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  • 2022 Volume 19 Issue 6
    Published: 25 June 2022
      
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  • Research Progress in the Hypoproteinemia on the Dose Adjustment of Antibacterials in Critically Ill Patients*1
    WANG Yin-hui, FAN Jing, LIN Bin
    2022, 19(6): 773-776. https://doi.org/10.13493/j.issn.1672-7878.2022.06-001
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    Hypoproteinemia is a common pathological condition in critically ill patients in ICU, with a significant impact on the in-vivo pharmacokinetics (PK)/pharmacodynamics (PD) of drugs (especially antibacterials with a high plasma protein binding rate), which can greatly affect the clinical efficacy of drugs and cause adverse drug reactions. Active therapeutic drug monitoring is a better strategy to cope with this problem. In this regard, the author reviewed the effect of hypoproteinemia on in-vivo PK/PD of antibacterials in critically ill patients and investigated the related effects.
  • Research Progress in the Clinical Diagnosis and Treatment of Patients with Liver Cirrhosis Complicated by Portal Vein Thrombosis*1
    CHEN Fan, WANG Yin-ling, ZHU Li, ZHU Chuan-wu
    2022, 19(6): 777-782. https://doi.org/10.13493/j.issn.1672-7878.2022.06-002
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    Portal vein thrombosis (PVT) is a complication frequently occurring in patients with liver cirrhosis, and it is usually hidden. PVT may worsen the ascites symptoms in patients with liver cirrhosis, and the successful treatment of PVT may reduce variceal pressure of such patients, indicating that PVT has an important impact on the development and outcome of patients with liver cirrhosis. Therefore, in this paper, the author reviews the risk factors of complicated PVT in patients with liver cirrhosis, the impact of PVT on the progress of cirrhotic disease, as well as the diagnosis and treatment of PVT, and analyzes the relevant condition.
  • Research Progress in the Anti-tumor Pharmacological Effect of Magnolol and Its Mechanism
    ZHANG Ming-fa, SHEN Ya-qin
    2022, 19(6): 783-787. https://doi.org/10.13493/j.issn.1672-7878.2022.06-003
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    Magnolol has a strong anti-tumor effect and has an inhibition effect on leukemia cells, lymphoma cells, sarcoma cells, skin cancer cells, breast cancer cells, cervical cancer cells, prostate cancer cells, nasopharyngeal cancer cells, etc. For different tumor cells, magnolol has different anti-tumor mechanisms. Its main action pathways include: (1) inhibiting type I deacetylase expression and activity, up-regulating DR5 expression, and activating tumor necrosis factor-related apoptosis inducing ligand (TRAIL) signal pathway; (2) regulating the TGF-β1/p38 MAPK/Hippo signal pathway; (3) regulating the BMP7/TGF-β1/p53 signal pathway, etc. This paper reviews the anti-tumor effect of magnolol and its pharmacological mechanism, and reviews related studies.
  • Analysis of the Irrationality of 11 213 Outpatient and Emergency Antibacterial Prescriptions in a Hospital of Traditional Chinese Medicine
    GONG Wen
    2022, 19(6): 788-791. https://doi.org/10.13493/j.issn.1672-7878.2022.06-004
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    Objective: To investigate the review results of outpatient and emergency antibacterial prescriptions and the types of reasons for irrational drug use in the hospital, and to provide reference for the rational use of clinical antibacterials. Methods: A total of 11 213 outpatient and emergency antibacterial prescriptions of Nanjing Jiangning Hospital of Traditional Chinese Medicine from January 2020 to December 2021 were sampled as research data through the hospital rational drug use system, and rational drug use review was conducted on the antibacterial prescriptions based on relevant authoritative data. The review results and the types of reasons for irrational drug use were analyzed, and corresponding countermeasures were proposed. Results: The review results showed that 1 518 irrational prescriptions were found in 11 213 outpatient and emergency antibacterial prescriptions (the rate of irrationality was 13.54%), among which emergency surgery (314 prescriptions, accounting for 20.69%), emergency internal medicine (263 prescriptions, accounting for 17.33%), outpatient pediatrics (152 prescriptions, accounting for 10.01%) and outpatient gynecology (107 prescriptions, accounting for 7.05%) had the most irrational prescriptions. The types of reasons for the irrationality were mainly incomplete clinical diagnosis (646 prescriptions, accounting for 41.25%), inappropriate combination of medications (303 prescriptions, accounting for 19.35%), and medications without indications (242 prescriptions, accounting for 15.45%). Conclusion: There are certain irrational uses of antibacterials in the outpatient and emergency departments of the hospital, and the administrative department of the hospital should enhance the management of the main departments and conduct regular prescription reviews to ensure the medication safety of patients.
  • Analysis of the Prophylactic Use of Perioperative Antibacterials in 357 Patients with Class II Incisions in a Primary Hospital
    LUO Guo-yi, LIU Jie
    2022, 19(6): 792-794. https://doi.org/10.13493/j.issn.1672-7878.2022.06-005
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    Objective: To investigate the prophylactic use of perioperative antibacterials in patients with Class II incisions in the hospital, and to provide reference for promoting the rational use of perioperative antibacterials of surgical patients in the hospital. Methods: A total of 357 patients with Class II incisions, admitted to Chongqing Shuangqiao Economic and Technological Development Zone People's Hospital from June 2021 to November 2021, were selected as study subjects, and the selection of perioperative antibacterials, the timing of administration and the duration of medication of patients were counted and analyzed. Results: In the 357 patients with Class II incisions, the perioperative antibacterials for prophylactic use were mainly cephalosporins (267 cases, accounting for 74.79%), among which the first generation of cefazolin (89 cases) and the second generation of cefuroxime (114 cases) were mainly used. In terms of the timing of administration, the drugs were mainly used 0.5-1h before surgery (276 cases, accounting for 77.31%). In terms of the duration of medication, only 27 patients (7.56%) were maintained for less than or equal to 24h, and 145 cases (40.62%) were maintained for longer than 24h but not over 72h. Conclusion: The perioperative antibacterials in patients with Class II incisions in the hospital are irrationally used in terms of variety selection, timing of administration and duration of medication. The hospital management department should enhance the training and assessment on use of perioperative antibacterials for clinicians and nurses to improve the rational use of antibacterials.
  • Impact of Pharmacological Interventions on the Rationality and Gastrointestinal Adverse Reactions of Prophylactic Use of PPIs in Chemotherapy Patients
    LU Wei, WANG Zhi-bin
    2022, 19(6): 795-798. https://doi.org/10.13493/j.issn.1672-7878.2022.06-006
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    Objective: To investigate the impact of pharmacological interventions on the rationality and gastrointestinal adverse reactions of prophylactic use of proton pump inhibitors (PPIs) in chemotherapy patients, and to provide reference for the rational use of clinical PPIs. Methods: A total of 925 tumor patients, admitted to the Department of Oncology of the Sixth People's Hospital of Nantong from December 2019 to November 2020, without pharmacological intervention were selected as the non-pharmacological intervention group, and 480 tumor patients, admitted to the Department of Oncology of the Sixth People's Hospital of Nantong from December 2020 to November 2021, with pharmacological interventions were selected as the pharmacological intervention group. The prophylactic use of PPIs and the occurrence rate of gastrointestinal adverse reactions caused by PPIs in the two groups were analyzed and compared. Results: The prophylactic use rate of PPIs in the pharmacological intervention group was lower than that in the non-pharmacological intervention group (78.33% vs. 84.76%, P<0.05), but the differences in the occurrence rate of irrational drug use and of the gastrointestinal adverse reactions caused by PPIs between the two groups were not statistically significant (P>0.05). Conclusion: The prophylactic use of PPIs in oncology patients can be reduced with pharmaceutical interventions performed by pharmacists, but the rationality of their prophylactic use and the occurrence of adverse reactions are not greatly affected.
  • Analysis of Distribution and Drug Resistance of Pathogens in Preterm Infants with Complicated Bloodstream Infections in the Pediatric Department of a Hospital
    SHI Yang-yi, JIAO Shu-li
    2022, 19(6): 799-802. https://doi.org/10.13493/j.issn.1672-7878.2022.06-007
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    Objective: To investigate the distribution and drug resistance of pathogenic bacteria in preterm infants with complicated bloodstream infections in the pediatric department of the hospital, and to provide reference for the use of clinical antibacterials. Methods: A total of 86 cases of preterm infants with complicated bloodstream infections admitted to the pediatric department of Mianyang Central Hospital from August 2019 to August 2021 were selected as study subjects, and the distribution and drug resistance characteristics of the major pathogenic bacteria in the blood specimens of the infants were analyzed. Results: A total of 98 strains of pathogenic bacteria were detected in the blood specimens of 86 preterm infants with complicated bloodstream infections, including 57 strains of Gram-negative bacteria (accounting for 58.16%, mainly Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa), 39 strains of Gram-positive bacteria (accounting for 39.80%, mainly coagulase-negative Staphylococcus and Staphylococcus aureus) and 2 strains of fungi (accounting for 2.04%). The drug susceptibility test results showed that the resistance rates of Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa to imipenem and meropenem were 0.00%, and their resistance rates to cefoperazone-sulbactam sodium and amikacin were also low (lower than or equal to 20.00%). The resistance rates of coagulase-negative Staphylococcus and Staphylococcus aureus to linezolid and vancomycin were 0.00%, and their resistance rates to ciprofloxacin were also low (lower than 30.00%). Conclusion: The pathogenic bacteria of bloodstream infections in preterm infants in the pediatric department of the hospital are mainly gram-negative and gram-positive bacteria, and fungi are rarely seen. The major pathogenic bacteria are generally more resistant to commonly used antibacterials, and antibacterials should be reasonably selected in clinical treatment according to the drug susceptibility test results of pathogenic bacteria to ensure the efficacy of treatment.
  • Analysis of Distribution and Drug Resistance of Pathogenic Bacteria in Incisional Drainage Fluid Specimens from Patients with OMSI in a Hospital
    LIU Lei-lei
    2022, 19(6): 803-805. https://doi.org/10.13493/j.issn.1672-7878.2022.06-008
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    Objective: To investigate the distribution and drug resistance characteristics of pathogenic bacteria in incisional drainage fluid specimens from patients with oral and maxillofacial space infection (OMSI) in the hospital so as to provide reference for the rational use of antibacterials in early clinical practice. Methods: A total of 96 patients with OMSI admitted to the Xuheng Community Health Service Center of Zhongzhan District of Jiaozuo City from August 2019 to August 2021 were selected as the study subjects, and the distribution and drug resistance of pathogenic bacteria in the incisional drainage fluid specimens from these patients were analyzed. Results: A total of 108 strains of pathogenic bacteria were isolated from the incisional drainage fluid specimens from 96 patients with OMSI, including 73 strains of Gram-positive bacteria (accounting for 67.60%, mainly Streptococcus constellatus, Streptococcus pneumoniae and Staphylococcus aureus), 31 strains of Gram-negative bacteria (accounting for 28.70%, mainly Pseudomonas aeruginosa) and 4 strains of fungi (accounting for 3.70%). The drug susceptibility test results showed that the resistance rates of Streptococcus constellatus, Streptococcus pneumoniae and Staphylococcus aureus to vancomycin and linezolid were 0.00%, and their resistance rates to ciprofloxacin and furantoin were also low (less than 30.00%). The resistance rate of Pseudomonas aeruginosa to imipenem and meropenem was 0.00%, and its resistance rate to cefoperazone-sulbactam sodium and amikacin was also low (less than 20.00%). Conclusion: The pathogenic bacteria that develop OMSI in patients are mainly gram-positive bacteria with strong drug resistance, so antibacterials should be clinically selected by taking the drug resistance of pathogenic bacteria into account, to avoid or reduce the production of drug-resistant strains.
  • Analysis of Epidemiological Characteristics and Risk Factors of Complicated CRPA Infections in Inpatients in a "Grade A Class 3" Tumor Hospital*1
    MA Ping-ping, JIN Xiao-jie, CHEN Lei
    2022, 19(6): 876-880. https://doi.org/10.13493/j.issn.1672-7878.2022.06-029
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    Objective: To investigate the epidemiological characteristics and risk factors of complicated carbapenem-resistant Pseudomonas aeruginosa (CRPA) infections in inpatients in a "Grade A Class 3" tumor hospital, and to provide reference for the prevention and treatment of CRPA infection. Methods: The medical records of 160 patients with Pseudomonas aeruginosa infection admitted to Nantong Tumor Hospital from 2018 to 2020 were selected, and they were divided into CRPA-infected group (n=80) and non-CRPA-infected group (n=80) according to whether they were resistant to carbapenems. The historical trends, specimen sources, departmental distribution of patients with CRPA infection and related risk factors were analyzed. Results: During the three years, CRPA was most detected in 2019 (38 strains, accounting for 47.50%) and least detected in 2020 (13 strains, accounting for 16.25%); the CRPA specimens were mainly detected from sputum (48 strains, accounting for 60.00%), followed by bile (9 strains, accounting for 11.25%); in terms of departmental distribution, CRPA was mainly detected in the ICU (18 strains, accounting for 22.25%) and the Respiratory Department (16 strains, accounting for 20.00%). The regression analysis results showed that the length of hospital stay, the complication of other pathogenic infections, the number of varieties of combined antibacterials, the use course of antibacterials, and the indwelling deep venous catheter, urethral catheter and drainage tube were related to CRPA infections in patients (P<0.05), among which the number of varieties of combined antibacterials greater than or equal to 3, the use course of antibacterials longer than or equal to 14d, and the complication of other pathogenic infections were independent risk factors of CRPA in patients (P<0.05). Conclusion: CRPA is mainly detected in sputum, and its infection mainly occurs in ICU and Respiratory Department. The number of varieties of combined antibacterials greater than or equal to 3, the use course of antibacterials longer than or equal to 14 d and the complication of other pathogenic infections are independent risk factors of CRPA in patients, so the management of antibacterials should be clinically enhanced and the use of antibacterials should be regulated, to eradicate or reduce the CRPA infection.
  • Analysis of Pathogenic Characteristics and Risk Factors of Complicated Pulmonary Infections in Patients with Esophageal Cancer after Chemoradiotherapy in a Hospital*1
    ZHANG Hai-feng, YAN Li-na, ZHONG Chun-yan
    2022, 19(6): 881-886. https://doi.org/10.13493/j.issn.1672-7878.2022.06-030
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    Objective: To investigate the pathogenic characteristics and risk factors of complicated pulmonary infections in patients with esophageal cancer (ECa) after radiotherapy and chemotherapy in the hospital, and to provide reference for the prevention and treatment of pulmonary infections in these patients. Methods: The medical records of 142 ECa patients admitted to the hospital from March 2020 to February 2022 were selected. The patients were divided into infected group (n=33) and non-infected group (n=109) according to whether they were complicated with pulmonary infections after radiotherapy and chemotherapy. The pathogenic characteristics and risk factors of pulmonary infections in these patients were counted and analyzed. Results: Among the 142 ECa patients after radiotherapy and chemotherapy, 33 cases had complicated pulmonary infections (the infection rate was 23.24%), and 57 strains of pathogenic bacteria were detected in their sputum specimens, including 36 strains of Gram-negative bacteria (accounting for 63.16%, mainly Pseudomonas aeruginosa and Klebsiella pneumoniae), 19 strains of Gram-positive bacteria (accounting for 33.33%, mainly Staphylococcus aureus and Staphylococcus epidermidis) and 2 strains of fungi (accounting for 3.51%). The drug susceptibility test results showed that the resistance rates of Pseudomonas aeruginosa and Klebsiella pneumoniae to imipenem, gentamicin, amikacin and ceftazidime were low (less than 25.00%); the resistance rates of Staphylococcus aureus and Staphylococcus epidermidis to vancomycin, rifampicin and gentamicin were low (less than 30.00%). The regression analysis results showed that the tumor size, length of hospital stay, and complications of diabetes, hypertension and chronic obstructive pulmonary disease were related to pulmonary infections of ECa patients after radiotherapy and chemotherapy (P<0.05), among which, hospital stay longer than or equal to 14d and complications of hypertension and chronic obstructive pulmonary diseases were independent risk factors for patients with pulmonary infections (P<0.05). Conclusion: The pathogenic bacteria of pulmonary infections in ECa patients after radiotherapy and chemotherapy are mainly gram-negative bacteria, which are strong in drug resistance and only sensitive to some antibacterials. The hospital stay longer than or equal to 14 days and complications of hypertension and chronic obstructive pulmonary diseases are important risk factors for patients with pulmonary infections. Therefore, nursing and protection should be enhanced for such patients in clinical diagnosis and treatment, to reduce pulmonary infections. In addition, antibacterials with strong sensitivity should be selected as far as possible in the anti-infection treatment of pulmonary infections, so as to promote recovery of patients.
  • Analysis of Clinical Characteristics of 110 Cases of Adverse Drug Reactions Caused by Anti-tumor Drugs Reported to the CHPS by a Hospital
    LIU Hui-chao, YU Ru-huan
    2022, 19(6): 893-896. https://doi.org/10.13493/j.issn.1672-7878.2022.06-033
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    Objective: To investigate the clinical characteristics of adverse drug reactions (ADRs) caused by anti-tumor drugs in the hospital so as to provide reference for the rational use of clinical anti-tumor drugs. Methods: A total of 110 cases of ADRs due to anti-tumor drugs reported to China Hospital Pharmacovigilance System (CHPS) by the First People's Hospital of Pingdingshan from July 2020 to December 2020 were selected as research data. The basic information of patients with ADRs, such as gender, age, diagnosis, as well as drug types, administration method, organs (or systems) involved, clinical manifestations, and the classification and outcome of ADRs were counted and analyzed. Results: ADRs caused by anti-tumor drugs mainly occurred in middle-aged and elderly people greater than 40 but not over 65 years old (67 cases, accounting for 58.18%) and greater than 65 years old (36 cases, accounting for 32.73%), mainly with diseases of respiratory system tumors (42 cases, accounting for 38.18%) and digestive system tumors (31 cases, accounting for 28.18%); the 110 cases of ADRs mainly involved anti-tumor drugs such as lobaplatin, carboplatin and cisplatin (43 cases, accounting for 39.09%) that directly affected the structure and function of DNA, anti-tumor drugs such as pemetrexed and gemcitabine (20 cases, accounting for 18.18%) that interfered with nucleic acid biosynthesis, and adjuvant anti-tumor drugs, such as compound radix sophorae flavescentis and Aide injection (22 cases, accounting for 20.00%); the drugs involved in the ADRs were mainly intravenously administrated (103 cases, accounting for 93.64%). ADRs mainly involved the digestive system (54 cases, accounting for 49.09%), followed by the hematologic system (17 cases), skin and its adnexa (13 cases) and the whole body (11 cases). The occurrence time of ADRs was mainly less than or equal to 1d (33 cases, accounting for 30.00%) and longer than 1 but not over 3d (57 cases, accounting for 51.81%) after drug administration. The 110 cases of anti-tumor drug ADRs included 23 serious cases, 84 mild cases and 3 new cases. The patients basically improved (92 cases, accounting for 83.63%) or were cured (16 cases, accounting for 14.55%) after treatment. Conclusion: ADRs caused by anti-tumor drugs in the hospital have certain clinical characteristics and patterns, and major groups, drugs and organs (or systems) involved should be more strictly monitored for early detection and disposal to improve the use safety of anti-tumor drugs.
  • Analysis of Clinical Characteristics of 121 Cases of Adverse Drug Reactions Caused by Antibacterials in a Hospital from 2017 to 2020
    LUO Qiu-qiong, LI Jie-xi, SHI Yu-ping
    2022, 19(6): 897-900. https://doi.org/10.13493/j.issn.1672-7878.2022.06-034
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    Objective: To investigate the clinical characteristics of adverse drug reactions (ADRs) caused by antibacterials in the hospital, and to provide reference for the safe and rational use of antibacterials. Methods: A total of 121 cases of ADRs of antibacterials reported to the National Adverse Drug Reaction Monitoring System by Chashan Hospital of Dongguan from January 2017 to December 2020 were collected as research data. The age and gender distribution of 121 patients with ADRs, the type of antibacterials involved in ADRs, the mode of administration and the organs (or systems) involved, and the antibacterials and clinical manifestations involved in severe ADRs were counted and analyzed. Results: The 121 patients with ADRs were mainly at the age greater than 14 but not over 40 years old (48 cases, accounting for 39.67%) and greater than 40 but not over 60 years old (38 cases, accounting for 31.40%); the antibacterials involved in ADRs were mainly cephalosporins (79 cases, accounting for 65.28%), and the mode of administration of the drugs involved was mainly intravenous drip (112 cases, accounting for 92.56%). The organs (or systems) involved were mainly the skin and its adnexa (89 cases, accounting for 73.55%); the 121 cases reported included 16 serious ADRs, of which 11 were suspected to be caused by cephalosporins. Conclusion: ADRs caused by antibacterials in the hospital have more obvious occurrence patterns and characteristics, and the main groups, antibacterials, administration methods and organs (or systems) involved should be clinically managed and monitored more strictly, to avoid or reduce the occurrence of ADRs and improve the use safety of antibacterials.
  • Clinical Treatment and Pharmaceutical Care of One Patient with Intracranial Streptococcus Pneumoniae Infection Participated by Clinical Pharmacist
    LIN Hui, LU Ping, RAN Ying, MOU Yin-yan, HONG Ming
    2022, 19(6): 904-907. https://doi.org/10.13493/j.issn.1672-7878.2022.06-036
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    Objective: To investigate the clinical treatment and pharmaceutical care of one patient with intracranial Streptococcus pneumoniae infection participated by clinical pharmacist, and to provide reference for the clinical treatment and safe and rational use of drugs in such patients. Methods: The clinical pharmacist participated in the treatment process of the patient with intracranial infection, during which he/she assisted the physician in formulating an individualized anti-infection treatment regimen based on the patient's physiological indexes and relevant domestic and international guidelines, consensus and authoritative data, and carried out pharmaceutical care to further optimize the treatment regimen and monitor adverse drug reactions. Results: With the coordination and cooperation of the clinical pharmacist and physician, a vancomycin-based treatment regimen was formulated, and the pathogen test results of the patient's cerebrospinal fluid showed positive Streptococcus pneumoniae, verifying the accuracy of the treatment regimen. The symptoms of the patient disappeared soon after the treatment and the patient was discharged successfully. Conclusion: The clinical pharmacist should try to accurately grasp the relevant symptoms and indexes of patients in clinical response to patients with intracranial infection, carry out empirical treatment and pharmaceutical care as early as possible, and timely adjust and optimize the treatment regimen according to the changes in patients' conditions and their own pharmacy expertise to achieve therapeutic effects. Meanwhile, therapeutic drug monitoring should be carried out actively to avoid adverse drug reactions.
  • Exploration of Infection Prevention and Control Strategies of Designated Hospitals in the Context of the Outbreak of Omicron COVID-19*1
    ZHANG Yun, ZHANG Jian-ping, JIN Mei-juan, TAN Si-yuan, JIANG Dan, HE Yong-ying, WU Yue-ren, GONG Yuan-yuan, MAO Yi-ping, CHENG Jun-ping
    2022, 19(6): 911-915. https://doi.org/10.13493/j.issn.1672-7878.2022.06-038
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    Objective: To explore and share the infection prevention and control strategies of designated hospitals in response to the outbreak of Omicron COVID-19 in Suzhou, and to provide reference for infection prevention and control in the hospital during the outbreak. Methods: Under the leadership of the epidemic prevention and control command of designated hospitals and the guidance of infection experts of provincial and municipal hospitals, these hospitals quickly improved the organizational structure of hospital infection prevention and control, established the Joint Infection Control Office ("JICO" for short), and set up five management groups, named office coordination group, supervision and inspection group, training and assessment group, system flow group and infection monitoring group, respectively. Each group had a clear division of labor, clear responsibilities, and close cooperation to ensure full infection control. Results and Conclusion:In the face of the epidemic, the hospitals quickly activated the emergency mechanism, established a rapid, comprehensive, precise and scientific infection prevention and control mechanism to effectively avoid the risk of the epidemic spreading in the hospital, and guaranteed the occupational safety of medical staff to the maximum extent.