Clinical Distribution and Drug Resistance of Enterococcus in Our Hospital from Jan. 2009 to Jun. 2017 / 中国药房

OBJECTIVE:To provide reference for hospital infection treatment and control. METHODS:The etiological data of Enterococcus isolated from clinical specimens were collected from our hospital during Jan. 2009-Jun. 2017. The drug resistance of commonly used antibiotics and infection related risk factors were analyzed retrospectively. RESULTS:A total of 6252 isolates of Enterococcus were isolated,of which there were 1994 strains of E. faecalis and 3575 strains of E. faecium. The bacteria were mainly isolated from urine(2009 strains),drainage liquids(1538 strains),bile(1168 strains),wound secretions(561 strains), blood (493 strains). The detection rate increased 9.4％ in 2009 to 13.4％ in 2017. Resistance rate of E. faecalis to ampicillin, penicillin and vancomycin showed a wavelike decrease,and E. faecalis showed low resistance rate to vancomycin,teicoplanin, linezolid and tigecycline. Resistance rate of E. faecalis to ciprofloxacin,moxifloxacin and levofloxacin decreased wavily to 2014 but showed a fluctuating upward trend since 2015. Resistance rate of E. faecium to linezolid decreased from 1.9％ in 2009 to 0.2％ in Jun. 2017;resistance rate of E. faecium to vancomycin and teicoplanin continues to fluctuate,but it is still at a low level;resistance rate of E. faecium to tetracycline decreased, but that to high concentration gentamicin increased. There were 43 strains of vancomycin-resistant E. faecium and 8 trains of vancomycin-resistant E. faecalis detected in 51 patients. Resistant rates of vancomycin-resistant E. faecium to linezolid,tigecycline and teicoplanin were 23.3％,0,35.3％,respectively. Resistant rates of vancomycin-resistant E. faecalis to linezolid,tigecycline and teicoplanin were 0. Pearson relationship analysis showed that days in ICU (r=0.225,P<0.01),tracheotomy or intubation (r=0.314,P<0.01),days of antibiotic use (r=0.347,P<0.01),types of antibacterial drugs (r=0.226,P<0.01),use of glucocorticoids (r=0.190,P<0.01),and days of carbapenems use (r=0.173,P<0.05)were positively correlated with vancomycin-resistant E. faecium infection rate and vancomycin-resistant E. faecalis infection rate. CONCLUSIONS:The detection rate of Enterococcus in our hospital is fluctuating upward. E. faecalis and E. faecium were the main types,mainly from urine and drainage fluids. The resistance rate of Enterococcus most of antibiotics shows a downward trend. The resistance rate of E. faecium to high concentration gentamycin is on the rise,while that of E. faecium to linezolid and tetracycline is decreased. The appropriate antibiotics should be selected according to the patient's condition and drug susceptibility results.

Analysis of Risk Factors and Clinical Outcome for Carbapenems-resistant Pseudomonas aeruginosa Infection in Our Hospital from 2013 to 2016 / 中国药房

OBJECTIVE: To investigate the risk factors and clinical outcome for carbapenems-resistant Pseudomonas aeruginosa (CRPA) infection, and to provide reference for the prevention and treatment of CRPA infection.METHODS: In retrospective investigation, medical records of CRPA and carbapenems-sensitive Pseudomonas aeruginosa (CSPA) infection were collected from our hospital during 2013-2016. CRPA infection risk factors were judged by single factor analysis. The relationship of CRPA risk factors and death was judged by multivariate Logistic regression analysis. RESULTS: A total of 556 cases of P. aeruginosa infection were collected, including 96 cases of CRPA injection, accounting for 17. 3％. Multivariate Logistic regression analysis of related factors of CRPA infection showed that independent risk factors of CRPA infection included admission to ICU for more than 3 days before the isolation of P. aeruginosa [OR= 2. 691, 95％ CI (1. 348, 5. 373), P=0. 005], the use of third-generation or fourth-generation cephalosporin [OR= 0. 386, 95％ CI (0. 200, 0. 742), P=0. 004], complicated with other pathogenic bacteria infection [OR= 1. 892, 95％ CI (1. 132, 3. 164), P=0. 015], combined with 2 kinds of antibiotics or above [OR=5. 631, 95％ CI (2. 556, 12. 407), P=0. 000]. Clinical outcome analysis, mortality rate of CRPA infection were 12. 5％, significantly higher than CSPA infection (2. 8％), Logistic regression analysis, there is a correlation between death rate [OR=5. 003, 95％CI (1. 975, 12. 675), P=0. 001] and CRPA infection. CONCLUSIONS: For the prevention of CRPA nosocomial infection, it is necessary to reduce the time of ICU stay and rationally select antibiotics according to pathogenic bacteria so as to reduce the occurrence of CRPA infection.

Absorption Characteristics of Isoimperatorin from Notopterygium in Different Parts of Rat's Intestines / 医药导报

Objective To study the absorption features of isoimperatorin in intestine of rat.Methods Establish a single-pass intestinal perfusion model of rat,take phenolsulfonphthalein as a marker for the detection of isoimperatorin concentration from crude extracts of notopterygium,and observe the absorption features of isoimperatorin and its reference substance in intestine of rat.Results The content of isoimperatorin in crude extracts was (0.43±0.02)% (n=5).The absorption parameters of duodenum,jejunum,ileum,colon were (5.28±0.82),(4.47±0.56),(4.17±0.94),(4.32±0.68)×10-5 cm·s-1,respectively.There were no significant differences among them (P>0.05).Compared with the reference substance of isoimperatorin,crude extracts showed better absorption features.Conclusion Isoimperatorin from crude extracts have better characteristics of absorption.This study can provide theoretical basis for design of notopterygium oral formulation.

Ambiguity and Countermeasures in the Drug Instruction Manual / 中国药房

OBJECTIVE:To provide reference for clinical use and revision of drug instruction manual. METHODS:The ambi-guity in drug instructions manual was summarized and countermeasures of revision were presented based on the practical clinical conditions. RESULTS & CONCLUSIONS:The problems of drug instruction manual that may mislead the patients and medical per-sonnel were as follows as controversial main contents,unclear descriptions of instruction,unfocused contents or without key points,one instruction for multiple drugs,obvious or inaccurate translations,words without popularity and standardization and wrong sentence division or non-standard typesetting. It is suggested that the manufacturers should attach highly importance to the re-vision of drug instruction manual;the revisers should understand the meaning of drugs instruction manual and know the subjects;the premarketing instructions should be tested and investigated by necessary persons;the major and cultural quality of revisers should be improved;the approval monitoring should be strengthened and the feedback mechanism should be established to further improve the instructions,guide the medical staff and patients with accurate use of drugs and ensure the safe drug use of patients.

Medication Analysis for One Patient with Severe Ulcerative Colitis / 中国药师

Objective:To analyze the medication of one patient with ulcerative colitis to provide pharmaceutical care and support for rational drug use in patients with ulcerative colitis. Methods:During the treatment of the patient with severe ulcerative colitis, clin-ical pharmacists analyzed the drugs used by the patient and provided pharmaceutical care for doctors and the patient according to the ex-amination and diagnosis of the patient. Results:The compliance, therapeutic effect and medication safety of the patient were all im-proved by giving clinical drug rationalization suggestions and targeted medication monitoring and education, which fully embodied the necessity of work of clinical pharmacists in the medication of patients. Conclusion:Through case analysis, clinical thinking of clinical pharmacists can be developed to promote rational drug use, avoid adverse drug reactions and achieve optimal effect of drug treatment.

Effect of methylcobalamin,gliclazide and combined application of both on sciatic nerve morphology and nerve growth factor contents in streptozotocin-induced diabetic rats / 中国药理学通报

Aim To investigate the curative effect and the mechanism of methylcobalamin,gliclazide and combined application of both on diabetic peripheral neuropathy(DPN)in streptozotocin-induced diabetic(STZ-D)rats.Methods STZ-D rats were administered with drugs orally for 8 weeks after streptozotocin treatment.Morphologies of sciatic nerve were observed with histological method.Nerve growth factor(NGF)contents in plasma or in sciatic nerve tissues were determined by ELISA kit or immunohistochemistry.Results Morphological degeneration in sciatic nerve,decrease of NGF concertration in plasma,as well as in nerve axis cylinder,in diabetic rats was all ameliorated by methylcobalamin and/or gliclazide.However,no significant differences in morphology and NGF contents were found between single drug treated groups and combined application group.Conclusions The observations suggest that methylcobalamin,gliclazide and combined application are effective in treating DPN in STZ-D rats.No significantly enhanced effect is found in combined application group as compared with methylcobalamin or gliclazide group.

Writing Model of Inpatient Medication Records / 中国药房

OBJECTIVE:To discuss an useful and convenient medication record writing mode to promote rational drug use.METHODS:Based on SOAP model,inpatient medication histories were established by combining medication data with clinical data collected from patients' clinical histories and pharmacists.RESULTS & CONCLUSIONS:The inpatient medication records that suited to the needs of clinical pharmaceutical care have been established and in which the clinical course of diseases and drug treatment course are recorded simply yet in detail,which can facilitate the evaluation on the safety,validity and rationality of medication.