| ObjectivesThis study aims to investigate the efficacy and safety of local application of vancomycin in preventing infection after internal fixation of tibial plateau fracture and the interventional role of clinical pharmacists in the clinical application of vancomycin in orthopedic patients after internal fixation.It is committed to improving the rationality of the application of vancomycin in the prevention and treatment of postoperative infection in our hospital.Methods(1)The clinical data of 156 patients with tibial plateau fracture internal fixation in the department of orthopaedics of our hospital from May 2017 to July 2019 were collected retrospectively.According to the perioperative preventive drug regimen,the patients were divided into VP group(routine infection prevention program + local application of vancomycin,n = 68)and control group(routine infection prevention program,n = 88).The postoperative deep incision infection rate and other complications(superficial incision infection,slow wound healing,traumatic arthritis and deep vein thrombosis),and other adverse drug reactions were calculated to analyze the efficacy and safety of local application of vancomycin in preventing infection after internal fixation of tibial plateau fracture.(2)The clinical data of 75 patients received anti-infective therapy with vancomycin after orthopedic surgery in our hospital from May 2019 to December2020 were collected retrospectively.The patients were divided into clinical pharmacist intervention group(n = 41)and non-intervention group(n = 34).therapeutic drug monitoring(TDM),pathogen test,solvent dosage,curative effect,adverse drug reactions and economics were compared to analyze the influence of clinical pharmacists on the clinical rational use of vancomycin in orthopedic patients.Results(1)Deep incision infection occurred in 2 cases(2.9%)in the VP group and 1case(1.1%)in the control group.There was no significant difference in deep incision infection rate between these two groups(P > 0.05).Pathogen examination suggested that the pathogens in VP group were Escherichia coli and Staphylococcus aureus.The pathogenic bacteria in the control group were methicillin-resistant Staphylococcus aureus.No significant difference in superficial incision infection,delayed wound healing,traumatic arthritis and deep venous thrombosis was observed between these two groups(P > 0.05).There was one patient with delayed wound healing in VP group.(2)The proportion of TDM was 73.2% in the intervention group while 55.9% in the non-intervention group.The clinical pharmacists failed to markedly improve the TDM rate(P > 0.05).The timely rate of the first blood collection in the intervention group was 56.7%,and that in the non-intervention group was 26.3%.The timely rate of the first blood collection in the intervention group was significantly higher than that in the non-intervention group(P < 0.05).The rate of reaching the standard of blood concentration in the intervention group was 80.0%,and that in the non-intervention group was 36.8%.The rate of reaching the standard of blood concentration in the intervention group was significantly higher than that in the non-intervention group(P < 0.05).The target treatment ratio of the intervention group was 36.6%,and that of the non-intervention group was 32.4%.There was no significant difference in the proportion of target treatment between these two groups(P > 0.05).The reasonable rate of solvent volume was 97.6% in the intervention group and 82.4% in the non-intervention group(P < 0.05).The effective rate in the intervention group was 87.8%,which was significantly higher than that in the non-intervention group(64.7%).Clinical pharmacist intervention significantly improved the efficacy of vancomycin(P < 0.05).There was no significant difference in the overall incidence of adverse reactions between these two groups.One patient in the intervention group developed delayed hypersensitivity and 2 patients in the non-intervention group developed renal injury or worsening kidney injury after medication.In addition,the drug cost was 8872.70(7770.83-12781.48)yuan in the intervention group and 9463.14(5937.94-18948.88)yuan in the non-intervention group.There was no significant difference in drug cost between these two groups(P >0.05).Conclusions(1)Local application of vancomycin in the internal fixation of tibial plateau fracture failed to reduce the infection rate of deep incision.It may delay the wound healing and increase the infection rate of Gram-negative bacteria.Accordingly,physicians should be cautious in the internal fixation of tibial plateau fractures with local use of vancomycin to prevent deep incision infection.(2)Clinical pharmacist intervention plays a positive role in improving the timeliness of blood collection of vancomycin TDM,the rate of reaching the standard rate of blood concentration,the reasonable rate of solvent volume and the therapeutic effect of orthopedic patients after orthopedic operation.Clinicians should improve their awareness of vancomycin TDM so as to further promote the rationality of clinical application of vancomycin. |
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