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

Objective: To analyze the occurrence and treatment process of thrombocytopenia caused by the concomitant use of vancomycin and piperacillin-tazobactam sodium, and provide a reference for the safe clinical use of vancomycin and piperacillin-tazobactam sodium. Methods and Results: The patient was admitted to the hospital due to "unconsciousness with limb convulsions for 2 hours". The examinations at admission showed that the patient had fever, and infection indicators such as white blood cell (WBC) count, neutrophil percentage (NEUT%), and C-reactive protein (CRP) were at high levels, suggesting the presence of infection. Therefore, piperacillin-tazobactam sodium was empirically administered. Subsequently, pathogens such as Klebsiella pneumoniae subsp. pneumoniae, Staphylococcus aureus, and Pseudomonas aeruginosa were successively detected in various specimens of the patient, so vancomycin was added. However, the patient's fever symptoms and infection indicators did not improve significantly, so the dosage of vancomycin was adjusted from "500 mg, q12h" to "500 mg, q6h". In the following days, the patient's platelet count rapidly decreased from 124×10⁹/L to 7×10⁹/L, so platelet transfusion was immediately given. Meanwhile, after evaluation, the thrombocytopenia was possibly related to vancomycin and piperacillin-tazobactam sodium, so the two drugs were immediately discontinued, and cefoperazone-sulbactam sodium was used for antimicrobial treatment. The next day, the patient's platelet count recovered to 74×10⁹/L. Conclusion: Both piperacillin-tazobactam sodium and vancomycin have the potential risk of inducing thrombocytopenia, and the concomitant use of them may have a superimposed risk. Therefore, it is necessary to strengthen the monitoring of adverse drug reactions for the clinical use of the two drugs to ensure the safety of medication for patients.

Objective: To analyze the process of anti-infective treatment and pharmaceutical care for one diabetic patient with concurrent skin and soft tissue infection and bloodstream infection, and provide a reference for the clinical treatment of secondary infections in diabetic patients. Method sand Results: The patient was hospitalized due to "skin ulcer on the right shoulder for 4 days", reported a 9-year history of diabetes with poor blood glucose control. Physical examination showed obvious necrosis and abscess in the shoulder ulcer, suggesting skin and soft tissue infection. Piperacillin-tazobactam sodium was empirically administered, combined with wound debridement and vacuum sealing drainage. On day 4, wound secretion culture results revealed Staphylococcus aureus, and drug susceptibility test showed resistance to penicillin but sensitivity to oxacillin, gentamicin, levofloxacin, erythromycin, clindamycin, vancomycin, tetracycline, etc. As the patient's infection symptoms and related indicators did not improve significantly, the anti-infective treatment regimen was adjusted to cefazolin + clindamycin. Subsequently, the patient's fever and related infection indicators gradually improved. During this period, Staphylococcus aureus was also detected in the patient's blood culture, which quickly turned negative. Conclusion: Diabetic patients with poor blood glucose control are prone to secondary skin and soft tissue infection, and severe cases may be complicated with bloodstream infection. In clinical practice, while initiating empirical treatment, etiological diagnosis should be performed as early as possible, and more targeted anti-infective treatment regimen should be formulated based on drug susceptibility test results to ensure the treatment efficacy of patients.

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.

As a representative drug of glycopeptide antibiotics, vancomycin is a first-line therapeutic agent for infections caused by drug-resistant Gram-positive bacteria such as methicillin-resistant Staphylococcus aureus. According to the existing theories, it is believed that prolonging the administration time via continuous intravenous infusion can improve the clinical efficacy and safety of time-dependent antibiotics. However, the efficacy and safety of vancomycin administered by continuous intravenous infusion, despite as a time-dependent antibiotic, remain at the theoretical level and case study stage. Therefore, in this article, the efficacy and safety of vancomycin administered by continuous intravenous infusion in different populations are reviewed to provide a reference for improving the clinical efficacy and medication safety of vancomycin.

目的：采用回顾性横断面分析法分析多西环素治疗儿童大环内酯类药物无反应性肺炎支原体肺炎（macrolide-unresponsive Mycoplasma pneumoniae pneumonia,MUMPP）的用药特点和用药合理性,为临床患儿的多西环素合理使用提供参考。方法：选取 2023 年 1 月—2024 年 6 月威海市妇幼保健院收治的 306 例使用多西环素治疗的 MUMPP 患儿作为研究对象,采集患儿的性别、年龄、药物过敏史、诊断、耐药基因检测结果,以及多西环素的用法、用量、疗程、药物不良反应发生情况、联合用药情况等信息,并依据相关权威资料进行合理用药点评,分析多西环素治疗儿童 MUMPP 的用药特点和用药合理性。结果：306 例 MUMPP 患儿在年龄上以 8~14 岁为主（220 例,占 71.90%）,其次为 6~<8 岁（69 例,占 22.55%）;306 例 MUMPP 患儿中共有 68 例进行了 MP 耐药基因检测,其中 23SrRNA 基因 2063 位点发生突变的有 12 例;306 例 MUMPP 患儿中,多西环素的疗程主要为 5~<14 d（228 例,占 74.51%）,有 160 例（占 52.29%）患儿存在与其他抗菌药物联用的情况,还有 216 例（占 70.59%）患儿存在于糖皮质激素甲泼尼龙联用的情况;点评结果显示,306 例 MUMPP 患儿中多西环素的适应证、用法、用量均较为合理,仅 86 例（占 28.10%）因年龄<8 岁而存在超说明书用药的情况;住院期间,306 例 MUMPP 患儿中发生多西环素相关药物不良反应的仅 1 例,发生率为 0.33%。结论：医院 MUMPP 患儿多西环素的使用除存在超说明书用药外整体较为规范、合理,并且用药安全性较好,对于多西环素的超说明书用药情况,临床应持续做好与患儿家属的事前沟通与宣教,以减少不必要的医患矛盾。

Objective: To investigate the stability of ceftriaxone-tazobactam sodium finished infusion under different temperature and solvent conditions, and provide a reference for improving the quality of ceftriaxone-tazobactam sodium finished infusions prepared in the Pharmacy Intravenous Admixture Services. Methods: 1.0 g of ceftriaxone-tazobactam sodium (750 mg ceftriaxone and 250 mg tazobactam) was sequentially dissolved in 250 mL of 0.9% sodium chloride injection, 5% glucose injection, 5% glucose sodium chloride injection, and 10% glucose injection. The solutions were then placed at 25 °C and 2-8 °C for 0, 2, 4, 8, 12, and 24 hours, respectively. The changes in pH values and the degradation rates of active ingredients of ceftriaxone-tazobactam sodium finished infusions under different temperature and solvent conditions were observed. Results: At 25 °C, the degradation rates of ceftriaxone in 0.9% sodium chloride injection, 5% glucose injection, 5% glucose sodium chloride injection, and 10% glucose injection within 24 hours were all lower than 10.00%, while the degradation rates of tazobactam in these four solvents within 12 hours were all lower than 10.00%, and only the degradation rate in 5% glucose and sodium chloride injection was lower than 10.00% when placed for 24 hours. At 2-8 °C, the degradation rates of both ceftriaxone and tazobactam in 0.9% sodium chloride injection, 5% glucose injection, 5% glucose sodium chloride injection, and 10% glucose injection within 24 hours were lower than 5.00%. Under both 25 °C and 2-8 °C conditions, the pH values of ceftriaxone-tazobactam sodium finished infusions showed minimal fluctuations (ranging from 0.00 to 0.17) within 24 hours. Conclusion: The ceftriaxone-tazobactam sodium finished infusions prepared with four common solvents should not be stored for more than 12 hours at 25 °C or more than 24 hours at 2-8 °C. Under these conditions, the degradation rates and changes in pH values of the ceftriaxone-tazobactam sodium finished infusions are small, which can ensure the safety and efficacy of the drug.

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 process of antimicrobial therapy and pharmaceutical care for one patient with cervical necrotizing fasciitis (CNF) caused by Streptococcus constellatus, and provide a reference for the treatment of such patients in clinical practice. Methods and Results: The patient presented with sore throat and bloody sputum after consuming fish one week ago, followed by swelling and pain in the left neck, chest tightness, and difficulty in eating. CT examination in another hospital suggested cervical soft tissue infection, and considering the severe condition, the patient was transferred to our hospital. Admission examinations showed persistent fever, significantly abnormal infection indicators such as white blood cell count, neutrophil percentage, and C-reactive protein. CT indicated possible infectious lesions in the larynx and neck, so debridement and drainage surgery was performed, and pus and drainage fluid were collected for microbial culture. Empirical antimicrobial therapy with linezolid plus meropenem was initiated postoperatively. Three days later, Streptococcus constellatus was isolated from the pus and drainage fluid, which was sensitive to linezolid. Considering the possibility of mixed infection, the current antimicrobial therapy regimen was maintained. Another four days later, the patient's infection indicators improved significantly, but large-area rash appeared on the back. Clinical pharmacists ruled out other causes and considered it might be caused by meropenem, so meropenem was discontinued. Another four days later, the patient developed intermittent fever again, and the white blood cell count increased. Sputum culture detected Stenotrophomonas maltophilia, but lung imaging showed no abnormalities. Therefore, it was considered that Stenotrophomonas maltophilia was likely a colonizing bacterium, and the recurrence of the disease was possibly attributed to incomplete treatment of CNF. Clinical pharmacists suggested adding levofloxacin, which was adopted by the doctor. One week later, the patient no longer had fever, and the white blood cell count returned to normal. Conclusion: As a severe infectious disease, CNF is caused by complex pathogens. Even if a single pathogen is detected, the possibility of mixed infection should not be ruled out. The principles of combined and full-course treatment should be adhered to ensure the effect of antimicrobial therapy.

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

Objective: To analyze the process of anti-infective treatment and pharmaceutical care for one patient with severe Chlamydia psittaci pneumonia and secondary infection with Candida glabrata, and provide a reference for the clinical diagnosis and treatment of such complicated and severe infections. Methods and Results: The patient had symptoms such as cough, expectoration and fever half a month ago. Examinations at an external hospital showed that the infection indicators such as the white blood cell count, percentage of neutrophils, C-reactive protein, and procalcitonin were all abnormal, and the chest CT suggested lobar pneumonia. During this period, amoxicillin, ceftazidime, and levofloxacin were successively administered, but the patient's condition did not improve, so the patient was transferred to our hospital. Considering that the patient's infection was severe and the pathogen was not identified, meropenem + moxifloxacin was empirically administered. After several days of treatment, the patient did not improve, and the targeted next-generation sequencing (tNGS) revealed Chlamydia psittaci (sequence number 58 971). Therefore, the doctor added doxycycline following the advice of the clinical pharmacist, later the patient's infection symptoms and related indicators gradually improved. However, one week later, the patient's condition relapsed again. The tNGS revealed Chlamydia psittaci (sequence number 1 131) and Candida glabrata (sequence number 626). The patient was clinically considered to have a fungal infection, so voriconazole was added at the suggestion of the clinical pharmacist, and meropenem was discontinued at the same time. 10 days later, the tNGS revealed Candida glabrata only (sequence number 388), while Chlamydia psittaci was not detected, and the chest CT suggested that the lung lesions were significantly absorbed compared with before, so doxycycline + moxifloxacin was discontinued; 13 days later, the patient's various symptoms and abnormal indicators basically disappeared, achieving clinical cure; so the patient was discharged from the hospital. Conclusion: For severe infections, anti-infective treatment should be carried out as early as possible in clinical practice, and the selected antibacterial drugs should cover common pathogens as much as possible. Meanwhile, various detection methods should be used to identify the pathogens as early as possible to facilitate the development of targeted treatment. During this period, clinical pharmacists should give full play to their professional expertise, actively assist doctors in the medication regimen and help them make a more scientific treatment regimen to ensure the effective treatment of patients.

目的：汇总分析医院临床药师参与的抗感染药学会诊的病例特点,并就典型案例进行剖析,为今后临床药师药学会诊工作的优化提升提供参考。方法：选取 2024 年 1—4 月中山大学附属第一医院广西医院临床药师参与的 104 例抗感染药学会诊病例作为研究对象,采集会诊病例的性别、所在科室、病史资料、病原学检查结果、会诊目的、会诊建议的采纳情况、病情转归等信息,分析抗感染药学会诊病例的规律和特点。结果：104 例抗感染药学会诊病例中,男性多于女性（67 例 vs 37 例）,并且有 18 例（占 17.31%）存在肝肾功能损伤;104 例会诊病例主要来自急诊监护病房（23 例,占 22.12%）、普外科（17 例,占 16.35%）、耳鼻咽喉头颈外科（13 例,占 12.50%）、肾内科（10 例,占 9.62%）和神经内科（8 例,占 7.69%）;104 例会诊病例中有 48 例病原学检查呈阳性,共检出病原菌 56 株,其中主要为革兰阴性菌（36 株,占 64.29%）;104 例会诊病例中,会诊目的主要为咨询调整抗感染治疗方案（84 例,占 80.77%）,而有 95 例（占 91.35%）的会诊建议得到了临床采纳,其中有 77 例患者的病情得到了好转。结论：临床药师通过参与多学科会诊,并基于抗感染药物的药学特点和患者的实际病情提出个体化用药建议,可有效提升抗感染治疗的精准性,从而使患者获得更好的治疗效果。

Objective: To analyze the process of antifungal therapy and pharmaceutical care for one patient with AIDS complicated by Talaromyces marneffei (TM) infection, and provide a reference for the clinical treatment of such patients. Methods and Results: The patient with AIDS was admitted to the hospital due to unexplained sore throat, dry mouth, shortness of breath after activity, and general malaise. Examinations at admission showed significant abnormalities in indicators such as neutrophil percentage (NEUT%), C-reactive protein (CRP), and procalcitonin (PCT), so empirical treatment with compound sulfamethoxazole was given. The next day, the patient developed fever, and lung CT showed scattered inflammation and local consolidation in both lungs, so piperacillin-tazobactam sodium was added. One day later, fungal hyphae were detected in the patient's blood culture, and the result of G test was 242.664 pg/mL. In combination with the umbilicated rashes and acne-like lesions scattered on the face and back, TM infection was highly suspected. Then, amphotericin B colloidal dispersion (ABCD) was immediately given for induction therapy. The next day, the patient's blood culture reported positive for TM, and bone marrow smear also showed phagocytes phagocytizing TM, confirming the diagnosis of TM infection. During ABCD treatment, when the dose was "150 mg, q24h", the patient developed acute kidney injury, so the dose was reduced to "100 mg, q24h". After 2 weeks of ABCD induction therapy, the patient's body temperature returned to normal, and the levels of infection indicators such as NEUT%, CRP, and PCT significantly decreased, so it was switched to voriconazole (0.2 g, q12h) for sequential therapy. Four days later, considering that the patient's condition was relatively stable, he/she was allowed to be discharged. However, one month after discharge, the reexamination of CT scan showed that the pulmonary infection had progressed compared with that at discharge, which was considered possibly related to insufficient ABCD dose during induction therapy or individual differences in voriconazole. Conclusion: ABCD and voriconazole are recommended drugs for the treatment of patients with AIDS complicated by TM infection. Standardized treatment with sufficient course and dose is the guarantee to achieve good curative effect. Due to the large individual differences in voriconazole plasma concentration, clinical plasma concentration monitoring should be carried out as much as possible to achieve individualized adjustment of medication and ensure the treatment effect of patients.

Objective: To analyze and identify drug-induced liver injury caused by voriconazole based on therapeutic drug monitoring and carry out the corresponding management, and provide a reference for the clinical safe use of voriconazole in pediatric patients. Methods and Results: A 10-year-old male patient (body weight: 35.5 kg) was hospitalized for the first time due to acute lymphoblastic leukemia requiring chemotherapy. During hospitalization, the patient was diagnosed with pulmonary aspergillosis and received voriconazole (300 mg, q12h). During treatment, the patient developed abnormally elevated alanine transaminase (ALT), and compound glycyrrhizin tablets were administered for liver protection, after which ALT returned to normal. One week later, the patient was re-admitted due to fever. Considering the patient's granulocytopenia and a history of liver injury, cefoperazone-sulbactam sodium and compound glycyrrhizin injection were added while continuing voriconazole treatment. However, the next day, the patient's levels of ALT and aspartate transaminase (AST) remained abnormally elevated. Tests for hepatitis viruses, TORCH antibodies, human immunodeficiency virus, syphilis, Epstein-Barr virus, etc. were performed and all results were normal. As ALT and AST levels continued to rise, ademetionine 1, 4-butanedisulfonate for injection was added, but the transaminase level continued to increase progressively. After excluding possible diseases and discontinuing multiple suspected drugs, the clinical pharmacist suspected that liver injury might be caused by voriconazole, so repeatedly suggested the blood concentration detection of voriconazole. The doctor eventually adopted this suggestion. The results showed that the blood concentration of voriconazole was 12.9 μg/mL, far beyond the recommended value; so the single dose of voriconazole was reduced from 300 mg to 150 mg, after which the transaminase level decreased significantly. Conclusion: Voriconazole may cause severe liver injury during administration. Therefore, the blood concentration of voriconazole should be routinely monitored during medication, especially when liver dysfunction has already occurred, to prevent more severe liver damage. In this case, the clinical pharmacist actively advocated for the therapeutic drug monitoring of voriconazole based on the professional knowledge, and finally ruled out the causes of liver injury, ensuring the patient's medication safety.

目的：分析 1 例患者使用伊立替康致急性乙酰胆碱能综合征的发生和处置过程,为临床伊立替康的用药安全提供参考。方法与结果：该患者因结肠和肾脏的恶性肿瘤复发又行手术治疗,之后经历了近 4 年的化疗和免疫靶向治疗;其间,患者也多次使用伊立替康,但患者在静脉滴注伊立替康约 30 min 后出现急性腹泻（水样便）伴出汗的情况;临床初步判断为急性乙酰胆碱能综合征,考虑此反应与伊立替康的时序关系紧密,遂立即停用伊立替康,并予洛哌丁胺胶囊对症治疗;但临床药师提出,洛哌丁胺主要用于治疗伊立替康引起的迟发性腹泻,对于急性腹泻伴出汗宜用阿托品,遂改用阿托品;30 min后,患者腹泻、出汗症状基本好转;14 d 后,在临床药师建议下,患者在再次使用伊立替康前预防性使用了阿托品,结果未再出现腹泻情况。结论：临床药师在临床实践过程中应密切关注患者的用药安全情况,尤其对于体质虚弱的癌症化疗患者,并协助医生做好药物不良反应的识别和处置,从而保证患者的用药安全。

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.

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：分析医院腰椎骨折手术患者术后切口感染的发生情况及其影响因素,为临床腰椎骨折手术患者术后感染的预防提供参考。方法：选取 2020 年 3 月—2023 年 3 月医院收治的 205 例行内固定术的腰椎骨折患者作为研究对象,采集患者的年龄、性别、身体质量指数、基础疾病、骨折类型、手术节段数、切口长度、手术时长、术中失血量、术中体温、抗菌药物预防使用情况、引流时间、相关实验室指标和术后切口感染发生情况等信息,采用 Logistic 回归分析法分析腰椎骨折手术患者并发术后切口感染的影响因素。结果：205 例腰椎骨折手术患者术后 3 个月内共有 40 例发生切口感染,感染发生率为19.51%;Logistic 回归分析结果显示,腰椎骨折手术患者并发术后切口感染与是否合并糖尿病、手术节段数、切口长度、手术时长、术中失血量、术中体温、引流时间、是否预防性使用抗菌药物、白蛋白水平、血红蛋白水平、球蛋白水平具有相关性（P<0.05）,而合并糖尿病、切口长度>5 cm、术中低体温、引流时间>3 d、球蛋白<20 g/L 是腰椎骨折手术患者并发术后切口感染的独立危险因素（P<0.05）,预防性使用抗菌药物、白蛋白≥35 g/L、血红蛋白≥110 g/L 是腰椎骨折手术患者并发术后切口感染的保护性因素（P<0.05）。结论：医院腰椎骨折手术患者术后切口感染的发生率较高,而是否合并糖尿病、切口长度、术中体温、引流时间、是否预防性使用抗菌药物、白蛋白水平、血红蛋白水平、球蛋白水平是患者发生术后切口感染的重要影响因素,对此临床应加强对高风险患者的监护和管理,以减少患者术后感染的发生。

Objective: To explore the bacteriostatic effect and related mechanism of Biyan Qingdu Granules (BQG) against Staphylococcus aureus (SA), and provide a reference for the relevant clinical application of BQG. Methods: SA was inoculated on a nutrient agar plate, and a well-grown single colony of SA was taken, dissolved in physiological saline and blown evenly for later use. Liquid medium and BQG were added to the corresponding wells in a 96-well plate, and then a fixed quantity of bacterial suspension was added. The antibacterial effect of BQG on SA and its effect on the biofilm and cell membrane permeability of SA were observed. Results: The minimum inhibitory concentration of BQG for SA was 62.5 mg/mL, while the minimum bactericidal concentration was not detected. When the drug concentration of BQG was 15.625 mg/mL, the biofilm formation of SA could be inhibited significantly (P<0.01) and the 50% minimum biofilm inhibitory concentration (MBIC₅₀) of BQG was 63.125 mg/mL. The BQG at concentrations of 125-250 mg/mL had a significant inhibitory effect on the biofilm activity of SA that was cultured for 2 hours (P<0.05), while the BQG at concentrations of 3.9-250 mg/mL had a significant inhibitory effect on the biofilm activity of SA that was cultured for 4 hours and 6 hours (P<0.01). The MBIC₅₀ values of BQG for the biofilms of SA that was cultured for 2 hours, 4 hours and 6 hours were 35.762, 19.838, and 36.278 mg/mL respectively. When the drug concentration of BQG was more than 20 mg/mL, the protein content in the supernatant increased significantly (P<0.01). Conclusion: BQG has a bacteriostatic effect on SA, and its mechanism is related to interference with the biofilm formation and adhesion of SA and increase in the cell membrane permeability.

目的：分析医院门急诊不合理处方的发生情况与特点,并就此提出针对性的应对策略,为促进医院门急诊合理用药提供参考。方法：选取 2023 年 1 月—2024 年 2 月常熟市第一人民医院本部和滨江院区门急诊进行处方点评的 80 990 张处方作为研究资料,采集处方中的前记、正文、后记等信息,然后依据相关权威资料对其进行合理用药点评,分析不合理处方的发生情况与特点。结果：处方点评结果显示,门急诊 80 990 张处方中共有不合理处方 880 张（不合理发生率为 1.09%）,其中门诊的处方不合理发生率略高于急诊（1.16% vs 0.88%）,滨江院区的处方不合理发生率略高于医院本部（1.18% vs 1.07%）;880 张不合理处方中,所涉患者在性别上女性多于男性（483 例 vs 397 例）,而在年龄上以 18~<45 岁者为最多（261 张,占 29.66%）,其次为 60~<75 岁者（199 张,占 22.61%）;880 张不合理处方共涉及 35 个门诊科室与 8 个急诊科室,其中不合理处方数居前 3 的科室依次为普通内科（116 张,占 13.18%）、急诊内科（95 张,占 10.80%）和耳鼻咽喉科（67 张,占 7.61%）;880 张不合理处方共涉及不合理原因类型 14 项,其中“用法用量不适宜”“处方未写临床诊断或临床诊断书写不全”“医师签名签章不规范,或者与签名签章的留样不一致”“联合用药不适宜”是主要的不合理原因类型;根据不合理原因类型进行分类,2023 年 1—6 月和2023 年 7 月—2024 年 2 月分别涉及不合理处方 342 张次和 613 张次,其前 3 位不合理原因类型均为“用法用量不适宜”“处方未写临床诊断或临床诊断书写不全”“医师签名签章不规范,或者与签名签章的留样不一致”。结论：医院门急诊处方的不合理率总体处于较低水平,但临床仍应加强合理用药的相关培训与考核,以进一步提高临床的合理用药水平。

目的：分析医院静脉用药调配中心（pharmacy intravenous admixture services,PIVAS）不合理用药医嘱的规律和特点,为提高临床合理用药水平提供参考。方法：选取 2022 年1 月—2024 年 9 月常熟市第一人民医院 PIVAS 的全部 1 609 810 条医嘱作为研究资料,采集医嘱所涉患者的年龄、性别、诊断、所在科室,以及所涉药物的名称、剂型、用法、用量、溶媒、联合用药等信息,依据相关权威文献资料对医嘱进行合理用药审核,然后采用帕累托图分析法分析不合理用药医嘱的规律和特点。结果：3 年间共发现不合理用药医嘱 572 条（不合理发生率为 0.355‰）,其中 2022—2024 年不合理医嘱的发生率分别为0.608‰、0.282‰、0.138‰,呈逐年下降趋势;572 条不合理医嘱共涉及 28 个临床科室,其中前 3 位的依次为肿瘤科（53 条,占 9.27%）、普外科（47 条,占 8.22%）和急诊科（40 条,占 6.99%）;帕累托图分析显示,PIVAS 不合理医嘱的原因类型主要为溶媒种类选择不当（220 条,占 38.46%）和溶媒用量不当（213 条,占 37.24%）,而其涉及的药物种类主要为消化系统用药（165 条,占 28.85%）、抗肿瘤药物（65 条,占 11.36%）、抗菌药物（62 条,占 10.84%）、神经系统用药（59 条,占 10.31%）、血液系统用药（58 条,占 10.14%）和维生素及肠内外营养药等（31 条,占 5.42%）;572 条不合理医嘱中,不合理医嘱数≥10 条的药品有 14 种,涉及不合理医嘱共 267 条（占 46.68%）,其中前 3 位的药品依次为盐酸雷尼替丁注射液（59 条,占 10.31%）、注射用奥美拉唑钠（44 条,占 7.69%）和香菇多糖注射液（21 条,占 3.67%）。结论：医院 PIVAS 的医嘱整体较为合理,并且不合理发生率呈逐年下降趋势,但审方药师仍应加强用药医嘱审核,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 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 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。

目的：分析肺结核合并新型冠状病毒感染（COVID-19）患者的 CT 影像学特征及其与预后的关系,为肺结核合并 COVID-19 患者的诊断和预后预测提供参考。方法：选取 2022 年 12 月—2023 年 2 月陕西省结核病防治院收治的 53 例肺结核合并 COVID-19 患者作为研究对象,根据患者的最终预后情况将其分为预后良好组（n=35）和预后不良组（n=18）,采集患者的入院时的临床表现、实验室检查结果、CT 检查结果、预后情况等资料,分析患者的 CT 影像学特征及其与预后的关系。结果：入院时,预后不良组患者胸闷气短、痰涂片阳性、结核抗体阳性、结核菌素皮肤试验阳性、超敏 C 反应蛋白升高、D-二聚体升高等的发生率均显著高于预后良好组（P<0.05）,并且其实变、边界模糊、受累肺叶数>2、空洞、树芽征等胸部 CT 表现的比例亦显著高于预后良好组（P<0.05）;受试者工作特征曲线显示,胸部 CT 影像中实变（AUC=0.859）、树芽征（AUC=0.844）、受累肺叶数>2（AUC=0.788）、边界模糊（AUC=0.760）对肺结核合并 COVID-19 患者预后不良具有较好的预测效能。结论：胸部 CT 影像对肺结核合并 COVID-19 患者的预后具有较好的预测作用,对此临床应尽可能完善患者的胸部 CT 检查,并加强对高不良预后风险的患者的干预,以促进患者的病情恢复。

Objective: To analyze the clinical diagnosis and treatment process of one child with Mycoplasma pneumoniae-induced rash and mucositis (MIRM) misdiagnosed as drug-induced dermatitis, and provide a reference for the clinical diagnosis and treatment of MIRM. Methods and Results: An 8-year-old male patient initially came to our hospital due to Mycoplasma pneumoniae infection, and was treated with azithromycin and doxycycline successively, with basic control of the infection. During this period, the patient developed oral mucosal ulcers and edematous erythema on the limbs. The family sought self-treatment without improvement, so the patient was referred to a local hospital, where drug-induced dermatitis was suspected. Doxycycline was discontinued, and anti-allergic symptomatic treatment was performed, but his condition did not improve, so the patient returned to our hospital. After completing clinical examinations, combined with the patient's medical history and medication history, it was considered that the condition was not drug-induced dermatitis but MIRM. Then the treatment with azithromycin for anti-infection, methylprednisolone and human immunoglobulin for immune blockade, and other symptomatic treatments were initiated. 8 days later, most of the oral ulcers healed, the swelling and skin lesions subsided, and the pain alleviated significantly. Conclusion: MIRM is rare in clinical practice and rarely reported in China, and doctors with limited understanding of MIRM may easily misdiagnose it as drug-induced dermatitis. Therefore, clinical learning and understanding about MIRM should be strengthened to achieve correct diagnosis and ensure the effective treatment of patients.

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.

目的：分析品管圈（quality control circle,QCC）活动对促进医院合理用药的作用,为保障患者用药安全提供参考。方法：选取 2021 年 10 月—2022 年 3 月（QCC 实施前,即第 1 阶段）、2022 年 4—9 月（QCC 实施中,即第 2 阶段）、2022 年 10 月—2023 年 3 月（QCC 实施后,即第 3 阶段）、2023 年 4—9 月（QCC 循环,即第 4 阶段）沭阳医院门诊的相关处方作为研究资料,在 QCC 实施过程中提出部署前置审方系统和合理用药系统,分析 QCC 活动对改善门诊处方合格率、前置审方和患者满意度等的作用。结果：QCC 活动实施后,医院门诊处方的合格率由第 1 阶段的 90.83% 增至第 3 阶段的 98.36%,目标达成率为 130.28%;在前置审方系统配置完成后,系统完成了超 95.00% 门诊处方的自动审核,并且随着 QCC 活动的进行,人工审方的完成率从第 2 阶段的 88.74% 增至第 4 阶段的 96.31%,而人工审方的通过率也从第 2 阶段的 63.27% 增至第 4 阶段的70.85%;QCC 活动实施后,患者在用药、费用、预后等方面的满意度均较前有明显提高（P<0.05）,而人均医疗费用则较前明显下降（P<0.05）;此外,通过开展 QCC 活动,圈员们的品管手法、解决问题能力、工作热情、团队意识、责任心、自信心均有了较大提升。结论：QCC 活动的开展提高了医院门诊处方的合格率,保障了患者的用药安全,从而提高了患者的满意度。

目的：分析医院门急诊抗菌药物的合理用药状况,为提高临床抗菌药物的合理用药水平提供参考。方法：以每月随机抽取 50 张处方的方式,选取 2023 年 1 月—2024 年 12 月苏州卫生职业技术学院附属眼视光医院门急诊的 1 200 张抗菌药物处方作为研究资料,采集处方中患者的年龄、性别、诊断,以及所用抗菌药物的种类、剂型、用法、用量等信息,然后依据相关权威资料对处方中抗菌药物的进行合理用药点评,分析医院门急诊抗菌药物的不合理用药特点。结果：1 200 张抗菌药物处方所涉患者在性别上女性略多于男性（53.92% vs 46.08%）,而在年龄上以<18 岁者为最多（524 张,占 43.67%）,其次为>60 岁者（395 张,占 32.92%）;1 200 张处方所涉及的抗菌药物品种主要有左氧氟沙星滴眼液（597 例）、妥布霉素地塞米松滴眼液（257 例）、妥布霉素地塞米松眼膏（187 例）、妥布霉素滴眼液（125 例）;处方点评结果显示,1 200 张抗菌药物处方中共有不合理处方 89 张（不合理发生率为 7.42%）,而不合理原因类型主要为遴选药品不适宜（43 张）、适应证不适宜（38 张）和联合用药不适宜（22 张）。结论：医院门急诊抗菌药物的使用整体较为合理,但仍存在较多的不合理用药情况,医院相关管理部门应督促临床加强培训和管理,以进一步促进抗菌药物的合理使用。

目的：分析医院 2021—2022 年所上报药物不良反应（adverse drug reactions,ADRs）的临床特点和规律,为临床患者的用药安全提供参考。方法：选取 2021 年 1 月—2022 年 12 月个旧市人民医院上报的 464 例 ADRs 报告作为研究资料,采集其中患者的性别和年龄,所涉药物的种类、给药方式,以及 ADRs 的严重程度和临床表现等信息,分析医院所上报 ADRs 的临床特点和规律。结果：医院上报的 464 例 ADRs 的报告类型主要为“一般”（402 例,占 86.64%）,而“严重”和“新的”则分别有 35 例（占 7.54%）和 27 例（占 5.82%）;464 例 ADRs 报告中,患者的男女比例基本相当（51.94% vs 48.06%）,而其在年龄上以>45~65 岁者为最多（147 例,占 31.68%）,其次为>75 岁者（98 例,占 21.12%）和>65~75 岁者（86 例,占 18.53%）;464 例 ADRs 报告共涉及 9 类 105 种药品,其中以抗菌药物为最多（152 例,占 32.76%）,其次为心血管用药（57 例,占 12.28%）和化疗药物（53 例,占 11.42%）;ADRs 所涉药物的给药途径以静脉滴注为最多（160 例,占 34.48%）,其次为静脉注射给药（156 例,占 33.62%）和口服给药（130 例,占 28.02%）;464 例 ADRs 报告中,ADRs 的累及器官（或系统）主要为皮肤及其附件（164 例,占 35.34%）和消化系统（123 例,占 26.51%）。结论：医院 2021—2022 年所上报 ADRs 在患者年龄、药物种类、给药途径、临床表现方面有着一定的规律和特点,对此临床应加强相关患者的用药安全监测,以保障患者的用药安全。

Objective: To analyze the process of antimicrobial therapy and pharmaceutical care for one patient with traffic accident injury complicated by Mycoplasma hominis bloodstream infection, and provide a reference for clinical antimicrobial treatment of patients with Mycoplasma hominis infection. Methods and Results: The patient was admitted to the hospital due to systemic contusion, fracture, and severe abdominal injury caused by a traffic accident. Surgical treatment was immediately performed after admission, and cefoperazone-sulbactam sodium was administered postoperatively. Two days later, the patient's white blood cell count, neutrophil percentage (NEUT%), and C-reactive protein (CRP) levels were all abnormal. Subsequently, fever, abdominal pain, and an increase in procalcitonin level occurred, indicating concurrent infection with a trend of aggravation, so meropenem was used instead. After 2 weeks of treatment, the patient's infectious symptoms improved significantly, and NEUT% and CRP also improved compared with before. However, the next day, the patient developed fever again, and the CRP level increased abnormally. Clinical pharmacists considered the possibility of other secondary infections, so they suggested improving etiological examinations and adding amikacin. Two days later, Mycoplasma hominis was detected in the culture of the tip of the patient's intravenous catheter. After comprehensively evaluating the patient's previous conditions, clinical pharmacists suggested adjusting the antimicrobial treatment regimen to doxycycline + meropenem. Another two days later, Mycoplasma hominis was also detected in the patient's blood culture, and the drug susceptibility test showed that it was sensitive to doxycycline. After 2 weeks of treatment with doxycycline, the patient's infectious symptoms basically disappeared, the infection indicators returned to normal, and the blood culture results also turned negative. Conclusion: As an atypical pathogen, mycoplasma is often ignored in clinical empirical antimicrobial treatment. When the empirical treatment has poor effect, the possible pathogens should be fully considered, and etiological examinations should be improved. After obtaining pathogen information, targeted antimicrobial treatment and pharmaceutical care should be carried out in a timely manner to ensure the effect of antimicrobial treatment for patients.

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 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。

目的：分析医院行腹腔镜腹股沟疝修补术（laparoscopic inguinal hernia repair,LIHR）患者术后手术部位感染（surgical site infection,SSI）的发生情况及其影响因素,为临床行 LIHR 患者术后感人的预防提供参考。方法：选取 2019 年 1 月—2023 年 8 月医院收治的 100 例行 LIHR 患者作为研究对象,统计患者术后 SSI 的发生情况,采集患者的年龄、性别、身体质量指数、基础疾病、疝类型、疝部位、疝囊直径、手术时长等信息,采用 Logistic 回归分析法分析行 LIHR 患者术后并发 SSI 的影响因素。结果：100 例行 LIHR 患者中,术后发生 SSI 的有 21 例,感染发生率为 21.00%;单因素分析结果显示,行 LIHR 患者术后并发 SSI 与其身体质量指数、是否合并糖尿病、是否合并低蛋白血症、疝囊直径、疝环粘连程度有关（P<0.05）;多因素 Logistic 回归分析结果显示,身体质量指数≥28、合并糖尿病、合并低蛋白血症、疝囊直径>5 cm、重度疝环粘连是行 LIHR 患者术后并发 SSI 的独立危险因素（P<0.05）。结论：医院行 LIHR 患者术后 SSI 的发生率较高,其发生与患者的身体质量指数、是否合并糖尿病、是否合并低蛋白血症、疝囊直径、疝环粘连程度密切相关,临床对高风险患者应加强监护和管理,以减少其术后 SSI 的发生。

目的：分析医院神经外科患者术后并发肺部感染的病原学特征与影响因素,为临床神经外科患者术后肺部感染的防治提供参考。方法：选取 2019 年 1 月—2024 年 1 月医院收治的 100 例神经外科手术患者作为研究对象,采集患者的年龄、性别、吸烟史、饮酒史、基础疾病、病原学检查结果和肺部感染发生情况等信息,采用 Logistic 回归分析法分析患者术后并发肺部感染的影响因素。结果：100 例神经外科手术患者中共有 38 例术后并发肺部感染,感染发生率为 38.00%;38 例并发肺部感染患者标本中共检出病原菌 46 株,其中革兰阴性菌 32 株（占 69.57%）、革兰阳性菌 12 株（占 26.09%）和真菌 2 株（占 4.35%）;药敏结果显示,肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌对头孢曲松、头孢他啶的耐药率较高（>60.00%）,对头孢哌酮-舒巴坦钠、阿米卡星、美罗培南的耐药率较低（<20.00%）;金黄色葡萄球菌和表皮葡萄球菌对头孢呋辛、青霉素的耐药率较高（≥75.00%）,对利奈唑胺、万古霉素的耐药率较低（<20.00%）;单因素分析结果显示,神经外科患者术后并发肺部感染与患者年龄、是否合并糖尿病、是否合并低蛋白血症有关（P<0.05）;多因素分析结果显示,年龄≥60 岁、合并糖尿病、合并低蛋白血症是神经外科患者术后并发肺部感染的独立危险因素（P<0.05）。结论：医院神经外科患者术后肺部感染的发生率较高,且其所检出主要病原菌具有较强的耐药性;此外,神经外科患者术后肺部感染的发生与患者年龄、是否合并糖尿病、是否合并低蛋白血症密切相关,对此临床应加强对相关高风险患者的监测和护理,以减少患者肺部感染的发生。

目的：分析合并新型冠状病毒感染（COVID-19）对慢性阻塞性肺疾病急性加重期（acute exacerbation of chronic obstructive pulmonary disease,AECOPD）患者的影响,为后疫情时代 COPD 患者的优化管理提供参考。方法：选取 2022 年 12 月—2023 年 2 月医院呼吸与危重症医学科收治的 180 例 AECOPD 患者作为研究对象,根据患者是否合并 COVID-19,将其分为合并 COVID-19 组（n=79）和未合并 COVID-19 组（n=101）,采集所有患者的年龄、性别、吸烟史、饮酒史、基础疾病、COPD 病程、COPD 的GOLD 分级、实验室检查结果、治疗措施、住院时间和治疗费用等信息,分析合并 COVID-19 对 AECOPD 患者的影响。结果：在 AECOPD 患者中,合并 COVID-19 者的年龄明显高于未合并 COVID-19 者（P<0.05）;合并 COVID-19 的 AECOPD 患者的白介素-6 水平明显高于未合并 COVID-19 者（P<0.05）,其甲泼尼龙使用天数和总用量明显大于未合并 COVID-19 者（P<0.05）,其住院天数明显多于未合并 COVID-19 者（P<0.05）。结论：合并 COVID-19 对 AECOPD 患者的病情和预后整体影响较小,临床做好对 COVID-19 和 AECOPD 各自的规范化治疗即可。

Objective: To analyze the clinical characteristics and prognosis of patients with pulmonary cryptococcosis, and provide a reference for the clinical identification, diagnosis, and treatment of pulmonary cryptococcosis. Methods: A total of 20 patients with pulmonary cryptococcosis admitted to Shangrao People's Hospital from July 2022 to December 2023 were selected as the research objects. Information such as age, gender, underlying diseases, clinical manifestations, laboratory and imaging examination results, medication conditions, and prognosis were collected to analyze the clinical characteristics and prognosis of patients with pulmonary cryptococcosis. Results: Among the 20 patients with pulmonary cryptococcosis, the middle-aged and elderly aged ≥40 years old were the main group (16 cases, 80.00%), and most of them had a history of smoking (12 cases, 60.00%) and immunodeficiency (11 cases, 55.00%). The main clinical symptoms of patients with pulmonary cryptococcosis included cough (14 cases, 70.00%), expectoration (9 cases, 45.00%), fever (9 cases, 45.00%), and malaise (7 cases, 35.00%). 7 cases and 11 cases underwent G test and GM test respectively, but the results were all negative. 12 cases underwent serum latex agglutination test, among which 10 cases were positive, with a positive rate of 83.33%. Imaging manifestations of pulmonary cryptococcosis mostly showed nodular/mass type (14 cases, 70.00%), among which single nodular/mass type was more common (10 cases). In terms of affected sites, the lower lobes of the lung (17 cases, 85.00%) and peripheral lung (17 cases, 85.00%) were the main sites. Among the 20 patients with pulmonary cryptococcosis, the vast majority had treatment outcomes of being cured (5 cases, 25.00%) or improved (12 cases, 60.00%). Conclusion: Pulmonary cryptococcosis mostly occurs in middle-aged and elderly people, and its clinical and imaging manifestations have obvious characteristics. Clinicians should pay attention to identification in early diagnosis. In addition, the prognosis of patients with pulmonary cryptococcosis is mostly good under standardized treatment.

目的：分析医院重症心肌炎患者的临床特征,为临床重症心肌炎患者的早识别、早诊断、早治疗提供参考。方法：选取 2021 年 1 月—2023 年 12 月苏州大学附属第一医院收治的 103 例心肌炎患者作为研究对象,根据病情严重程度将其分为重症心肌炎组（n=28）和普通心肌炎组（n=75）,采集所有患者的年龄、性别、临床表现、相关检查结果、用药情况、预后情况等信息,分析和比较重症心肌炎和普通心肌炎的临床特征区别。结果：与普通心肌炎组相比,重症心肌炎组患者的年龄更大（P<0.05）,其左室射血分数水平更低（P<0.05）,其心包积液、肺部感染、晕厥、休克、心律失常、传导阻滞、心脏衰竭等的发生率更高（P<0.05）,其升压药、激素、丙种球蛋白、抗菌药物和抗病毒药物的使用率也更高（P<0.05）;血清实验室检查显示,与普通心肌炎组相比,重症心肌炎组患者的白细胞计数、中性粒细胞计数、肌钙蛋白、脑钠肽、D-二聚体等指标的水平均更高（P<0.05）,丙氨酸转氨酶、天冬氨酸转氨酶、肌酐等指标异常的发生率亦更高（P<0.05）,但淋巴细胞计数的水平更低（P<0.05）;心电图检查显示,与普通心肌炎组相比,重症心肌炎组患者室性逸搏心律、低电压、室性心动过速、节段减弱等的发生率明显更高（P<0.05）;在救治措施方面,与普通心肌炎组相比,重症心肌炎组患者进行气管插管、起搏器安装、主动脉球囊反搏、体外膜肺氧合等救治措施的比例更高（P<0.05）。结论：重症心肌炎患者在临床表现、实验室指标、心电图指标等方面有着较为明显的特点,临床在早期诊断时应注意观察和识别;此外,为获得较好的治疗效果,重症心肌炎患者常需要更多的药物治疗和其他救治措施。

目的：分析赣州某医院抗菌药物所致药物不良反应（adverse drug reactions,ADRs）的临床特点,并提出针对性预防措施,为临床抗菌药物的用药安全提供参考。方法：选取 2021 年 5 月 20 日—2023 年 2 月 18 日于都县人民医院上报至国家药品不良反应监测平台的 152 例抗菌药物所致 ADRs 报告作为研究资料,采集其中患者的性别、年龄,所涉抗菌药物的种类、给药方式,以及 ADRs 的发生时间等信息,分析医院抗菌药物所致 ADRs 的临床特点。结果：152 例抗菌药物所致 ADRs 患者中,男性略多于女性（83 例 vs 69 例）,而年龄上以 60~75 岁者为最多（50 例,占 32.89%）,其次为 18~<60 岁者（45 例,29.61%）;152 例 ADRs 所涉抗菌药物共 6 类 17 种,其中最多的为头孢菌素类（51 例,33.55%）,其次为氟喹诺酮类（35 例,23.03%）和青霉素类（30 例,19.74%）,抗菌药物在给药方式方面多为静脉给药（91 例,占 59.87%）;152 例抗菌药物所致 ADRs 的发生时间主要集中于用药后的 3 d 内（122 例,占 80.26%）;152 例抗菌药物所致 ADRs 主要累及患者的皮肤及其附件（53例,占 34.87%）和消化系统（38 例,占 25.00%）。结论：医院抗菌药物所致 ADRs 在患者年龄、药品种类、发生时间、累及器官等方面有着较明显的特点,临床对具备相应特征的患者应加强用药安全监测,以保障患者的用药安全。

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.