The Rationality Analysis To Treatment Plan Of Patients With Klebsiella Pneumoniae Infection And Evaluation Of Pharmaceutical Intervention

Objective 1.Through a retrospective study on the anti-infective treatment plan for hospitalized patients with Klebsiella pneumoniae infection in our hospital,To analyze the rationality of anti-infective drugs,To identify the irrational drug use problems and proportions,To clarify the status of drug resistance of Klebsiella pneumoniae to the current main varieties antibacterial therapy.To provide reference for the later treatment of therapeutic drugs.2.In the stage of pharmacy intervention,suggestions for improvement of anti-infective drugs for hospitalized patients with K.pneumoniae infection are proposed,and face-to-face communication with the competent doctor and submit a written intervention plan to optimize the doctor’s medication habits,reduce the incidence of adverse reactions,and improve the incidence of adverse reactions The clearance rate of antibacterial drugs against Klebsiella pneumoniae reduces and delays the production of multi-drug resistant bacteria.3.To establish an in vivo meropenem HPLC method to investigate the effect of meropenem blood concentration monitoring on the clinical treatment of patients with multi-drug resistant Klebsiella pneumoniae infection,evaluate the effectiveness of optimized drug regimen,and further explore the effectiveness of pharmacist intervention.Promote the role of clinical pharmacists.Methods 1.In the first stage,a retrospective study of clinical epidemiology was conducted to collect 382 inpatients with Klebsiella pneumoniae infection from2017.9.01²018.1.01 in our hospital as the research object,To check the basic situation of the patients in the medical records.Basic information on the disease and anti-infective drug administration plan information,according to the drug label,relevant guidelines at home and abroad,and the Guiding Principles for Clinical Application of Antimicrobial Drugs,from the formulation of treatment plans,indications,dosages,modes of administration,combination drugs,etc.In terms of rational evaluation of the application of antibacterial drugs,it was found that the clinical irrational drug use phenomenon provided support for the second phase of pharmaceutical intervention research.2.In the second stage,based on the results of retrospective analysis,this part uses the real-time intervention research method to check the results of all bacterial cultures and drug susceptibility of hospitalized patients on the same day through the Laboratory Information System（LIS）from 2018.3.01 to 2018.5.31.Results,inpatients screening Klebsiella pneumoniae infection,according to the instructions and relevant domestic and foreign guidelines,use the rational drug monitoring system（PASS）to check whether there is irrational drug use in the anti-infective drug treatment,for the existence of irrational drug problems Propose rationalized medication recommendations based on authoritative materials such as instructions,face-to-face communication with physicians and submit communication intervention advice sheets for unreasonable medications.Then,through the rational drug monitoring system（PASS）,the modification of the drug order was confirmed and the effect of the intervention was evaluated.3.In the third stage,an accurate,rapid and simple HPLC method for the determination of meropenem in human plasma was established.We collected2018.7.01-2019.1.31 patients who were treated with multi-drug resistant Klebsiella pneumoniae treated with meropenem.They were divided into experimental group and control group according to whether blood concentration monitoring was performed.The experimental group was adjusted according to blood drug concentration monitoring results.The medication regimen was used by the clinician as an empirical medication.The clinical sample collection time of the meropenem in the experimental group was before and after the seventh dose,and the blood concentration was determined by the established HPLC method.SPSS19.0 statistical software was used to analyze whether there were differences in clinical efficacy,bacteriological efficacy,adverse reaction rate,and 28-day mortality in the two groups.Result 1.According to the first phase of retrospective study,there were 46,125inpatients in 2017.9.01²018.1.01,of which 412 were infected with Klebsiella pneumoniae and 382 were included（male 225,female 157）.The number of patients with multi-drug resistant Klebsiella pneumoniae infection was 126（about 32.98%of the total number of patients infected with Klebsiella pneumoniae）.The initial microbiological examination rate of 382 patients was only 71.99%.The current status of drug resistance was investigated.The rate of drug resistance of Klebsiella pneumoniae to meropenem was the fastest.The difference between the rate of 17commonly used antibiotics was 25.89.The drug resistance of Klebsiella pneumoniae became more and more serious.Comparing the multi-drug resistant group with the non-multi-drug resistant group,the number of days of antibiotic use,the number of used varieties,the use rate of carbapenems,and clinical outcomes were statistically different.A long-term and temporary medication examination of 382 patients found that there were 91 patients with irrational drug use problems,a total of 135,of which18 were improperly selected,42 doses were unreasonable,and the drug was administered.The frequency interval is unreasonable 38,the medication treatment is unreasonable 19,and the combined medication is unreasonable 18.2.In the second phase,the time for real-time intervention was 2018.3.01²018.5.31,and there were 299 Klebsiella pneumoniae positive patients in bacterial culture,and a total of 282 patients（male 159/female 123）met the inclusion criteria.A total of 782medical examinations were reviewed,and 126 unreasonable medication problems were found.The number of patients with irrational medication was 69.Through face-to-face communication and submission of 102 unreasonable medical advice statements,the competent doctor accepted 86（intervention success rate 68.25%）.3.In the third stage,the HPLC method for determination of meropenem concentration in human plasma established by this subject is in line with the requirements of biological sample analysis.The linear range of the standard curve is 3.125-200μg·mL^-1,and the intra-assay and inter-assay variability are less than 5%.The mean values were 90.64%,87.35%,and 89.51%,respectively.The stability test results show that the sample is stable after treatment in the prescribed manner.In the experimental group,67.3%of patients did not achieve f_T>MIC>100%,suggesting that routine experience treatment is often insufficient to achieve the PK/PD criteria.According to the monitoring results of meropenem blood concentration monitoring,the microbiology and long-term prognosis of patients with severe drug-resistant Klebsiella pneumoniae can be improved,which can reduce the inflammatory response of the body and promote the improvement of organ function.And does not increase the incidence of adverse reactions of the drug.Conclusion The clinical antibacterial drugs in patients with K.pneumoniae infection still have unreasonable use.Most doctors can refer to pathogen examinations,drug susceptibility results,etc.or adjust antibiotics in a timely manner.In some cases,there are unreasonable problems such as unreasonable drug selection,unreasonable usage and dosage,long course of medication,and frequent replacement of drugs without indication.However,under the pharmacist’s reminder and suggestion,most clinicians are willing to modify the irrational medication instructions.The pharmacist should work closely with the clinician to provide clinical guidance and literature support for the rational use of antimicrobial agents.Meropenem empirical treatment of patients with multi-drug-resistant Klebsiella pneumoniae infection is often insufficient to achieve pharmacokinetic and pharmacodynamic goals,increased dose or increased toxicity and increased adverse reactions,individualized dosing regimens based on TDM.