- Journal Information
- Archive
- Submission
- For Reviewers
- Statement and Policies
- 个人中心
- 退出登录
浏览全部资源
扫码关注微信
- Journal Information
- Archive
- Submission
- For Reviewers
- Statement and Policies
Establishment and application of clinical pharmaceutical pathway of anti-infective treatment for high-risk populations of antibiotic-associated encephalopathy
- ZHONGGUO YAOFANG Vol. 35, Issue 21, Pages: 2690-2696(2024)
- 作者机构：
1.天津医科大学朱宪彝纪念医院药剂科/天津市内分泌研究所/国家卫健委激素与发育重点实验室/天津市代谢性疾病重点实验室，天津 300134
2.天津医科大学朱宪彝纪念医院重症医学科/天津市内分泌研究所/国家卫健委激素与发育重点实验室/天津市代谢性疾病重点实验室，天津 300134
- 作者简介：
- 基金信息：
DOI：10.6039/j.issn.1001-0408.2024.21.19
CLC： R95;R969.3Published：15 November 2024，
Received：20 May 2024，
Revised：01 October 2024，
- 稿件说明：
移动端阅览
杜春辉,万永丽,杨晓姣等.抗菌药物相关性脑病高风险人群抗感染治疗临床药学路径的建立与应用 Δ[J].中国药房,2024,35(21):2690-2696.
DU Chunhui,WAN Yongli,YANG Xiaojiao,et al.Establishment and application of clinical pharmaceutical pathway of anti-infective treatment for high-risk populations of antibiotic-associated encephalopathy[J].ZHONGGUO YAOFANG,2024,35(21):2690-2696.
杜春辉,万永丽,杨晓姣等.抗菌药物相关性脑病高风险人群抗感染治疗临床药学路径的建立与应用 Δ[J].中国药房,2024,35(21):2690-2696. DOI： 10.6039/j.issn.1001-0408.2024.21.19.
DU Chunhui,WAN Yongli,YANG Xiaojiao,et al.Establishment and application of clinical pharmaceutical pathway of anti-infective treatment for high-risk populations of antibiotic-associated encephalopathy[J].ZHONGGUO YAOFANG,2024,35(21):2690-2696. DOI： 10.6039/j.issn.1001-0408.2024.21.19.
摘要
目的
2
建立抗菌药物相关性脑病（AAE）高风险人群抗感染治疗临床药学路径，并分析其应用效果。
方法
2
临床药师根据文献资料和专家意见自制“AAE高风险人群筛查表”和“抗菌药物AAE发生风险比较表”，在此基础上建立我院“AAE高风险人群抗感染治疗临床药学路径”。采用前瞻性、非随机对照研究，将2023年5月至2024年4月我院内科收治的肺部感染患者分为观察组（50例）和对照组（50例）。观察组由临床药师参与并按照临床药学路径制定抗感染方案并进行治疗，对照组由临床医师给予常规抗感染治疗。观察2组AAE发生情况、抗菌药物使用的合理性和初始抗感染治疗有效性，总结AAE病例的干预措施及转归。
结果
2
初步建立我院AAE高风险人群抗感染治疗临床药学路径。应用效果分析显示，观察组和对照组分别有1例和8例患者发生AAE，观察组AAE发生率显著低于对照组，抗菌药物使用合理率、初始抗感染治疗有效率均显著优于对照组（
P
＜0.05）。停药、换药是AAE首选的有效干预措施，脑病治疗药物可作为症状缓解的辅助措施，及时有效地干预有利于症状快速缓解，AAE总好转率为88.89%。
结论
2
AAE高风险人群抗感染治疗临床药学路径可有效预防AAE的发生，同时有助于提高用药合理性和初始抗感染方案的有效性，改善发生AAE患者的治疗结局。
Abstract
OBJECTIVE
2
To establish a clinical pharmaceutical pathway of anti-infective therapy for high-risk populations of antibiotic-associated encephalopathy （AAE）， and analyze its application effects.
METHODS
2
Clinical pharmacists developed the “AAE High-Risk Population Screening Form” and “Antibiotic AAE Risk Comparison Form”
based on literature and expert opinions， and established the
“
Clinical Pharmaceutical Pathway of Anti-infective Treatment for AAE High-Risk Population” in our hospital. A prospective， non-randomized controlled study was conducted from May 2023 to April 2024， including 50 cases in the observation group and 50 cases in the control group among patients with pulmonary infections admitted to the Dept. of Internal Medicine in our hospital. The observation group was involved in the development of an anti-infective treatment following the clinical pharmaceutical pathway by clinical pharmacists， while the control group received routine anti-infective treatment by clinical physicians. The occurrence of AAE， the rational antibiotic drug use， and the effectiveness of initi
al anti-infective treatment in the two groups were observed， and the intervention measures and outcomes of AAE cases were summarized.
RESULTS
2
The anti-infective treatment clinical pharmaceutical pathway for AAE high-risk population was preliminarily established in our hospital. The analysis of the application effects showed that there was 1 case of AAE in the observation group and 8 cases in the control group， with a significantly lower incidence of AAE in the observation group than in the control group； the rational antibiotic drug use and the effectiveness of initial anti-infective treatment in the observation group were both significantly superior to those in the control group （
P
＜0.05）. Drug withdrawal and dressing change were the preferred effective intervention measures for AAE， and encephalopathy treatment drugs could be used as auxiliary measures for symptom relief. Timely and effective intervention was conducive to rapid symptom relief， with a total improvement rate of AAE of 88.89%.
CONCLUSIONS
2
The anti-infective treatment clinical pharmaceutical pathway for AAE high-risk population can effectively prevent the occurrence of AAE as well as contribute to promoting rational drug use and the effectiveness of initial anti-infection plans and strengthening treatment outcomes.
关键词
抗菌药物相关性脑病临床药学路径抗感染神经毒性个体化用药合理用药高风险人群筛查
Keywords
clinical pharmaceutical pathwayanti-infectionneurotoxicitypersonalized medicationrational drug usehigh-risk population screening
references
HUANG Q X，LI J B，HUANG N Y，et al. Clinical characteristics and outcomes of antibiotic-associated encephalopathy in patients with end-stage kidney disease[J]. Ren Fail，2022，44（1）：1708-1716.
KIM J H，KIM T，KIM W，et al. The incidence and predictors of antibiotic-associated encephalopathy：a multicenter hospital-based study[J]. Sci Rep，2024，14（1）：8747.
SODHI K，KOHLI R，KAUR B，et al. Convulsions in a critically ill patient on hemodialysis：possible role of low dose colistin[J]. J Anaesthesiol Clin Pharmacol，2014，30（3）：415-418.
代雪飞，杜娟. DRGs环境下2型糖尿病临床药学路径制定及应用成效分析[J]. 中国医院药学杂志，2022，42（22）：2415-2420.
DAI X F，DU J. Formulation and application effect analysis of clinical pharmaceutical pathway for type 2 diabetes mellitus under the environment of DRGs[J]. Chin J Hosp Pharm，2022，42（22）：2415-2420.
SCHLIAMSER S E，CARS O，NORRBY S R. Neurotoxi- city of beta-lactam antibiotics：predisposing factors and pathogenesis[J]. J Antimicrob Chemother，1991，27（4）：405-425.
上海市肾内科临床质量控制中心专家组. 慢性肾脏病早期筛查、诊断及防治指南：2022年版[J]. 中华肾脏病杂志，2022，38（5）：453-464.
Expert Group of Shanghai Clinical Quality Control Center for Nephrology.Guidelines for early screening，diagnosis，prevention and treatment of chronic kidney disease：2022 edition[J]. Chin J Nephrol，2022，38（5）：453-464.
CAMPANY-HERRERO D，PAU-PARRA A，GONZÁLEZ- MORENO P，et al. Ertapenem blood concentration：a retrospective cohort study to analyse risk of neurotoxicity[J]. Br J Clin Pharmacol，2023，89（9）：2843-2850.
HUANG W T，HSU Y J，CHU P L，et al. Neurotoxicity associated with standard doses of piperacillin in an elderly patient with renal failure[J]. Infection，2009，37（4）：374-376.
SARRO A D，AMMENDOLA D，ZAPPALA M，et al. Relationship between structure and convulsant properties of some beta-lactam antibiotics following intracerebroventricular microinjection in rats[J]. Antimicrob Agents Chemother，1995，39（1）：232-237.
SUNAGAWA M，MATSUMURA H，SUMITA Y，et al. Structural features resulting in convulsive activity of carbapenem compounds：effect of C-2 side chain[J]. J Antibiot，1995，48（5）：408-416.
CANNON J P，LEE T A，CLARK N M，et al. The risk of seizures among the carbapenems：a meta-analysis[J]. J Anti- microb Chemother，2014，69（8）：2043-2055.
DOMAGALA J M. Structure-activity and structure-side-effect relationships for the quinolone antibacterials[J]. J Antimicrob Chemother，1994，33（4）：685-706.
HURKACZ M，DOBREK L，WIELA-HOJEŃSKA A. Anti- biotics and the nervous system-which face of antibiotic therapy is real，Dr. Jekyll （neurotoxicity） or Mr. Hyde （neuroprotection）?[J]. Molecules，2021，26（24）：7456.
SEGAL J A，HARRIS B D，KUSTOVA Y，et al. Aminoglycoside neurotoxicity involves NMDA receptor activation[J]. Brain Res，1999，815（2）：270-277.
WESTPHAL J F. Macrolide-induced clinically relevant drug interactions with cytochrome P-450A （CYP） 3A4：an update focused on clarithromycin，azithromycin and dirithromycin[J]. Br J Clin Pharmacol，2000，50（4）：285-295.
OZSOYLAR G，SAYIN A，BOLAY H. Clarithromycin monotherapy-induced delirium[J]. J Antimicrob Chemother，2007，59（2）：331.
NIGAM A，KUMARI A，JAIN R，et al. Colistin neurotoxi-city：revisited[J]. BMJ Case Rep，2015，2015：bcr2015210787.
GUGLIELMO B J. Metronidazole neurotoxicity：suspicions confirmed[J]. Clin Infect Dis，2021，72（12）：2101-2102.
BHATTACHARYYA S，DARBY R R，RAIBAGKAR P，et al. Antibiotic-associated encephalopathy[J]. Neurology，2016，86（10）：963-971.
黄蓓.《医疗机构处方审核规范》印发[J].中医药管理杂志，2018，26（14）：1.
HUANG B. The Norms for Prescription Review in Medical Institutions has been issued [J]. J Tradit Chin Med Managem，2018，26 （14）：1.
《抗菌药物临床应用指导原则》修订工作组.抗菌药物临床应用指导原则：2015年版[M].北京：人民卫生出版社，2015：1-3.
Revision Working Group of Clinical Application Guidelines for Antibiotics. Clinical application guidelines for antibiotics：2015 edition[M]. Beijing：People’s Health Press，2015：1-3.
中华医学会呼吸病学分会. 中国成人社区获得性肺炎诊断和治疗指南：2016年版[J]. 中华结核和呼吸杂志，2016，39（4）：253-279.
Respiratory Disease Branch of Chinese Medical Association.Guidelines for diagnosis and treatment of adult community-acquired pneumonia in China ：2016 edition[J]. Chin J Tuberc Respir Dis，2016，39（4）：253-279.
中华医学会呼吸病学分会感染学组. 中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南：2018年版[J].中华结核和呼吸杂志，2018，41（4）：255-280.
Infectious Diseases Group，Respiratory Disease Branch，Chinese Medical Association. Diagnosis and treatment guidelines for adult hospital acquired pneumonia and ventilator-associated pneumonia in China：2018 edition[J]. Chin J Tubere Respir Dis，2018，41 （4）：255-280.
戴维·吉尔伯特.热病：桑德福抗微生物治疗指南[M].范洪伟，译.53版.北京：中国协和医科大学出版社，2024：1.
GILBERT D N. The Sanford guide to antimicrobial therapy[M]. FAN H W，translated. 53rd edition. Beijing：Peking Union Medical College Press，2024：1.
国家卫生健康委合理用药专家委员会.国家抗微生物治疗指南[M]. 3版.北京：人民卫生出版社，2023：4.
National Health Commission Rational Drug Use Expert Committee. National guidelines for antimicrobial therapy[M]. 3rd edition. Beijing：People’s Health Press，2023：4.
李佳，陈孝. 重视抗菌药物不良反应相关危险因素的研究[J]. 药物不良反应杂志，2024，26（6）：326-330.
LI J，CHEN X. Pay attention to the study of risk factors related to adverse reactions of anti-bacterial agents[J]. Adverse Drug React J，2024，26（6）：326-330.
孔钦翔，张照如，李家斌. 抗菌药物相关性脑病研究进展[J]. 中国抗生素杂志，2017，42（7）：621-625.
KONG Q X，ZHANG Z R，LI J B. Research progress on antibiotic-associated encephalopathy[J]. Chin J Antibiot，2017，42（7）：621-625.
HUWYLER T，LENGGENHAGER L，ABBAS M，et al. Cefepime plasma concentrations and clinical toxicity：a retrospective cohort study[J]. Clin Microbiol Infect，2017，23（7）：454-459.
HIMALI N A，AL SULEIMANI Y M，AL-ZAKWANI I，et al. Antibiotics utilization patterns and dosage appropriate- ness among patients receiving hemodialysis[J]. Saudi Pharm J，2022，30（7）：971-978.
MATUSIK E，LEMTIRI J，WABONT G，et al. Beta-lactam dosing during continuous renal replacement therapy：a survey of practices in French intensive care units[J]. BMC Nephrol，2022，23（1）：48.
CALANDRA G，LYDICK E，CARRIGAN J，et al. Factors predisposing to seizures in seriously ill infected patients receiving antibiotics：experience with imipenem/cilastatin[J]. Am J Med，1988，84（5）：911-918.
GRILL M F，MAGANTI R K. Neurotoxic effects associa- ted with antibiotic use：management considerations[J]. Br J Clin Pharmacol，2011，72（3）：381-393.
0
Views
0
下载量
0
CSCD
- L-PDFDownload
- WORDDownload
- Meta-XMLDownload
- BibTeXDownload
- EndnoteDownload
- RefMan Download
- NoteExpressDownload
- NoteFirstDownload
Publicity Resources
Related Articles
Related Author
Related Institution
- Address：8th Floor, Sihuan Building, No. 129 Daping Main Street, Yuzhong District, Chongqing, China Postal code：400042
- Technical support is provided by Beijing Founder Electronics co., LTD 渝ICP备15012710号
公网安备50010302001817 - It is recommended to read the content of this site in Chrome&IE9+. Please switch to extreme mode in browser 360.
- Cookies We use cookies to help provide and enhance our service and tailor content. By continuing, you agree to the use of cookies.