due to the patient's recent history of long-term use of broad-spectrum antibacterials and proton pump inhibitors, recommending CDI-related examinations. 10 days later, tests for Clostridium difficile glutamate dehydrogenase antigen, toxin A, and toxin B all showed positive, confirming the diagnosis of CDI. Clinical pharmacists were consulted again and recommended oral vancomycin treatment (125 mg, q6h, course: 10-14 days). After 5 days of vancomycin treatment, the patient's diarrhea improved significantly, with yellow formed stools. 4 days later, the patient was discharged without recurrence. Conclusion: The causes of diarrhea are complex. When empirical antidiarrheal treatment is ineffective, clinical practice should actively carry out etiological diagnosis based on the medical history and medication history of patients, identify the cause in a timely manner through various examinations, and implement precise treatment to ensure effective therapy of patients.

目的：分析品管圈（quality control circle,QCC）在多重耐药菌（multidrug-resistant organism,MDRO）医院感染防控中的作用,为提高临床 MDRO 医院感染的防控提供参考。方法：选取 2022 年 1 月—2023 年 12 月河北医科大学第二医院各临床科室的 MDRO 检出情况和院感防控措施执行情况等相关资料作为研究资料,其中 2022 年为开展 QCC 活动前,而 2023 年为 QCC 开展年;通过成立 QCC 小组,并运用 QCC 工具对 MDRO 医院感染防控措施执行情况进行现状和问题分析,再进行对策拟定和实施,最后验证 QCC 活动对提高临床 MDRO 医院感染防控的作用。结果：QCC 活动后 MDRO 医院感染的防控措施执行率从 24.51% 升至 67.65%,目标达成率为 104.81%,进步幅度为 176.01%;实施 QCC 活动后,MDRO 医院感染的人数从 387 人降至 285 人,感染发生率也从 0.36% 降至 0.25%（P<0.001）。结论：通过 QCC 活动的开展,感控团队分析和解决问题的能力得到了有效提高,从而减少了 MDRO 医院感染在临床的发生。

Objective: To analyze the pharmaceutical care process in anti-infective therapy of a patient with severe community-acquired pneumonia (CAP) caused by Chlamydia psittaci, and provide a reference for the clinical diagnosis and anti-infective therapy of infections caused by such atypical pathogens. Methods and Results: The patient was hospitallized with "recurrent fever for 8 days, worsening with dyspnea for 2 days". Prior to admission, the patient was diagnosed with pulmonary infection and treated at another hospital. After admission, based on the patient's clinical manifestations and relevant examination results, the condition was considered to have progressed to severe pneumonia. Empirical therapy with imipenem-cilastatin sodium plus vancomycin was initiated. The next day, metagenomic next-generation sequencing (mNGS) of previously collected bronchoalveolar lavage fluid returned positive for Chlamydia psittaci. Considering the patient's history of poultry rearing, Chlamydia psittaci was suspected as the causative pathogen, and the clinical pharmacist recommended adding minocycline. After 8 days of treatment, the patient's temperature and blood count returned to normal, while sputum volume and bilateral pulmonary moist rales were markedly reduced, indicating effective anti-infective therapy. During treatment, sputum cultures, blood cultures, G test, and GM test were all negative. Conclusion: Chlamydia psittaci is an atypical pathogen rarely seen in clinical CAP cases, but is relatively more common in severe CAP presentations. Clinicians should remain vigilant in identifying it when determining the causative pathogen of CAP. Once confirmed, targeted anti-infective therapy should be promptly initiated to ensure effective treatment of patients.

目的：分析和比较经尿道等离子前列腺剜除术（transurethral plasmakinetic enucleation of the prostate,TUPKEP）与经尿道前列腺电切术（transurethral resection of the prostate,TURP）对良性前列腺增生患者的有效性与安全性,为临床良性前列腺增生患者的救治提供参考。方法：选取 2022 年 4 月—2023 年 10 月医院收治的 82 例良性前列腺增生患者作为研究对象,根据患者手术方式的不同,将其分为 TURP 组（n=40）和 TUPKEP 组（n=42）,分析和比较 TUPKEP 与 TURP 对良性前列腺增生患者的临床疗效和术后并发症的发生情况。结果：TUPKEP 组患者的手术时长、术后膀胱冲洗时间、导尿管留置时间、住院时间均显著短于 TURP 组（P<0.05）,并且术中出血量也明显小于 TURP 组（P<0.05）;2 组患者术后 1、6 个月的最大尿流速、膀胱顺应性、剩余尿量等指标均明显优于术前（P<0.05）,其中术后 1 个月时 TUPKEP 组患者的最大尿流速、膀胱顺应性、剩余尿量等指标均明显优于 TURP 组（P<0.05）;2 组患者术后 1、6 个月的国际前列腺症状评分（international prostate symptom score,IPSS）、勃起功能评分（international index of erectile function-5,IIEF-5）、生活质量评分（quality of life score,QOL）等评分均明显好于术前（P<0.05）,其中术后 1 个月时 TUPKEP 组患者的 IPSS、IIEF-5、QOL 等评分均明显好于 TURP 组（P<0.05）;TUPKEP 组患者术后并发症的发生率低于 TURP 组（4.76% vs 15.00%）,但其差异经比较无统计学意义（P>0.05）。结论：TUPKEP 和 TURP 均可以较好、较安全地治疗良性前列腺增生患者,但 TUPKEP 具有术中出血量小、手术时长短、恢复快等优点。

Objective: To analyze the pharmaceutical care process in anti-infective therapy of a patient with upper urinary tract infection caused by multidrug-resistant Preudomonas aeruginos (MDR-PA), and provide a reference for clinical anti-infective therapy of MDR-PA induced infections. Methods and Results: The patient visited the hospital due to "left flank pain for 7 days". Based on clinical symptoms and CT findings, renal ureteral calculi with concurrent infection was suspected. Empirical therapy with cefotiam was initiated. Two days later, urine culture identified Preudomonas aeruginos (PA), and susceptibility testing showed sensitivity to amikacin and piperacillin-tazobactam sodium, but resistance to ceftazidime, meropenem, and levofloxacin, confirming MDR-PA infection. The clinical pharmacist suggested adjusting to amikacin plus piperacillin-tazobactam sodium; however, a skin test for piperacillin-tazobactam sodium was positive, so amikacin monotherapy was used. After 10 days, the anti-infective therapeutic effect was not very satisfactory. Cefoperazone-sulbactam sodium, to which the isolate was intermediately susceptible, was added. Four days later, infection indicators improved significantly, and percutaneous nephrolithotripsy was performed, although some stones remained. On postoperative days 3 and 4, the patient developed fever, worsening infection indicators, and right ear pain, the latter was suspected to be amikacin-induced. The anti-infective therapeutic regimen was adjusted to cefepime plus ciprofloxacin. Seven days later, the patient's condition improved, and a second percutaneous nephrolithotripsy was performed to remove residual stones. On postoperative day 5, the infection was essentially controlled, and the patient was discharged with a sequential therapy by oral administration of cefixime and ciprofloxacin. Conclusion: For patients with renal ureteral calculi with concurrent infection, it is essential to control infection positively prior to stone removal surgery. During this period, clinical pharmacists should actively assist physicians in quickly identifying the types and drug susceptibility characteristics of pathogenic bacteria, enabling the development of more precise anti-infective therapeutic regimens and creating conditions for removing infectious stone lesions during the surgery.

目的：分析和比较头孢呋辛国谈药与原研药对泌尿外科围术期感染的预防效果,为临床头孢呋辛不同品种的合理选用提供科学依据。方法：选取 2021 年 9 月—2023 年 3 月中山大学附属第一医院收治的 315 例使用头孢呋辛进行围术期感染预防的泌尿外科患者作为研究对象,根据所用头孢呋辛品种的不同将其分为原研药组（149 例）和国谈药组（166 例）,然后采用最邻近匹配法进行 1∶1 倾向评分匹配（propensity score matching,PSM）,分析和比较 PSM 后头孢呋辛国谈药与原研药对泌尿外科围术期感染的预防效果。结果：PSM 前,2 组患者在医保类型、抗菌药物使用品种数、抗菌药物联用品种数方面的差异有统计学意义（P<0.05）,而在其他方面均无统计学差异（P>0.05）;以 1∶1 进行 PSM后,2 组最终纳入的有效病例数均为 106 例;PSM 后,2 组患者在各考察指标上的差异均无统计学意义（P>0.05）;PSM 后,2 组患者在术后 72 h 内的发热情况经比较其差异无统计学意义（P>0.05）;PSM 后,2 组患者在术后的 0~24 h、>24~48 h、>48~72 h 各个时间内体温、白细胞计数、C 反应蛋白、降钙素原 4 个指标上的差异均无统计学意义（P>0.05）。结论：头孢呋辛国谈药与原研药在预防泌尿外科围术期感染方面的疗效无明显差异,提示二者在预防泌尿外科患者术后感染时具有可替代性。

Objective: To explore the clinical characteristics of adverse drug reactions (ADRs) induced by colchicine using China Hospital Pharmacovigilance System (CHPS), and provide a reference for the safe use of colchicine in clinical practice. Methods: Using CHPS, patients who used colchicine in the First People's Hospital of Qinzhou from January 2021 to December 2022 were selected as the research objects. The occurrence of ADRs after colchicine use was statistically analyzed, and a correlation evaluation was conducted. Information such as patient age, gender, ADR occurrence time, clinical manifestations, and outcome was collected to analyze the clinical characteristics of colchicine-related ADRs. Results: A total of 2 008 patients who used colchicine were retrieved through CHPS, among which 133 cases were reported of ADRs, with an incidence rate of ADRs at 6.62%. According to the classification and evaluation criteria for ADR causality of WHO-UMC, the vast majority had a "probable" association with colchicine (119 cases, 89.47%). Among 133 patients with colchicine-related ADRs, males were far more than females (120 cases vs 13 cases), and middle-aged and elderly patients aged not below 45 were the main group (117 cases, 87.97%). Most of 133 colchicine-related ADRs occurred within the first five days of colchicine use (116 cases, 87.22%), with diarrhea being the most common clinical manifestation (120 cases, 90.23%), followed by abdominal pain (12 cases, 9.02%). Among 133 ADR patients, most adopted the strategies of discontinuing colchicine and using montmorillonite powder (56 cases, 42.11%) and simply discontinuing colchicine (47 cases, 35.34%). After treatment, ADRs of all patients gradually disappeared, and related indicators returned to normal. Conclusion: As a drug with a narrow therapeutic window, colchicine has a high incidence rate of ADRs, especially in middle-aged and elderly patients. Clinicians should strengthen the monitoring of medication safety in related patients, such as using CHPS, to ensure medication safety of patients.

目的：分析和评价孕妇产前 B 族链球菌（group B Streptococcus,GBS）感染对妊娠结局与胎儿产后并发症的影响,为改善临床母婴预后提供参考。方法：选取 2019—2024 年万载县妇幼保健院收治的 140 例行 GBS 感染筛查的孕妇作为研究对象,采集所有孕妇的 GBS 感染筛查结果、分娩方式、不良妊娠结局情况、新生儿不良情况、新生儿 Apgar 评分等信息,分析孕妇产前 GBS 感染对妊娠结局与胎儿产后并发症的影响。结果：140 例孕妇中,GBS 感染筛查结果呈阳性的有 104 例,阳性率为 74.29%;GBS 阳性与 GBS 阴性孕妇在自然分娩、剖宫产和产钳助产等分娩方式方面经比较其差异均无统计学意义（P>0.05）;GBS 阳性孕妇不良妊娠结局的总发生率明显高于 GBS 阴性孕妇（40.38% vs 18.75%,P<0.05）,但 2 组孕妇在胎膜早破、早产、宫内感染、胎儿窘迫等具体不良妊娠结局方面经比较其差异均无统计学意义（P>0.05）;GBS 阳性与 GBS 阴性孕妇的新生儿在感染、窒息、败血症、低体质量等不良情况方面的发生率经比较其差异均无统计学意义（P>0.05）;GBS 阳性孕妇的新生儿 Apgar 评分显著低于 GBS 阴性孕妇（8.82±0.06 vs 9.21±0.08,P<0.001）。结论：孕妇产前 GBS 感染会在一定程度上对妊娠结局与胎儿健康产生不利影响,对此临床应加强孕妇的产前 GBS 感染筛查,并对 GBS 阳性孕妇加强管理和治疗,以保证产妇和胎儿的健康。

目的：基于成本-效果分析法,分析和评估集采前后哌拉西林-他唑巴坦钠治疗产超广谱 β-内酰胺酶（extended-spectrum β-lactamases,ESBLs）大肠埃希菌感染患者的安全性、有效性和经济性,为国家集采政策的深入实施提供参考依据。方法：选取 2022 年 2 月—2024 年 12 月赣南医科大学附属兴国医院收治的 141 例使用哌拉西林-他唑巴坦钠治疗的产 ESBLs 大肠埃希菌感染患者作为研究对象,以执行集采为基准,将患者分为集采前组（50 例）和集采后组（91 例）,集采前组患者使用的是非集采品种的哌拉西林-他唑巴坦钠,而集采后组患者使用的是集采中选品种的哌拉西林-他唑巴坦钠,分析和比较集采前后哌拉西林-他唑巴坦钠治疗产 ESBLs 大肠埃希菌感染患者的安全性、有效性和经济性。结果：治疗后,集采后组和集采前组患者的总有效率经比较其差异无统计学意义（94.51% vs 88.00%,P>0.05）,2 组患者的病原菌清除率经比较其差异亦无统计学意义（76.92% vs 84.00%,P>0.05）,并且 2 组患者治疗期间均未发生药物不良反应;集采后组患者的抗菌药物费用、总药品费用和总住院费用均显著低于集采前组（P<0.05）;成本-效果分析结果显示,集采后组患者的 C/E 低于集采前组（69.37 vs 105.30）,并且与集采前组相比,集采后组每增加一个单位效果可减少 416.32 元的医疗费用;敏感度分析结果显示,当药费下降 10%,集采后组患者的 C/E 依旧低于集采前组（67.53 vs 101.85）,并且与集采前组相比,集采后组每增加一个单位效果可减少 396.41 元的医疗费用。结论：集采中选品种的哌拉西林-他唑巴坦钠与非集采品种的哌拉西林-他唑巴坦钠具有相似的临床有效性和药物安全性,但集采中选品种的哌拉西林-他唑巴坦钠具有较明显的药物经济性。

Objective: To analyze the pharmaceutical care process in anti-infective therapy of a patient with endophthalmitis caused by Streptococcus agalactiae, and provide a reference for anti-infective therapy of such patients in clinical practice. Methods and Results: The patient was admitted to the hospital with eye swelling and headache after left eye intraocular lens implantation + silicone oil removal. Admission examinations showed conjunctival congestion, corneal edema, aqueous humor turbidity of the left eye, with abnormal white blood cell count and neutrophil percentage. The clinical initial diagnosis was left eye endophthalmitis, and surgical treatment was given, followed by postoperative empirical systemic treatment with vancomycin + ceftazidime, intermittent vitreous cavity perfusion, and local treatment with levofloxacin eye drops. On the 6th day of admission, Streptococcus agalactiae was detected in the aqueous humor of the left eye, and drug susceptibility test results showed susceptibility to ampicillin, vancomycin and linezolid, so ceftazidime was discontinued. After about 3 weeks of vancomycin treatment, the patient's ocular inflammation was controlled, but mild conjunctival congestion and corneal edema persisted. Considering that the effect of vancomycin was less than expected, vancomycin was adjusted to linezolid. After 11 days of linezolid treatment, the aqueous humor culture of the left eye was negative. 2 days later, the patient's ocular infection symptoms improved, and the infection was basically controlled, so the patient was allowed to be discharged. Conclusion: Endophthalmitis caused by Streptococcus agalactiae is rare in clinical practice, and its treatment is challenging. Clinicians should pay more attention, and make personalized treatment adjustments in a timely manner based on the patient's condition changes and etiological results to ensure effective treatment.

目的：评价抗菌药物规范管理对医院抗菌药物规范合理使用的成效,为临床抗菌药物的规范管理和合理使用提供参考。方法：选取 2020—2022 年泰和县中医院的抗菌药物使用的相关数据作为研究资料,统计和计算 3 年间医院的门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、I 类切口手术患者的预防用抗菌药物比例、住院患者抗菌药物使用前的微生物标本送检率,以及抗菌药物医嘱的点评结果,比较 2021 年开始进行抗菌药物规范管理前后各抗菌药物考察指标的变化情况。结果：2020—2022 年,医院门诊和住院患者的抗菌药物使用率、住院患者抗菌药物使用前的微生物标本送检率始终符合考核要求,并且经抗菌药物规范管理后这 3 个指标均呈逐年持续改善趋势（P<0.05）;而经抗菌药物规范管理后,住院患者抗菌药物使用强度也很快从不达标转为达标,并且呈逐年持续改善趋势（P<0.05）;2020—2022 年,医院 Ⅰ 类切口手术患者围手术期抗菌药物的预防使用率从 58.26% 降至 26.58%,变化差异具有统计学意义（P<0.05）;经过抗菌药物规范管理,所有手术类型患者围手术期抗菌药物的预防使用率均得到大幅下降（P<0.05）,并且除了骨科内固定术和大隐静脉手术外,所有手术类型患者围手术期抗菌药物的预防使用率均达到考核要求;2020—2022 年,经过抗菌药物规范管理,医院抗菌药物医嘱的给药剂量不适宜、用药时机不适宜、药品遴选不适宜、给药方法不适宜等不合理用药情况的发生率均大幅下降（P<0.05）。结论：抗菌药物规范管理有效改善了医院的各项抗菌药物相关指标,提高了临床的抗菌药物合理用药水平。

目的：分析 1 例急性腹膜炎患者抗感染治疗与并发血小板增多症的药学监护过程,为临床此类患者的有效救治提供参考。方法与结果：患者因不明原因地出现间断性腹部疼痛不适伴恶心、停止排便而入院治疗,医生综合患者的各种检查结果,初步考虑为急性腹膜炎,遂经验性予头孢哌酮-舒巴坦钠+奥硝唑;次日,临床考虑患者感染较为严重,遂将抗感染治疗方案调整为亚胺培南-西司他丁钠,另外由于解脲脲原体、沙眼衣原体检查均呈阳性,又加用阿奇霉素;入院第 9 天,患者体温基本恢复正常,中性粒细胞百分比、C 反应蛋白、降钙素原等指标水平也有较大下降,但白细胞水平仍居高不下,临床药师分析后认为原因可能为腹腔形成了局部脓肿,建议将抗感染方案调整为替加环素,并完善检查明确是否存在局部脓肿;同时,临床药师观察到患者血小板计数达 479×10⁹/L,可能为药物引起的血小板增多症;入院第 10 天,MRI 检查提示患者盆腔存在水肿积液;入院第 13 天,患者行盆腔脓肿穿刺置管引流术,抽取出黄色脓液,伴臭味;2 周后,患者白细胞计数等感染指标明显改善,遂将抗感染治疗方案调整为头孢哌酮-舒巴坦钠+奥硝唑;4 d 后,患者的感染症状、感染指标和血小板水平均基本恢复正常,准予出院;住院期间,患者血小板水平的升高经分析可能与低分子肝素、头孢哌酮-舒巴坦钠、亚胺培南-西司他丁钠有关,其中以亚胺培南-西司他丁钠的可能性最大。结论：对于腹腔感染患者,在抗感染药物治疗的同时,应积极观察是否存在局部脓肿形成的情况,如存在此情况则应及时联合外科治疗,清除感染灶,从而促进感染的消除;同时,在药物治疗过程中应加强药物不良反应监测,并做好相应的评估和处置,以保障患者的用药安全。

Objective: To analyze the pharmaceutical care process in anti-infective therapy of a patient with meningoencephalitis complicated by bilateral pneumonia caused by Scedosporium apiospermum, and provide a reference for improving clinical understanding and diagnosis and treatment level of infections caused by such fungi. Methods and Results: The patient was admitted to the hospital with "recurrent headache and fever for more than 1 month after drowning". Based on admission examination results and past medical history, the clinical diagnosis was initially purulent meningitis and bilateral pneumonia, and empirical anti-infective therapy with ceftriaxone + acyclovir was administered. During further examinations, CT and MR confirmed the diagnosis of meningoencephalitis and bilateral pneumonia, but acid-fast bacillus staining and ink staining of cerebrospinal fluid (CSF), T-SPOT test, G test, and blood culture all showed negative, making it difficult to identify the pathogen. On the 5th day of admission, metagenomics next-generation sequencing of CSF suggested Scedosporium apiospermum, which was considered the probable pathogen. After consultation, clinical pharmacists recommended voriconazole treatment. After about 3 weeks of antifungal therapy, the patient's fever, headache and other symptoms disappeared, and brain and lung lesions improved significantly. The patient was allowed to be discharged and instructed to continue oral voriconazole treatment to complete the course. Conclusion: Central nervous system infections caused by Scedosporium apiospermum are relatively rare. Delayed treatment can easily lead to poor prognosis. Actively using mNGS and other examination methods to identify the pathogen promptly and carry out targeted antifungal therapy can help patients achieve good therapeutic effect.

目的：分析医院尿路真菌感染患者尿标本中病原菌的分布情况及其耐药特点,为临床尿路真菌感染患者的抗真菌治疗提供参考。方法：选取 2020 年 1 月—2023 年 12 月茂名市人民医院收治的 1 499 例尿路真菌感染患者作为研究对象,采集患者的中段尿标本行微生物检测和药敏试验,分析尿路真菌感染患者尿标本中病原菌的分布情况及其耐药特点。结果：1 499 例尿路真菌感染患者主要来自重症医学科（719 例,占 47.97%）、泌尿外科（144 例,占 9.61%）和呼吸内科（81 例,占 5.40%）;1 499 例尿路真菌感染患者中,男性略多于女性（805 例 vs 694 例）,而年龄上以>60 岁为主（1 133 例,占 75.58%）;1 499 例尿路真菌感染患者尿标本中共检出真菌 1 499 株,其中排名前 5 位的依次为白假丝酵母（646 株,占 43.10%）、热带假丝酵母（425 株,占 28.35%）、光滑假丝酵母（187 株,占 12.47%）、近平滑假丝酵母（79 株,占 5.27%）和阿萨希毛孢子菌（78 株,5.27%）;2020—2023 年尿路真菌感染的检出数呈逐年增长趋势,其中以白假丝酵母和热带假丝酵母的增加为最甚;药敏结果显示,2020—2023 年,白假丝酵母、热带假丝酵母、光滑假丝酵母、近平滑假丝酵母和阿萨希毛孢子菌对两性霉素 B、5-氟胞嘧啶的总耐药率均低于 15.00%;白假丝酵母、光滑假丝酵母、近平滑假丝酵母和阿萨希毛孢子菌对氟康唑的总耐药率亦均低于 15.00%,但热带假丝酵母对氟康唑的总耐药率则达 85.88%。结论：医院尿路真菌感染患者以老年患者为主,并且有逐年增多趋势,所感染致病菌主要为白假丝酵母、热带假丝酵母和光滑假丝酵母,其对抗真菌药物的耐药率整体较低,但临床仍应加强对真菌耐药性的关注,以指导抗真菌药物的合理使用,从而保障患者取得较好的抗真菌治疗效果。

Objective: To analyze the practice of anti-infective therapy in a patient with septic shock undergoing continuous renal replacement therapy (CRRT), and provide a reference for anti-infective therapy in patients undergoing CRRT. Methods and Results: The patient was admitted due to "abdominal pain for 5 days, aggravated by dyspnea and disturbance of consciousness for 4 hours". Based on symptoms and examination results, a preliminary diagnosis of sepsis with septic shock, acute diffuse peritonitis, pulmonary infection, and multiple organ failure was made. Antishock symptomatic treatment and imipenem-cilastatin sodium (0.5 g, q8h) were initiated. On the morning of admission, the patient underwent emergency exploratory laparotomy with cholecystectomy and abdominal drainage. Intraoperatively, gangrenous cholecystitis with perforation was found. Postoperatively, CRRT was initiated. The following day, the clinical team consulted a clinical pharmacist regarding optimized imipenem-cilastatin sodium dosing during CRRT. The clinical pharmacist suggested maintaining the current dose and frequency of imipenem-cilastatin sodium, but prolonging the infusion time to over 2 hours per dose. Two days later, blood cultures grew Escherichia coli, with extended-spectrum beta-lactamase test as positive, and susceptibility testing showed sensitivity to imipenem. One day later, due to worsening infection symptoms and indicators, and given that renal function had largely recovered and CRRT had been discontinued, the clinical pharmacist suggested adjusting the dosage regimen to "1 g, q8h". After treatment for additional 11 days, with normalization of temperature and significant improvement in infection indicators, the clinical pharmacist advised de-escalation of the anti-infective scheme to cefoperazone-sulbactam sodium. Conclusion: CRRT is an important therapeutic intervention for patients with septic shock, particularly those with multiple organ failure. However, it may affect the pharmacokinetics/pharmacodynamics parameters of drugs (antibacterial drugs in particular) in human body. Therefore, clinicians should individualize dosage regimens by integrating the patient's condition with the pharmacological characteristics of the drug to achieve the optimal therapeutic effect.

目的：分析医院门诊抗菌药物的处方点评结果,为提高临床抗菌药物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 2023 年 1—12 月习水县人民医院门诊的 600 张（每月 50 张）处方作为研究资料,采集处方中患者的年龄、性别、诊断和抗菌药物使用情况等信息,依据相关权威资料对抗菌药物进行专项的合理用药点评,分析医院门诊抗菌药物的不合理使用特点。结果：处方点评结果显示,600 张门诊抗菌药物处方中不合理用药处方有 113 张,不合理发生率为 18.83%;113 张不合理抗菌药物处方主要来自儿科（23 张,占 20.35%）、呼吸与危重症科（18 张,占 15.93%）、泌尿外科（15 张,占 13.27）、口腔科（14 张,占 12.39%）和妇科（11 张,占 9.73%）等科室,所涉药物主要有阿莫西林-克拉维酸钾（17 张,占 15.04%）、阿奇霉素（16 张,占 14.16%）、头孢克肟（14 张,占 12.39%）、头孢克洛（12 张,占 10.62%）、头孢氨苄（11 张,占 9.73%）;113 张不合理抗菌药物处方主要的不合理原因为用法用量不适宜（31 张,占 27.43%）、联合用药不适宜（25 张,占 22.12%）和药物遴选不适宜（22 张,占 19.47%）。结论：医院门诊抗菌药物的使用存在较多的不合理情况,医院对涉及的主要科室、主要药物应加强相关培训和管理,切实保障患者用药的安全和有效。

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：通过文献检索,分析程序性死亡受体-1（programmed death 1,PD-1）/程序性死亡配体-1（programmed death ligand 1,PD-L1）抑制剂所致甲状腺功能异常患者的流行病学特征,为临床 PD-1/PD-L1 抑制剂的用药安全提供参考。方法：以“PD-1/PD-L1 抑制剂（PD-1/PD-L1 inhibitors）”“帕博利珠单抗（pembrolizumab）”“纳武单抗（nivolumab）”“阿替利珠单抗（atezolizumab）”“度伐利尤单抗（durvalumab）”“卡瑞利珠单抗（camrelizumab）”“特瑞普利单抗（toripalimab）”“信迪利单抗（sintilimab）”“替雷利珠单抗（tislelizumab）”“甲状腺疾病（thyroid diseases）”“甲亢（hyperthyroidism）”“甲减（hypothyroidism）”等为关键词,在国内外数据库中检索 PD-1/PD-L1 抑制剂致甲状腺功能异常的相关文献,采集文献中患者的相关临床资料,分析 PD-1/PD-L1 抑制剂致甲状腺功能异常患者的临床特点。结果：经过检索和筛选,共纳入符合要求的 PD-1/PD-L1 抑制剂致甲状腺功能异常相关文献 44 篇,其中共涉患者 51 例;51 例患者中,男性 29 例（占 56.86%）,女性 20 例（占 39.22%）,另有 2 例性别不详;在年龄分布方面,≥60 岁者有 36 例（占 70.59%）,<60 岁者则为 15 例（占 29.41%）;患者 PD-1/PD-L1 抑制剂的对应诊断以肺癌（25 例,占 49.02%）和黑色素瘤（12 例,占 23.53%）为最多;甲状腺功能异常所涉 PD-1/PD-L1 抑制剂以纳武单抗（22 例,占 43.14%）为最多,其次为帕博利珠单抗（14 例,占 27.45%）和信迪利单抗（10 例,占 19.61%）;PD-1/PD-L1 抑制剂所致甲状腺功能异常的表现以单纯甲减为最多（23 例,占 45.10%）;经过相应处置后,除 13 例患者未记录转归情况外,其余 38 例患者均好转或恢复。结论：肿瘤患者在接受 PD-1/PD-L1 抑制剂治疗期间较易发生免疫相关不良事件,如甲状腺功能异常,对此临床在整个治疗过程中应做好用药安全监测,尤其对于高风险的人群和药品,以实现早期发现和及时干预,从而最大程度保障患者治疗的安全性和连续性。

目的：分析医院苹果酸奈诺沙星氯化钠注射液相关药物不良反应（adverse drug reactions,ADRs）的发生情况与临床特点,为临床该药物的用药安全提供参考。方法：选取 2023 年 1 月—2024 年 12 月嘉善县中医医院收治的 94 例使用了苹果酸奈诺沙星氯化钠注射液的患者作为研究对象,采集患者的性别、年龄、奈诺沙星的用药原因,以及奈诺沙星相关 ADRs 的发生情况、临床表现、严重程度、处置情况、转归情况等信息,分析奈诺沙星相关 ADRs 的临床特点。结果：94 例患者中,发生奈诺沙星相关 ADRs 的有 6 例,发生率为6.38%;6 例发生奈诺沙星相关 ADRs 的患者中,奈诺沙星与 ADRs 的关联性有“很可能”和“可能”,分别为 4 例和 2 例;ADRs 主要发生于用药后的 2 d 内（4 例,占 66.67%）;所发生 ADRs 的严重程度多为一般（4 例）,但有 2 例为严重,且其中 1 例未好转;6 例患者中有 5 例的 ADRs 最终得到好转。结论：奈诺沙星主要引起轻中度的 ADRs,但也可能引起难以恢复的严重 ADRs,对此临床应加强对奈诺沙星的用药安全监测,以便临床对可能发生的 ADRs 进行及时处置,从而保障患者的用药安全。

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.

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。

目的：分析清热类中成药前置审方规则的探索与实践,为提高临床中成药的合理用药水平提供参考。方法：以权威文献资料为依据,对南京市中医院清热类中成药的前置审方规则进行精细化设置,采集规则维护前后医院的连花清瘟颗粒处方各 100 张,对其开展处方点评,从适应证、药品遴选、用法用量、联合用药四个方面分析规则维护前后前置审方系统的警示提醒效果。结果：医院共有清热类中成药 46 种,涉及内科、外科、妇科、眼科等多个科室,其中内科用药有 26 种（占 56.52%）,外科用药有 14 种（占 30.43%）,妇科用药有 4 种（占 8.70%）;清热类中成药的组方中出现频次前 10 位的分别为黄芩、大黄、金银花、黄柏、冰片、黄连、甘草、人工牛黄、栀子、连翘;在规则维护前,审方系统只对连花清瘟颗粒的适应证不适宜和用法用量不适宜有警示提醒;而规则维护后,审方系统对连花清瘟颗粒的适应证不适宜、用法用量不适宜、药品遴选不适宜、联合用药不适宜均有警示提醒。结论：对清热类中成药进行药前置审方规则的精细化设置可有效提高合理用药监测系统监测的准确性,从而提高临床对清热类中成药的合理用药水平。

目的：分析 1 例以液气胸为临床表现的食源性寄生虫病患者诊断和治疗的临床实践过程,为临床食源性寄生虫病的诊断的治疗提供参考。方法与结果：患者因“右下腹部疼痛 3 d”入院,检查显示其白细胞计数、中性粒细胞绝对值、C 反应蛋白等感染指标均异常升高,且 CT 检查提示盆腔存在少许积液,考虑存在感染,遂经验性予头孢呋辛+甲硝唑抗感染治疗;次日,胸片和胸部 CT 提示存在右侧液气胸,考虑为肺部感染;之后,经胸外科会诊后转入胸外科行右侧胸腔闭式引流术,而胸水的微生物培养和结核分枝杆菌 DNA 检查结果均为阴性,结核菌素皮肤试验结果亦为阴性,并且肺泡灌洗液涂片未找到抗酸杆菌、真菌和其他一般细菌,故基本排除常规病原体感染的可能;随后,送检血清寄生虫抗体检查,提示裂头蚴 IgG 抗体呈阳性,结合患者有喝生水的习惯,以及此前被忽视的嗜酸性粒细胞水平异常升高等情况,临床基本判断该患者为裂头蚴所致的食源性寄生虫病;遂请临床药师会诊,临床药师建议顿服吡喹酮,若病情反复,可每月重复予吡喹酮,直至病变消失;1 d 后,患者胸闷、咳嗽症状明显好转,并且拔除胸腔引流管后出院;后续随访显示,肺泡灌洗液病理检查提示存在嗜酸性粒细胞浸润,并且胸部 CT 检查提示胸腔积液基本消失。结论：液气胸是肺部创伤和肺部感染后的常见表现,临床在探寻常规病原体无果的情况下,可考虑寄生虫感染的可能,并开展寄生虫病相关的检查,尤其对于嗜酸性粒细胞水平异常升高和有流行病学史的患者;在抗寄生虫治疗方面,临床应尽量根据寄生虫的种类合理选用相关抗寄生虫药物,以保障患者的治疗效果。

目的：探究品管圈（quality control circle,QCC）活动在降低医院住院药房近效期药品占比中的应用成效,为住院药房近效期药品的有效管理提供参考。方法：借助医院信息系统,采集 2023 年 7 月—2024 年 4 月洛阳市妇幼保健院住院药房的在用药品情况和近效期药品数量等资料,其中 2023 年 7—8 月为 QCC 活动开展前,2023 年 7 月—2024 年 1 月为 QCC 活动开展中,2024 年 2 月—2024 年 4 月为 QCC 活动开展后;住院药房在成立 QCC 小组和确定活动主题后,围绕主题进行现状调查和原因分析,并拟定对策和实施,最后在活动结束后对实施效果进行评估。结果：QCC 活动后住院药房近效期药品占比从最初的 5.25% 降至活动后首月的 2.10%,并且之后始终维持在目标值 2.45% 以下,目标达标率为 112.50%,进步幅度为 60.00%;QCC 活动后,住院药房近效期药品的品种数明显减少,从最初的 25 种降至 9 种。结论：QCC 活动的开展有效减少了医院住院药房的近效期药品数量,提高了科室对药品管理的效能。

目的：调查和分析医院门诊药房冷藏药品的使用情况与取药时长情况,为临床冷藏药品的管理提供参考。方法：选取 2023 年 3 月 1—31 日苏州大学附属儿童医院的 176 493 张门诊处方作为研究资料,采集处方中冷藏药品的品类和频次等情况,并随机抽取 1032 张含冷藏药品的处方,调查冷藏药品的取药时长。结果：176 493 张门诊处方中,含冷藏药品的处方共有 14 185 张（占 8.04%）,其中冷藏药品主要为消化系统用药（6 862 张,占 48.38%）和外科用药（4 190 张,占 29.54%）,其次为免疫系统用药（1 402 张,占 9.88%）和抗菌药物（1 124 张,占 7.92%）;在随机抽取的 1 032 张含冷藏药品的处方中,冷藏药品的取药时长主要集中于 0~5 min（750 张,占 72.67%）和 >5~10 min（173 张,占 16.76%）,但也有>60 min~24 h（7 张,占 0.68%）和>24 h（2 张,占 0.19%）。结论：医院门诊药房冷藏药品的取药时长整体较为合理,但个别处方的留滞时间过长,科室应重视和加强对冷藏药品的管理,以保证冷藏药品的质量安全。

目的：分析 1 例儿童发生药物所致中毒性表皮坏死松解症（toxic epidermal necrolysis,TEN）的诊疗过程,为临床 TEN 的诊断和救治提供参考。方法与结果：患儿（男,9 岁） 1 d 前因不明原因发热而服用头孢克肟和布洛芬,之后陆续出现皮疹、皮肤潮红等症状,20 min 前在经外院抢救后转至我院;入院后,临床根据患儿的症状表现判断其为过敏性休克和急性扁桃体炎,遂予肾上腺素、甲泼尼龙等抗休克治疗,以及头孢曲松抗感染治疗;在之后的 3 d 内,患者仍持续高热,且皮疹较前加重,出现大片潮红斑、弥漫性斑丘疹、靶形损害和皮肤水疱等;临床药师考虑头孢曲松有二次致敏可能,建议停用头孢曲松;临床医生综合患儿近日的临床表现,判断其为 TEN,而头孢克肟和布洛芬是主要的怀疑药物,遂加用丁酸氢化可的松乳膏外涂和静注人免疫球蛋白静脉滴注治疗;之后,患儿发热逐渐好转,全身红斑逐渐转暗、淡化,水疱也逐渐干瘪、结痂;在住院治疗近 2 周后,患儿体温恢复正常,红斑、水疱基本消退,蜕皮皮肤也基本恢复粉红色,遂准予出院。结论：TEN 是一种主要由药物引起的、以水疱和泛发性表皮松解为特征的严重皮肤黏膜反应,临床医生和药师在面对此类患者时应注意加强识别,一旦明确诊断应及时停用可疑药物,并进行规范化治疗,以保障患者获得较好的预后结果。

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.

目的：基于 Excel 平台和药代动力学/药效动力学（pharmacokinetic/pharmacodynamic,PK/PD）理论,构建针对下呼吸道感染中国老年患者的美罗培南个体化给药计算器,并进行模拟实践,为临床美罗培南的个体化用药提供指导。方法：以 Excel 软件为支撑,美罗培南 PK/PD 理论为基础,药品说明书为参考,通过蒙特卡洛模拟优化针对下呼吸道感染中国老年患者的美罗培南的给药方案,制作出包含初始经验治疗和病原学目标治疗的美罗培南个体化给药计算器。结果：对于下呼吸道感染的中国老年患者,在初始经验治疗情况下,当美罗培南给药方案为“2 g,q8h,持续输注 3 h”,只有病原菌为鲍曼不动杆菌、铜绿假单胞菌、屎肠球菌、表皮葡萄球菌时,美罗培南的累积响应百分率未达到 90%;当美罗培南给药方案优化为“2 g,q8h,持续输注 6 h”,只有屎肠球菌时,美罗培南的累积响应百分率为 31.63%;在致病菌为肺炎克雷伯菌的病原学目标治疗情况下,当美罗培南给药方案为“1 g,q8h,持续输注 0.5 h”,美罗培南的达标概率为 78.15%（<90%）,故不是优选方案;而当美罗培南给药方案为“1 g,q8h,持续输注 4 h”,美罗培南的达标概率为 92.1%,该方案可作为优选方案。结论：对于下呼吸道感染的中国老年患者,美罗培南个体化给药计算器能方便、快捷地计算出不同个体不同给药方案的累积响应百分率或达标概率,从而辅助临床决策者判断各种给药方案的优劣性。

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.

目的：分析老年肺炎克雷伯菌（Klebsiella pneumoniae,KP）感染患者发生碳青霉烯类耐药的影响因素,并采用列线图构建预测模型进行验证,为临床老年 KP 感染患者的耐药防范提供参考。方法：选取 2022 年 1 月—2024 年 3 月上饶市人民医院收治的 196 例明确为 KP 感染的老年患者作为研究对象,采集感染患者的年龄、性别、基础疾病、住院时间、入住 ICU、侵入性操作、初始感染部位、病原学检查结果、实验室检查结果、抗菌药物使用品种和时长等信息,采用 Logistic 回归分析法分析老年 KP 感染患者发生碳青霉烯耐药的影响因素,再采用列线图法和接受者操作特征（receiver operating characteristic,ROC）曲线进行预测结果的验证分析。结果：196 例老年 KP 感染患者中发生碳青霉烯类耐药的有 45 例,耐药发生率为22.96%;单因素分析结果显示,老年 KP 感染患者发生碳青霉烯耐药与住院时间是否>14 d、是否入住 ICU、是否合并糖尿病、是否合并呼吸系统疾病、是否合并消化系统疾病、是否行机械通气、是否留置导尿管、是否留置中心静脉导管、是否使用碳青霉烯类药物、是否联合使用抗菌药物、抗菌药物使用时间是否≥7 d 具有相关性（P<0.05）;多因素 Logistic 分析结果显示,住院时间>14 d、行机械通气、留置中心静脉导管、使用碳青霉烯类药物、联合使用多种抗菌药物、抗菌药物使用时间≥7 d 是老年 KP 感染患者发生碳青霉烯耐药的独立危险因素（P<0.05）;以多因素 Logistic 分析所检出的独立危险因素作为预测因子,构建列线图,该列线图预测模型的曲线下面积（area under the curve,AUC） 为 0.883（P<0.001）,敏感性为 88.89%,特异性为 76.82%而其 C 指数为 0.883（0.823~0.942）;该列线图预测模型的决策曲线显示,当风险阈值>0.06 时,此模型在预测老年 KP 感染患者发生碳青霉烯类耐药的概率方面较单个独立危险因素具有更高的临床净收益。结论：住院时间、是否行机械通气、是否留置中心静脉导管、是否使用碳青霉烯类药物、是否联合使用多种抗菌药物、抗菌药物使用时间是老年 KP 感染患者发生碳青霉烯耐药的重要影响因素,而其联合构建的列线图预测模型可以较好地预测 KP 是否发生碳青霉烯耐药,对此临床可以针对性制定相关预防策略,以减少耐药情况的发生。

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.

目的：分析医院妇科肿瘤患者并发术后感染的病原菌分布特点与影响因素,为临床此类患者术后感染的防治提供参考。方法：选取 2021 年 6 月—2024 年 6 月赣州市肿瘤医院收治的 260 例妇科肿瘤患者作为研究对象,采集患者的年龄、性别、吸烟史、饮酒史、基础疾病、各项检查结果、肿瘤类型、ASA 分级、手术方式、手术时长、术中失血量、术后置管时间、预防性抗菌药物使用等信息,统计患者术后感染的发生情况,采用 Logistic 回归分析法分析妇科肿瘤患者并发术后感染的影响因素。结果：260 例妇科肿瘤患者中发生术后感染的 51 例,术后感染发生率为 19.62%;51 例并发术后感染患者的标本中共检出病原菌 70 株,其中革兰阴性菌 47 株（占 67.14%）、革兰阳性菌 17 株（占 24.29%）和真菌 6 株（占 8.57%）;单因素分析结果显示,妇科肿瘤患者并发术后感染与患者年龄、是否术前合并化疗、手术方式、手术时长、术后置管时间、是否预防性使用抗菌药物有关（P<0.05）;多因素分析结果显示,年龄大、术前合并化疗、开放式手术、手术时长长、术后置管时间长是妇科肿瘤患者并发术后感染的独立危险因素（P<0.05）,而围术期预防性使用抗菌药物是妇科肿瘤患者并发术后感染的保护因素（P<0.05）。结论：医院妇科肿瘤患者的术后感染发生率较高,革兰阴性菌为主要致病菌;术后感染的发生与患者年龄、是否术前合并化疗、手术方式、手术时长、术后置管时间密切相关,为此临床对感染高风险患者应加强监护和管理,并采取预防性使用抗菌药物等干预措施,以减少患者术后感染的发生。