质量管理工具在抗菌药物使用强度管理中的运用

目的 探讨质量管理工具在抗菌药物使用强度管理中的应用价值。方法 采用PDCA循环、追踪方法学、根本原因分析法、头脑风暴法、鱼骨图、决策树等管理工具,寻找医院抗菌药物使用强度管理中存在的问题并进行持续质量改进。结果 通过质量管理工具的应用,医院抗菌药物使用强度明显下降,并控制在每百人天40 DDDs以下。结论 质量管理工具应用于抗菌药物使用强度管理,能有效发现并解决问题,促进抗菌药物临床合理使用。     

专项整治对综合医院抗菌药物使用强度的影响

??????? 目的 探讨抗菌药物临床应用专项整治活动对综合医院住院患者抗菌药物使用强度的影响。方法 以限定日剂量（DDD）为单位,对某综合性医院在实施专项整治前、后住院患者抗菌药物使用强度（AUD）进行统计、分析。结果 专项整治活动降低了住院患者累计AUD值,大环内酯类等药物AUD明显下降,第二代、第三代和第四代头孢菌素和不同管理级别抗菌药物AUD均下降。但还存在用药集中、注射用头孢哌酮钠舒巴坦钠AUD下降不明显等问题。结论 专项整治有效降低了综合医院住院患者AUD,但与卫生行政部门标准仍存在差距,应进一步加强管理。     

医院计算机网络在抗菌药物使用管理中的应用

利用医院计算机网络管理抗菌药物使用,提高抗菌药物使用的合理性。经统计学检验,说明计算机网络在抗菌药物管理中的应用是有效的。它能准确、高效、有效地协助管理部门做好抗菌药物合理使用的管理工作,协助临床医生规范、合理地使用抗菌药物。     

我国抗菌药物临床应用专项整治情况调查与分析

目的 了解抗菌药物临床应用专项整治以来,我国医院的抗菌药物使用情况。方法 2011年和2012年分别选取了241所医院进行调查。运用系统随机抽样方法抽取5—9月期间医院的门诊处方和住院病历进行分析。抗菌药物使用强度（每百人天DDDs值）、门诊患者抗菌药物处方比例、综合I类切口手术预防使用抗菌药物比例等为主要分析指标。结果 从2011年至2012年,被调查医院的平均抗菌药物使用强度和综合I类切口手术预防使用抗菌药物比例下降有统计学意义;门诊患者抗菌药物处方使用率整体变化不显著,联合用药情况仍普遍存在。且医院的规模与抗菌药物使用存在显著关联性。结论 仍需通过进一步加强抗生素耐药性监测以及对医务工作者和公众抗菌药物使用培训等管理措施,从本质上改善抗菌药物使用情况。     

抗菌药物应用现状的分析

目的 分析新乡市中心医院治疗败血症时抗菌药物的应用现状,加强质量控制的监督和检查,使抗生素合理使用。方法 对2000年7月～2003年7月住院的败血症患者抗菌药物的应用现状作回顾性调查。结果 治疗败血症共用50种抗菌药物,使用803人次,居前3位药物依次为3代头孢菌素类202人次（25．16％）、喹诺酮类160人次（19．93％）、大环内酯类93人次（11．58％）;单用占67．71％,2联使用占30．19％,3联使用占2．10％;3年平均住院费增长率为16％。结论 全部用药基本合理。由于抗生素的正确使用,使该院在治疗败血症方面取得好的效果。     

采用综合干预措施 加强抗菌药物使用管理

目的 通过采取综合干预措施,促进住院患者抗菌药物的临床合理应用。方法 采用抗菌药物合理使用国际指标进行基线调查后,进行多手段干预,用SPSS12.0软件进行统计分析调查结果,评价干预措施的有效性和可行性。结果 接受抗菌药物治疗的住院患者使用抗菌药物的平均品种数从干预前的2.06种降到干预后的1.78种,抗菌药物治疗的平均费用从干预前的1 038.26元降到干预后的696.21元,抗菌药物的平均使用天数从干预前的6.99 天下降到干预后的5.81天,接受抗菌药物治疗患者的平均住院日从干预前的13天下降到干预后的10天,其他多项指标均有改善。结论 综合干预措施对提高合理用药水平效果显著,促进了管理水平的提升。     

我院2015-2018年度抗菌药物的使用强度与鲍曼不动杆菌的耐药性的关系研究

摘要 目的：分析我院2015-2018年度抗菌药物的使用强度与鲍曼不动杆菌的耐药性的关系。方法：统计2015年1月～2018年12月北京中医医院顺义医院抗菌药物的应用情况以及鲍曼不动杆菌的耐药性。鲍曼不动杆菌的耐药性资料来源于检验科临床送检的伤口分泌物、痰液、血液、尿液等病原学标本。结果：2015年～2018年,共分离到菌株13246株,其中分离到鲍曼不动杆菌株1927株,分离率为14.55 %。其中 2015 年的分离率为3.11 %,2016年的分离率为4.51 %,2017 年的分离率为5.15 %,2018 年的分离率为2.11 %;鲍曼不动杆菌标本分离率最高的为痰液,占78.83 %,其次为伤口分泌物,占12.51 %,尿液标本占5.81 %,血液标本占2.85 %;鲍曼不动杆菌在我院所有致病菌中的排序均为第一位或者第二位;2015年～2018年抗菌药物的使用强度逐年升高,2018年有所降低;2015年～2018年鲍曼不动杆菌对哌拉西林钠他唑巴坦钠、美洛培南以及亚胺培南的耐药率均逐年升高,2018年有所降低;哌拉西林钠他唑巴坦钠、美洛培南以及亚胺培南的耐药性与抗菌药物使用强度之间具有明显的相关性（P<0.05）。结论：哌拉西林钠他唑巴坦钠、美洛培南以及亚胺培南的使用,是造成鲍曼不动杆菌耐药的重要原因之一,临床应加以重视。     

2009年我院抗菌药物用药强度分析

目的 分析住院患者2009年抗菌药物用药强度。方法 以限定日剂量（DDD）为单位,以DDD/100人天值计算抗菌药物使用强度。结果 住院患者抗菌药物平均用药强度为88.32。二代头孢、三代头孢、其他β内酰胺类和头孢呋辛钠、头孢米诺钠、头孢哌酮舒巴坦钠分别位于各类别及各品种抗菌药物用药强度的前3位。各科室抗菌药物用药强度的中位数为78.37,泌尿外科、普外二科和腔镜外科位于前3位。结论 医院可能存在抗菌药物用药过度、用药集中等问题,应进一步加强监督管理。     

对围手术期抗菌药物应用进展及干预管理的探讨

抗菌药物合理应用是医院感染管理的一个重要方面。为减少医院感染的发生,降低药品不合理支出费用及住院天数,减少耐药菌株的产生和不良反应,必须加强对抗菌药物合理应用的管理。从手术部位感染的病原体种类、来源、围手术期预防使用抗菌药物的适应症、给药的时机、使用的疗程、选择的种类、预防手术部位感染的预防措施及围术期抗菌药物的干预管理等几方面的进展作一概述。     

三种清洁围手术期抗菌药物预防应用分析

目的:通过开展抗菌药物临床应用专项整治活动,探讨我们所在医院甲状腺手术、乳腺手术、疝气修补术三种Ⅰ类切口预防应用抗菌药物的情况及其用药的合理性.方法:抽取2012年6～11月出院的三种单病种255例Ⅰ类切口患者手术资料,分析抗菌药物的使用情况及合理性.结果:255例Ⅰ类切口患者围手术期抗菌药物的使用率为26.27％,证实我院通过整治活动的过程中,抗菌药物的使用率明显下降,用药合理性呈现持续改进的良好趋势.结论:不断加强对医务人员的培训和监督力度,能够明显改善抗菌药物用药不合理的现状.     

The Use of Day Beds in Gynaecology

Over a ten-year period more than 3,000 patients have been admitted to 12 day beds for minor gynaecological operations. Of the first 500 women, five were detained in hospital, but subsequent experience indicated that in only about 0·4% was admission necessary. Most patients approved of the scheme and underwent their operations more readily. Provided sufficient day beds, theatre accommodation and equipment, and staff are available, greater use of day beds for minor procedures would reduce both gynaecological waiting lists and costs.     

Optimal Drug Synergy in Antimicrobial Treatments

The rapid proliferation of antibiotic-resistant pathogens has spurred the use of drug combinations to maintain clinical efficacy and combat the evolution of resistance. Drug pairs can interact synergistically or antagonistically, yielding inhibitory effects larger or smaller than expected from the drugs'' individual potencies. Clinical strategies often favor synergistic interactions because they maximize the rate at which the infection is cleared from an individual, but it is unclear how such interactions affect the evolution of multi-drug resistance. We used a mathematical model of in vivo infection dynamics to determine the optimal treatment strategy for preventing the evolution of multi-drug resistance. We found that synergy has two conflicting effects: it clears the infection faster and thereby decreases the time during which resistant mutants can arise, but increases the selective advantage of these mutants over wild-type cells. When competition for resources is weak, the former effect is dominant and greater synergy more effectively prevents multi-drug resistance. However, under conditions of strong resource competition, a tradeoff emerges in which greater synergy increases the rate of infection clearance, but also increases the risk of multi-drug resistance. This tradeoff breaks down at a critical level of drug interaction, above which greater synergy has no effect on infection clearance, but still increases the risk of multi-drug resistance. These results suggest that the optimal strategy for suppressing multi-drug resistance is not always to maximize synergy, and that in some cases drug antagonism, despite its weaker efficacy, may better suppress the evolution of multi-drug resistance.     

Symbiotic Antimicrobial Effects of Cellulose-Based Bio-Nanocomposite for Disease Management of Agricultural Crops

In the present work, a bionanocomposite for plant crop protection was prepared by non-toxic biocompatible & biodegradable nanomaterials (Cellulose & TiO₂) to utilize its synergistic effects against antimicrobial pathogens. The commercially available microcrystalline cellulose has been reduced to a nanometric scale regime using acid hydrolysis, while the standard TiO₂ nano-powder of particle size ~20 nm has been used to prepare their nanocomposite (NC). The antibacterial studies via agar well diffusion method demonstrated that after 72 h of incubation, parent nanomaterials Ncell and TiO₂ were not showing any activity against phytopathogens X. campestris pv. campestris, and Clavibacter while the nanocomposite's NC's were still effective depicting both bacteriostatic and bactericidal actions. However, the bacterial growth of biocontrol P. fluorescence was not affected by Ncell, TiO₂ NPs and NC after 72 h of incubation. The antifungal testing results via poison food agar assay method suggest that the nanocomposite, along with Ncell and TiO₂ NPs, exhibited strong inhibition of fungal growth of Phytophthora Spp at 0.125 mg/ml concentration while for F. graminearum, similar effect was observed at 0.25 mg/ml concentration. The nanocomposite has proved its potential by exhibiting longer & stronger synergistic effects against plant pathogens as a good antimicrobial agent for protection of agricultural crops.     

Sulphur Deficiency Causes a Reduction in Antimicrobial Potential and Leads to Increased Disease Susceptibility of Oilseed Rape

The reduction of atmospheric sulphur dioxide pollution is causing increasing problems of sulphur deficiency in sulphur‐demanding crop plants in northern Europe. Elemental sulphur and many sulphur containing compounds such as cysteine‐rich antifungal proteins, glucosinolates (GSL) and phytoalexins play important roles in plant disease resistance. The aim of this work was to analyse the effect of inadequate sulphur supply on disease resistance of oilseed rape (Brassica napus). Compared with fertilized oilseed rape, healthy looking S‐deficient plants showed increased susceptibility to the blackleg fungus Leptosphaeria maculans, to the generalist necrotroph Botrytis cinerea and to the oomycete Phytophthora brassicae. To analyse possible causes of the increased disease susceptibility of S‐deficient plants, protein extracts and methanolic extracts of secondary metabolites of plants grown with and without adequate sulphur supply were tested for antimicrobial activity. None of the protein extracts showed antimicrobial activity. However, extracts containing secondary metabolites from normally grown plants showed a strong antimicrobial activity in in vitro tests with various fungal and bacterial pathogens. This activity was almost totally lost in extracts derived from S‐deficient plants. The antimicrobial activity did not appear to be based on the activity of phytoalexins because it was present in healthy plants and was not increased by a previous inoculation with Botrytis cinerea. The loss of antifungal activity in S‐deficient plants correlated with a strong reduction of various GSL, thus suggesting a reduced level of GSL as a possible cause of the reduced antimicrobial potential. However, limited tests of commercially available GSL or their degradation products did not demonstrate a causal link. Our results show that S‐deficiency of oilseed rape negatively affects disease resistance and suggest that this effect is at least partially caused by a reduction of sulphur‐dependent phytoanticipins.     

循证医学视角下的超说明书用药分级管理研究

目的 为规范超说明书用药的管理,促进临床合理用药,保障患者用药安全,对超说明书用药进行分级管理。方法 以循证医学证据为分级管理依据,启动了全院临床科室超说明书用药备案评审工作。结果 在406条备案药物中,抗肿瘤药物超说明书用药占78.8%,依据国际指南用法的比例最高,占48.8%,其次为其他循证支持用法（包括文献报道）占36.4%,再次为国内指南用法占11.1%。结论 超说明书用药的管理应重点集中于证据等级较低、药物不良反应发生率较高,且曾发生过医患纠纷的药物。     

血液科感染患者致病菌耐药性分析

目的：了解血液科病房感染患者常见病原茵的分布情况及其对药物的敏感率和耐药性,为临床诊断及用药提供参考依据。方法：回顾性分析北京友谊医院血液科2008年7月至2011年7月病房送检细菌和真菌培养标本分离出的357株病原菌的药敏试验结果。结果：革兰阳性球菌对克林霉素和各种喹诺酮类抗生素均显示出很高的耐药性,但对利奈唑胺和万古霉素较敏感;革兰阴性杆菌对碳青霉烯类抗生素的敏感率达到90％以上。屎肠球菌耐药较严重,对万古霉素的敏感率仅71．4％,而对利奈唑胺敏感率为100％。铜绿假单胞菌对亚胺培南的耐药率为19％,鲍曼不动杆菌对亚胺培南的耐药率为14．3％,而丁胺卡那霉素和妥布霉素对铜绿假单胞茵和鲍曼不动杆菌的敏感率均为100％。大多数真菌对抗真菌药物敏感。结论：对合并感染的血液病患者应及时留取标本寻找病原学证据,并依据药敏试验调整用药,以便有效的控制感染和防止耐药性的产生。     

Oligodeoxyribonucleotide Phosphorothioates: Substantial Reduction of (N-1)-mer Content Through the Use of Trimeric Phosphoramidite Synthons

Abstract

Use of fully protected trimeric phosphoramidite synthons in the synthesis of oligonucleotide phosphorothioate shows a substantial reduction (>85%) in (n-1)-mer content as compared to oligomers synthesized through coupling of standard phosphoramidite monomers. A 20-mer oligodeoxyribonucleotide phosphorothioate which is in phase I clinical trials was chosen as an example for the studies.     

Oligodeoxyribonucleotide Phosphorothioates: Substantial Reduction of (N-1)-Mer Content Through the Use of Blockmer Phosphoramidite Synthons

Abstract

Sequence-specific modulation of gene expression for the treatment of diseases has come to reality. Multiple examples of oligodeoxyribonucleotide phosphorothioates, in which one nonbridging oxygen atom of the internucleotide phosphate group of DNA is replaced by a sulfur atom are currently in advanced clinical trials. Recent advances in phosphoramidite coupling chemistry and solid phase synthesis methodology, together with current state of the art large-scale synthesizers, allow complete assembly of a 20-mer deoxyribonucleotide phosphorothioate at 150 mmole scale in just 8 h. Very high average coupling efficiencies (>98.5%) have been achieved at these scales with only 1.75-fold molar amidite excess.