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

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

Objective: To analyze the diagnosis and treatment process of a patient with cryptococcal infection, and to provide reference for the treatment of patients suffering from cryptococcosis. Methods and Results: The patient was admitted to the department of respiratory and critical care medicine of the hospital for treatment due to "pneumonia", and was given expectorant and anti-infection treatment in the emergency; on Day 5 after admission, pulmonary cryptococcosis was diagnosed according to serum cryptococcal capsule antigen examination, lung CT imaging results and inflammatory index results of the patient, and then the anti-infection treatment with fluconazole sodium chloride injection was added. Through analysis of anti-infection treatment of patients with pulmonary cryptococcosis, and in combination with the clinical symptoms, medication adjustment and patient outcomes and reference to relevant literature, the clinical pharmacist considered that the patient was obese with a body mass index of 28. In order to ensure the effective blood concentration in the body, the loaded dose of fluconazole could be 0.84 g, and intravenous drip of the fluconazole sodium chloride injection (400 mg, q12h) was recommended; on Day 7 after admission, the clinical symptoms of the patient improved, and the frequency of the fluconazole sodium chloride injection for anti-infection treatment was reduced (0.4 g, q24 h); on Day 13 after admission, the lung CT of the patient showed that the inflammation had progressed, and anti-infection treatment was continued. On Day 17 after admission, the patient's general condition was good and the patient was approved to discharge from the hospital. Conclusion: In the process of cryptococcal anti-infection treatment, clinical pharmacists actively carry out pharmaceutical care and medication education, in combination with the actual situation of the patient, fully consider the influence of basic diseases (diabetes) on infection and self-resistance and the physical condition of the patient, take into account adverse drug reactions and interactions, and formulate individualized medication regimens, thus obtaining valuable experience in formulating treatment regimens for pulmonary cryptococcosis.

Objective: To analyze the diagnosis and treatment process of one case of neutropenia with fever caused by substitution of linezolid for vancomycin, and provide a reference for the safe use of linezolid and vancomycin in clinical practice. Methods and Results: The patient was admitted to the hospital due to "right knee pain and limited mobility caused by trauma for 9 days". Arthroscopic examination of the knee joint showed purulent arthritis, and vancomycin was administered empirically. Subsequent culture of the joint drainage fluid did reveal methicillin-resistant Staphylococcus aureus. After ten days of vancomycin treatment, the results of blood and joint drainage fluid cultures were negative, however, the patient still had intermittent fever, and the neutrophil count was progressively decreasing to 1.29×10⁹/L. After consultation with the infectious disease experts, it was believed that the neutropenia and fever were possibly caused by vancomycin, and it was suggested to use linezolid. Within one week after administration of linezolid, the neutrophil count continued to decrease, even falling below 0.1×10⁹/L. Therefore, linezolid was immediately discontinued and recombinant human granulocyte colony-stimulating factor was administered. Three days later, the neutrophil count recovered significantly, and 13 days later, the neutrophil count returned to normal level without further decline. Conclusion: Neutropenia caused by non-chemotherapy drugs is a serious adverse drug reaction. Vancomycin and linezolid can both cause neutropenia. Clinically, the adverse drug reactions should be monitored and neutropenia without other obvious inducements should be concerned, so as to ensure the safe medication for patients.

Objective: To construct a prediction model for secondary nosocomial infections in patients with COVID-19 based on multi-modal neural network, and provide reference for the prevention and treatment of secondary nosocomial infections of clinical patients. Methods: A total of 2 519 patients with COVID-19 admitted to the Third People's Hospital of Zhenjiang from August 1, 2022 to January 20, 2023 were selected as the research objects, and the information of these patients such as age, past medical history, length of stay (LOS), use of antibacterial drugs, and mechanical ventilation was collected. A multi-modal neural network prediction model was used to analyze the factors influencing the patients' secondary nosocomial infections, and compare it with the conventional multi-factor Logistic regression analysis model. Results: Among the 2 519 patients with COVID-19, 312 had nosocomial infections, with an infection incidence of 12.39%; the Logistic regression analysis results showed that, the secondary nosocomial infections in patients with COVID-19 were related to the age, history of hypertension and history of respiratory diseases, empirical use of antibacterial drugs and immunosuppressants, and mechanical ventilation (P<0.05); among which, the age >65 years, the presence of history of hypertension, the presence of history of respiratory diseases, LOS >7 days, empiric use of antibacterial drugs, and mechanical ventilation were independent risk factors for secondary nosocomial infections in patients (P<0.05); the multi-modal neural network prediction results showed that, the LOS, history of respiratory diseases, age, empirical use of antibacterial drugs, and mechanical ventilation were the five major risk factors of secondary nosocomial infections in patients. The accuracy of the training samples, test samples and persistence samples was 87.49%, 86.31% and 90.28% respectively; the areas under the curve of receiver operating characteristic curves of the multi-modal neural network prediction model and multi-factor Logistic regression analysis model were 0.879 and 0.852 respectively, and the Delong test results showed there was a statistical difference between them (P<0.05). Conclusion: Both the multi-modal neural network prediction model and the multi-factor Logistic regression analysis model can be used to predict the risk of secondary nosocomial infections in patients with COVID-19, but the multi-modal neural network prediction model has better prediction results.

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

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

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

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

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

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

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

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

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

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

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

Objective: The effectiveness, safety and economy of centrally purchased and original cefoperazone-sulbactam sodium in the treatment of patients with bacterial infections were compared and evaluated based on the cost-effectiveness analysis method, to provide a reference for more rational allocation of medical resources clinically. Methods: Using 191 patients with bacterial infections who were treated with centrally purchased and original cefoperazone-sulbactam sodium in Suqian First Hospital from January to December 2022 as the research objects, the 1:1 nearest neighbor matching method was used to perform propensity score matching, and the effectiveness, safety and economy of centrally purchased and original cefoperazone-sulbactam sodium in the treatment of patients with bacterial infections were compared. Results: After propensity score matching, 110 effective cases were finally included, including 55 cases in each of the centrally purchase group and the original group. The clinical effective rates in the centrally purchase group and the original group were 69.09% and 70.91% respectively, the bacterial clearance rates were 58.18% and 60.00% respectively, and the incidences of adverse drug reactions were 5.45% and 3.64% respectively. There was no statistical significance for difference in the three indicators by comparison between the two groups (P>0.05). Pharmacoeconomic analysis showed that the per capita treatment costs of the centrally purchase group and the original group were RMB 67 804.11 and RMB 5 193.52 respectively, and the cost-effectiveness ratios (CER) were 981.39 and 1 060.56 respectively. The obtained incremental cost-effectiveness ratio (ICER) of the original cefoperazone-sulbactam sodium was 4 060.11. The sensitivity analysis showed that when the cost was reduced by 10%, the incremental cost required for each patient to benefit clinically was RMB 3 654.10 in the original group; when the effect was reduced by 10%, the incremental cost required for each patient to benefit clinically was RMB 4 505.74 in the original group. Conclusion: The effectiveness and safety of centrally purchased cefoperazone-sulbactam sodium and original cefoperazone-sulbactam sodium in the treatment of patients with bacterial infections were similar, but the centrally purchased cefoperazone-sulbactam sodium is significantly more economical.

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

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

Objective: To analyze the epidemiological characteristics of severe allergic reactions caused by moxifloxacin based on literatures and relevant examples, and provide a reference for clinically safe use of moxifloxacin. Methods: By using "moxifloxacin", 'hypersensitivity", "anaphylaxis", etc. as keywords, relevant literature on severe allergic reactions caused by moxifloxacin was searched in Chinese and foreign databases such as CNKI, Chongqing VIP, Wanfang Database, PubMed, and Embase, and relevant epidemiological information of patients was collected. Combined with the adverse drug reaction report of one patient with severe allergic reaction caused by moxifloxacin previously reported by the hospital, the clinical characteristics of severe allergic reactions caused by moxifloxacin were analyzed. Results: A total of 13 articles on severe allergic reactions caused by moxifloxacin were searched from Chinese and foreign databases, involving 15 patients. Among the 16 patients in total, there were significantly more females than males (15 vs 1); there were 14 patients aged less than 60 years and 4 patients aged not less than 60 years; 9 patients with a latency period of not more than 1 hour and 6 patients with a latency period of more than 1 hour and less than 7 days; 3 patients who developed hypersensitivity syndrome and 10 patients who had hypersensitivity. In terms of outcomes, 11 patients improved after drug discontinuation and administration of glucocorticoids or antihistamines, 4 patients improved after drug discontinuation but without medication, and 1 patient eventually died of fulminant hepatic failure. Conclusion: Allergic reactions caused by moxifloxacin mostly occur in female patients, and the latency period is short. The severity includes mild rash and itching, severe dyspnea and even death. Therefore, when handling adverse drug reactions caused by moxifloxacin, it is necessary to implement early identification and early management to ensure medication safety of patients.

Septic shock occurs when pathogenic microorganisms and their toxins invading the blood circulation activate the host's cellular and humoral immune systems, producing various cytokines and inflammatory mediators to cause systemic inflammatory response syndrome, and further act on various organs and systems, causing histiocytic destruction, metabolic disorders, dysfunction, and even multiple organ dysfunction, ultimately leading to a critical syndrome with shock as a prominent manifestation. Levosimendan, as a calcium ion sensitizer, can not only improve myocardial contractility without increasing cellular oxygen consumption, but also dilate coronary arteries and systemic blood vessels, thereby improving hemodynamics. In this article, the epidemiological characteristics and pathogenesis of septic shock, the pharmacological effects and mechanisms of levosimendan, and the application and potential risks of levosimendan in septic shock are mainly reviewed, to provide a reference for the clinical use of levosimendan.

Objective: To analyze the effect of PDCA cycle management in lowering the antibiotics use density (AUD) in hospitalized patients in the hospital, and provide a reference for the clinically rational use of antibacterial drugs. Methods: The use data of antibacterial drugs in hospitalized patients in the whole hospital before the implementation of PDCA cycle management from April to June 2020 were set as the pre-implementation group, and the use data of antibacterial drugs in hospitalized patients in the whole hospital after the implementation of PDCA cycle management from July 2020 to September 2021 were set as the post-implementation group. The AUD conformance of the whole hospital and each department before and after the implementation of PDCA cycle management, and the changes in the use rates of antibacterial drugs in the whole hospital were analyzed. Results: Before the implementation of PDCA cycle management, the AUDs of hospitalized patients in the whole hospital were higher than 40, and the proportion of departments with AUD nonconformance was always more than 65.00%; within 15 months after the implementation of PDCA cycle management, except for one month, the AUDs of the whole hospital were less than 40 in other months, and the proportion of departments with AUD nonconformance decreased gradually, reaching a minimum of 28.57%; in addition, with the implementation of PDCA cycle management, the use rates of antibacterial drugs in hospitalized patients in the whole hospital also showed a downward trend. Conclusion: The implementation of PDCA cycle management can effectively reduce the AUD of hospitalized patients in the hospital to meet the national requirements; in addition, it can lower the use rate of antibacterial drugs in the hospital, thereby promoting the clinically standardized use of antibacterial drugs.

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

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

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

目的：分析 CD4⁺ T 淋巴细胞计数和病毒载量与艾滋病患者机会性感染的相关性,为预防和治疗艾滋病患者的机会性感染提供参考。方法：选取 2023 年 1 月—12 月现住址为吉安市的 1 377 例接受抗艾滋病治疗的艾滋病患者作为研究对象,按照是否发生机会性感染分为感染组与未感染组,采集所有艾滋病患者的年龄、性别、婚姻状况、文化程度、感染途径、临床分期等基本临床信息,以及血中 CD4⁺ T 淋巴细胞计数和病毒载量等指标的水平,分析机会性感染的发生与 CD4⁺ T 淋巴细胞计数、病毒载量的关系。结果：1 377 例接受抗病毒治疗的艾滋病患者中发生机会性感染的有 130 例（感染发生率为 9.44%）,感染主要累及呼吸系统（55 例,占 42.31%）,其次为皮肤黏膜（25 例,占 19.23%）;机会性感染患者的 CD4⁺ T 淋巴细胞计数水平显著低于非机会性感染患者（145.28±56.39 vs 211.25±57.10,P<0.05）,而其病毒载量>10⁴/mL 的比例则明显高于非机会性感染患者（76.15% vs 22.05%,P<0.05）;Spearman 相关分析结果显示,艾滋病患者发生机会性感染与病毒载量呈正相关（r=0.356,P<0.001）,而与 CD4⁺ T 淋巴细胞计数呈负相关（r=–0.321,P<0.001）。结论：艾滋病患者发生机会性感染的概率较高,而 CD4⁺ T 淋巴细胞计数的下降和病毒载量的上升会增加机会性感染的发生风险,临床应加强对风险患者的管理和照护,以减少或及早发现机会性感染的发生。

Berberine is a bioactive substance with a wide range of pharmacological effects. In addition to anti-inflammatory, antibacterial, antiviral, anti-diarrhea, anti-hypertension, anti-hypoxia, hypoglycemic and hypolipidemic effects, berberine has a broad-spectrum anti-tumor effect. In this article, the effects of berberine on inhibiting the formation of skin cancer, inhibiting and killing skin melanoma cells and human cutaneous squamous cell carcinoma A431 cells, etc. are reviewed and analyzed, providing a reference for further study on berberine in skin cancer.

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

目的：分析医院门诊抗菌药物处方的合理用药情况,为促进医院门诊抗菌药物的合理使用提供参考。方法：抽取 2021 年 1 月—2022 年 12 月贛州市中医院的门诊抗菌药物处方 7 859 张作为研究资料,依据《处方管理办法》、《抗菌药物临床应用指导原则》、药品说明书和相关指南共识等,对处方中抗菌药物的使用进行合理用药点评,分析不合理抗菌药物处方的临床特点。结果：处方点评结果显示,2 年间医院门诊 7 859 张抗菌药物处方中共发现不合理处方 719 张,不合理率为 9.15%,其中 2022 年的处方不合理率低于 2021 年（7.65% vs 10.59%）;医院门诊抗菌药物不合理使用的主要原因是用法用量不适宜（325 张,占 45.20%）,其次为联合应用不适宜（110 张,占 15.30%）和药物遴选不适宜（106 张,占 14.74%）;医院门诊不合理抗菌药物处方涉及的药物种类主要为头孢菌素类（285 张次）,其次为喹诺酮类（177 张次）和青霉素类（128 张次）;医院门诊不合理抗菌药物处方主要来自急诊（215 张,占 29.90%）,其次为内科（142 张,占 19.75%）和骨科（135 张,占 18.78%）。结论：医院门诊抗菌药物整体使用较为合理,但仍存在诸多不合理用药现象,主要分布在用法用量、联合用药等方面,医院相关部门应加强对抗菌药物使用的干预管理,定期开展处方点评,以确保用药的安全性、有效性。

目的：探究厦门地区结核病患者对利福平与异烟肼的耐药情况及其耐药基因突变位点,为临床耐药结核病患者的抗结核治疗提供参考。方法：选取 2019 年 1 月—2020 年 12 月厦门大学附属第一医院收治的 1 029 例结核病患者作为研究对象,采集患者的各种临床标本并通过 DNA 微阵列芯片技术检测结核分枝杆菌（Mycobacterium tuberculosis,MTB）对利福平与异烟肼的耐药情况及其耐药基因突变位点的分布情况。结果：1 029 例结核病患者分离出的 MTB 对利福平和/或异烟肼的总耐药率为 18.56%（191/1 029）;男性患者对利福平和/或异烟肼的总耐药率略高于女性（19.24% vs 16.60%,P>0.05）;在各年龄段中,40~<60 岁患者对利福平和/或异烟肼的总耐药率最高（19.80%）,而<20 岁患者对利福平和/或异烟肼的总耐药率最低（12.82%）,但各年龄段结核病患者对利福平和/或异烟肼的总耐药率经比较其差异无统计学意义（χ²=1.553,P>0.05）;共有 127 例患者的利福平耐药相关基因 rpo B 发生突变,突变率为 12.34%,位点 531（C→T）突变频率最高（为 52.76%）,共有 141 例患者的异烟肼耐药相关基因发生突变,其中 kat G 基因突变 100 例,突变率为 9.72%,位点 315（G→C）突变频率最高（为 68.09%）,inh A 基因启动子突变 40 例,突变率为 3.89%,kat G 基因和 inh A 基因启动子同时突变 1 例;1 029 例结核病患者中耐多药结核病（multidrug-resistant tuberculosis,MDR-TB）的发生率为 7.48%,基因 rpo B 531（C→T）-kat G 315（G→C）的突变率最高（为 45.45%）,有 1 例患者的MTB 的 rpo B、kat G和 inh A 基因均发生了突变。结论：厦门地区 MTB 耐多药和利福平耐药的形势严峻,rpo B 531、kat G 315 和 rpo B 531-kat G 315 是其利福平耐药、异烟肼耐药和耐多药的主要突变位点。

目的：分析医院 2021—2022 年抗菌药物相关药物不良反应（adverse drug reactions,ADRs）的临床特点,为临床抗菌药物的安全、合理使用提供参考。方法：选取 2021—2022 年浙江大学医学院附属第四医院上报国家药品不良反应监测系统的 116 例抗菌药物相关 ADRs 报告作为研究资料,采集 ADRs 的报告类型、累及器官（或系统）、处置结局,所涉患者的年龄和性别,所涉药物的品种、用药途径和用药原因等信息,分析抗菌药物相关 ADRs 的临床特点。结果：116 例 ADRs 所涉的患者中,性别上男性多于女性（64 例 vs 52 例）,年龄上以 18~<75 岁占比为主（90 例,占 77.59%）;抗菌药物的用药原因主要为呼吸系统感染（44 例,占 37.93%）,其次为尿路感染（18 例,占 15.52%）和术后感染（13 例,占 11.21%）;所涉抗菌药物的种类主要为喹诺酮类（36 例,占 31.03%）、β-内酰胺类/β-内酰胺酶抑制剂（27 例,占 23.28%）和头孢菌素类（20 例,占 17.27%）,而涉及的品种主要有左氧氟沙星（30 例）、哌拉西林-他唑巴坦钠（19 例）和头孢曲松（12 例）;所涉抗菌药物的给药途径主要为静脉滴注（99 例,占 85.34%）,而 ADRs 主要发生在给药后的 60 min内（81 例,占 69.82%）;抗菌药物相关 ADRs 主要累及患者的皮肤及其附件,其次为消化系统和呼吸系统,主要的临床表现则为瘙痒、皮疹和皮肤发红;116 例 ADRs 中,报告类型主要为“一般”（94 例,占 81.03%）,而“严重”的有 16 例（占 13.79%）,“新的一般”的有 6 例（占 5.17%）;100 例严重程度为“一般”的 ADRs 患者,在停用可疑药物或对症处理后,均好转或痊愈;16 例严重程度为“严重”的 ADRs 患者中,在处置后,有 15 例均得到好转,余 1 例结局不详。结论：医院抗菌药物相关 ADRs 在患者年龄、所涉药物种类、累及器官方面有其一定的规律,临床应加强对风险患者的护理和观察,以保障患者的用药安全。

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

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

Objective: To analyze the pharmaceutical care for anti-infective therapy in one patient with right-sided infective endocarditis (IE) complicated by infection at other sites, and provide a reference for the anti-infective therapy of similar patients in clinical practice. Methods and Results: The patient was admitted to the Hospital due to intermittent fever for nearly a month, and was preliminarily diagnosed with pulmonary infection clinically due to occasional coughing and expectoration. Empiric treatment with piperacillin-tazobactam sodium was administered. Upon completion of the admission examination, it was clinically considered, based on the results of the cardiac color ultrasonography, that a right-sided IE was present. Accordingly, the clinical pharmacist recommended the addition of vancomycin for the methicillin-resistant Staphylococcus aureus (MRSA); but in consideration of gradual alleviation of the fever, the recommendation was not adopted. However, the patient developed a fever a week later, and Staphylococcus aureus was detected in the blood culture. Considering the renal function of the patient, linezolid and levofloxacin were administered clinically. Two days later, in consideration of the improved renal function, vancomycin was administered instead. Shortly after, the patient's fever symptoms improved significantly. In addition, given that candida parapsilosis was repeatedly detected in the urine fungal culture recently, fluconazole was added for treatment, and the urine fungal culture result turned negative after 10 days. Conclusion: For patients suffering from complicated infections, clinical pharmacists should fully consider the conditions of the patients to assist physicians in making more accurate judgments, so as to formulate more individualized anti-infective treatment regimens and implement pharmaceutical care, thereby ensuring the medication safety and effectiveness for patients.

Objective: To compare the differences in the anti-inflammatory effects in vivo and in vitro of fresh Hedyotis diffusa water extract and alcohol extract, so as to lay a theoretical foundation for further clinical studies. Methods: Fresh Hedyotis diffusa was subjected to refluxing extraction with water or 75% ethanol, and the extract was concentrated and freeze-dried to obtain the extract powder. The extract powder was prepared into the corresponding herbal medicine solution, then the anti-inflammatory effects on mouse macrophages (RAW264.7) and mice in an inflammatory model were observed, and the differences between the water extract and alcohol extract were compared. Results: Both the water extract and the alcohol extract of fresh Hedyotis diffusa inhibited the viability of lipopolysaccharide-induced RAW264.7, and the water extract was generally superior to the alcohol extract in terms of the inhibition rate of inflammatory factors such as interleukin-6, interleukin-1β, and tumor necrosis factor-α. In addition, both the water extract and the alcohol extract of fresh Hedyotis diffusa reduced ear swelling and writhing times in inflammatory model mice. The overall effect of the water extract was superior to the alcohol extract. Conclusion: The anti-inflammatory effects of the water extract and the alcohol extract of Hedyotis diffusa are different, and the former was superior to the latter, which may be correlated with the difference in their components.

Objective: To explore the mechanism of action of erigeron breviscapus in treating hypertension using network pharmacology and molecular docking techniques. Methods: The active ingredients of erigeron breviscapus and its targets were searched on the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform, and the related protein targets of hypertension were searched in GeneCards, TTD and OMIM databases, and the gene names of the targets were available in the Uniprot and STRING databases. A Venn diagram was drawn to obtain the intersection targets. Then, the "erigeron breviscapus-ingredients-hypertension-targets" network diagram was constructed using the software Cytoscape 3.10.0 to obtain the main compound components, and then the main targets of erigeron breviscapus for the treatment of hypertension were obtained by constructing a protein-protein interactions (PPI) network; the DAVID database was used to perform GO functional enrichment analysis and KEGG pathway enrichment analysis on the intersection targets of drugs and diseases. Finally, molecular docking verification was performed on the main compounds and main targets, and the binding energy was calculated. Results: After screening, 207 targets of erigeron breviscapus, 1 585 hypertension-related targets and 113 intersection targets were obtained; among them, the top 5 components with the highest degree value were quercetin, kaempferol, luteolin, formononetin and baicalein, and the top 5 intersection targets with the highest degree value were transcription factor activator protein 1 (JUN), tumor suppressor gene p53 (TP53), heat shock protein HSP90-α (HSP90AA1), serine/threonine kinase 1 (AKT1), mitogen-activated protein kinase 1 (MAPK1). The GO functional enrichment analysis and KEGG pathway enrichment analysis showed that the reactive oxygen species signaling pathway, PI3K-Akt, tumor necrosis factor (TNF) signaling pathway, etc. were the main pathways of erigeron breviscapus in treating hypertension. The molecular docking results showed that the binding energy of the top 5 components and the top 5 intersection targets was less than -5 kJ/mol, indicating that the main components bound with the main targets well. Conclusion: The main active ingredients in erigeron breviscapus can bind with the therapeutic targets of hypertension well, so it is potentially developed into a drug for the treatment of hypertension.

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

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

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

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