广西医学

目的探讨临床药师会诊的细菌性感染患者抗菌药物治疗的效果，并分析其影响因素。方法回顾性分析某综合三甲医院临床药师会诊的210例细菌性感染患者的临床资料，根据患者的抗菌药物治疗效果分为无效组（42例）和有效组（168例），比较两组患者的相关临床资料。采用多因素Logistic回归模型分析临床药师会诊的细菌性感染患者抗菌药物治疗效果的影响因素。结果（1）临床药师会诊意见被采纳率为89.05%；临床药师会诊意见被采纳的患者的抗菌药物治疗有效率高于临床药师会诊意见未被采纳患者的抗菌药物治疗有效率（P<0.05）。（2）临床药师会诊前后患者全身性使用抗菌药物的比例及联用抗菌药物的比例差异无统计学意义（P>0.05），临床药师会诊后患者单用1种抗菌药物的比例高于临床药师会诊前（P<0.05）。（3）210例细菌性感染患者中有164例送病原学检查，共培养出79株细菌，以革兰氏阴性菌为主（72.15%），排前3位的细菌分别是大肠埃希氏菌和肺炎克雷伯菌（均为16.46%）、铜绿假单胞菌（15.19%）、金黄色葡萄球菌（7.59%）。（4）有效组的出院诊断数、肺部感染比例、低蛋白血症比例、肾脏疾病比例、休克比例、主要出院诊断数、临床药师会诊后病原学送检比例、临床药师会诊前使用碳青霉烯类药物比例、临床药师会诊后使用碳青霉烯类药物比例、临床药师会诊前的中性粒细胞百分比>75%比例、临床药师会诊前的AST>40 U/L比例少于或低于无效组，临床药师会诊前病原学送检比例、采纳临床药师会诊意见比例、临床药师会诊后使用头孢哌酮舒巴坦比例、临床药师会诊前的内生肌酐清除率高于无效组（P<0.05）。（5）出院诊断数多、休克、临床药师会诊后病原学送检、临床药师会诊前的中性粒细胞百分比>75%是临床药师会诊的细菌性感染患者抗菌药物治疗无效的危险因素，而临床药师会诊前病原学送检、采纳临床药师会诊意见、临床药师会诊后使用头孢哌酮舒巴坦是临床药师会诊的细菌性感染患者抗菌药物治疗有效的保护因素（P<0.05）。结论出院诊断数多、休克、临床药师会诊后病原学送检、临床药师会诊前的中性粒细胞百分比>75%是临床药师会诊的细菌性感染患者抗菌药物治疗无效的危险因素，而临床药师会诊前病原学送检、采纳临床药师会诊意见、临床药师会诊后使用头孢哌酮舒巴坦是临床药师会诊的细菌性感染患者抗菌药物治疗有效的保护因素。

Objective To explore the therapeutic effect of antibacterial agents in patients with bacterial infection consulted by clinical pharmacists, and to analyze its influencing factors. Methods A retrospective analysis was conducted on clinical data from 210 patients with bacterial infection consulted by clinical pharmacists in a general class Ⅲ hospital. Patients were assigned to ineffective group (42 cases) or effective group (168 cases) according to antibacterial agents therapeutic effect. The relevant clinical data were compared between patients of the two groups. The multivariate Logistic regression model was adopted to analyze the influencing factors for therapeutic effect of antibacterial agents in patients with bacterial infection consulted by clinical pharmacists. Results (1) The acceptance rate of clinical pharmacists' consultation opinions was 89.05%. The therapeutic effectiveness rate of antibacterial agents in patients with acceptance of clinical pharmacist's consultation opinions was higher than that in patients without acceptance of clinical pharmacists' consultation opinions (P<0.05). (2) There was no statistically significant difference in the proportions of systemic use of antibacterial agents and combined use of antibacterial agents between patients before and after clinical pharmacists' consultation (P>0.05). The proportion of patients using only one antibacterial agent after clinical pharmacists' consultation was higher than that before clinical pharmacists' consultation (P<0.05). (3) Among 210 patients with bacterial infections, 164 underwent pathogen submission, and a total of 79 bacterial strains were cultured. Gram⁃negative bacteria (72.15%) were the predominant type. The top three bacterial isolates were as follows: Escherichia coli and Klebsiella pneumoniae (both 16.46%), Pseudomonas aeruginosa (15.19%), and Staphylococcus aureus (7.59%). (4) In the effective group, the number of discharge diagnoses, and the proportions of pulmonary infection, hypoproteinemia, renal disease, shock, as well as the number of main discharge diagnoses, the proportion of pathogen submission after clinical pharmacists' consultation, the proportion of carbapenem use before clinical pharmacists' consultation, the proportion of carbapenem use after clinical pharmacists' consultation, and the proportion of neutrophil percentage>75% before clinical pharmacists' consultation, the proportion of patients with AST>40 U/L before clinical pharmacists' consultation were less or lower than those in the ineffective group, whereas the proportion of pathogen submission before clinical pharmacists' consultation, the proportion of acceptance of clinical pharmacists' consultation opinions, the proportion of cefoperazone sulbactam use after clinical pharmacists' consultation, and the endogenous creatinine clearance rate before clinical pharmacists' consultation in the effective group were higher than those in the ineffective group (P<0.05). (5) More discharge diagnoses, shock, pathogen submission after clinical pharmacists' consultation, and neutrophil percentage>75% before clinical pharmacists' consultation were the risk factors for ineffective antibacterial agents therapy in patients with bacterial infection who were consulted by clinical pharmacists. While pathogen submission before clinical pharmacists' consultation, acceptance of clinical pharmacists' consultation opinions, and use of cefoperazone sulbactam after clinical pharmacists' consultation were the protective factors for effective antibacterial agents therapy in patients with bacterial infection who were consulted by clinical pharmacists (P<0.05). Conclusion More discharge diagnoses, shock, pathogen submission after clinical pharmacists' consultation, and neutrophil percentage>75% before clinical pharmacists' consultation are the risk factors for ineffective antibacterial agents therapy in patients with bacterial infection who are consulted by clinical pharmacists. However, pathogen submission before clinical pharmacists' consultation, acceptance of clinical pharmacists' consultation opinions, and use of cefoperazone sulbactam after clinical pharmacists' consultation are the protective factors for effective antibacterial agents therapy in patients with bacterial infection who are consulted by clinical pharmacists.