| Objective: With the increasing use of vancomycin in clinical applications,vancomycin resistant strains appeared, the correct understanding and rational use of vancomycin has important clinical significance. In order to further promote the reasonable application and provide a theoretical basis and reference of the use of vancomycin in elderly patients, the study investigated the clinical use of vancomycin in the elderly patients in a 3A grade hospital in Henan Province, including analysis of the drug use situation and evaluation of rationality.Methods: Collecting the research object of medical records, elderly patients in general, clinical diagnosis, dosage, frequency and period of treatment, rational use of drugs, drug combination, pathogenic examination and drug sensitivity, adverse drug reactions and blood drug concentration through Electronic Medical Record?Hospital Information System and Prescription Automatic Screening System from January to December, 2015.Results:(1)273 cases of vancomycin in the elderly patients including 79 cases of ICU, 45 cases of respiratory medicine, 34 cases of general surgery, 25 cases of neurosurgery, 23 cases of geriatric medicine, 19 cases of internal medicine-neurology, 16 cases of cardiovascular internal medicine,17 cases of cardiovascular surgery and 15 cases of orthopaedics, age distribution is mainly over 70 years old, accounting for 65.0%,followed by 60 years old to 70 years old, accounting for 35.0%.(2)The main clinical diagnosis was pneumonia(Severe pneumonia), sepsis and pneumonia?thoracic and abdominal infection, craniocerebral infection, cardiovascular system infection and catheter-related bloodstream infection, accounting for 89.0%.(3)273 cases of elderly patients with 251 cases of the examination of 291 cases of pathogens,the samples were mainly collected from the sterile cavity samples such as blood, puncture fluid, alveolar lavage fluid, pus and catheter tip culture, accounting for 58.8%. In 291 cases, there were 177 cases of gram positive bacteria, mainly Staphylococcus aureus, MRSA, fecal streptococcus and enterococcus faecium, the results of drug sensitivity tests were vancomycin susceptible strains, no vancomycin resistant strains were found;101 cases of 273 patients with other bacterial infections,gram negative bacteria infection.(4)Vancomycin was administered intravenously, the most frequency of drug use was q8 h 0.5g, accounting for 63.0%; Vancomycin DDD value was 1.55 g, average time of 9.9d, daily average cost of 446.4 yuan, DUI value was 0.89, 91 of 273 cases had blood concentration monitoring, accounting for 33.3%. 189 cases of 273 were combined with other antibiotics, accounting for 69.2%.(5) The total efficacy rate was 81.7% in 273 cases with 7.7% adverse reaction, a total of 182 cases among 273 patients with reasonable and rational use of drugs, accounting for 79.5%.Conclusion: The use of vancomycin in elderly patients in the hospital is reasonable, before the search for pathogenic evidence, the hospital pay attentions on use of vancomycin, and according to the characteristics of the etiology of clinical treatment, vancomycin sensitive tests were carried out on all specimens of gram positive bacteria, but there are some deficiencies in the use of vancomycin in the hospital, monitoring adverse effect and vancomycin concentration in serum of elderly patients should be further strengthened. Elderly patients should strictly grasp the indications, pay more attention to the initial dose of vancomycin and routine blood drug concentration monitoring; To further standardize the clinical application of vancomycin, dosage and frequency were adjusted according to severity of illness and renal function, it is helpful to improve the clinical treatment effect, rational drug use level and prevent adverse reaction. |
PDF Full Text Request