تعیین میزان تجویز و مصرف کلیستین در کنترل عفونت های رایج باکتریایی
محورهای موضوعی : پاتوبیولوژی مقایسه ایمحمد طهماسبی فر 1 , سید رضا ابطحی 2 , محمد درویشی 3
1 - کمیته تحقیقات دانشجويی، دانشگاه علوم پزشكی اجا، تهران، ايران
2 - گروه فارماکولوژی و سم شناسی، دانشکده پزشکی، دانشگاه علوم پزشكی اجا، تهران، ايران
3 - دانشیار بیماری‌های عفونی، گروه آموزشی بالینی در طب هوافضا و زیرسطحی، دانشکده طب هوافضا و زیرسطحی، مرکز تحقیقات بیماری های عفونی، دانشگاه علوم پزشکی اجا، تهران، ایران
کلید واژه: کلیستین, آنتی¬بیوتیک, بخش¬های ویژه,
چکیده مقاله :
در این مطالعه پرونده¬های بیماران تحت درمان با کلیستین بخش¬های مراقبت-های ویژه، داخلی، ارتوپدی و نفرولوژی بیمارستان بعثت نهاجا بررسی شد. 65 پرونده در سال 1398 قبل از اجرای طرح مدیریت تجویز منطقی کلیستین و 65 پرونده بعد از اجرای طرح در سال 1399 ارزیابی و بررسی اندیکاسیون¬های تجویز، دوز تجویزی، تداخلات دارویی، تجویز دارو براساس حساسیت میکروبی به کلیستین انجام گرفت. داده¬ها توسط نرم افزار SPSS نسخه 26 آنالیز شد. تجویز کلیستین قبل از اجرای طرح در 1/23% موارد قبل از کشت و تعیین حساسیت انجام شد. در طول طرح در 2/9% موارد تجویز کلیستین بدون درخواست کشت بوده است (027/0=p). قبل از اجرای طرح، اندیکاسیون تجویز کلیستین در 2/26% بیماران وجود نداشت و در طول طرح، اندیکاسیون تجویز در 7/7% بیماران وجود نداشت (004/0=p). قبل از اجرای طرح، دوز کلیستین 1/23% بیشتر از استاندارد بود. در طول طرح، دوز کلیستین در 2/9% موارد بیشتر از استاندارد بوده است (032/0=p). قبل از اجرای طرح، تجویز همزمان کلیستین با سایر داروهای نفروتوکسیک در 8/10% موارد و در طول اجرای طرح تداخل دارویی کلیسیتین با داروهای نفروتوکسیک 6/4% بود (16/0=p). بعد از تجویز منطقی آنتی¬بیوتیک، تداخلات دارویی کلیستین با داروهای نفروتوکسیک، تنظیم دوز صحیح، شناسایی اندیکاسیون¬های تجویز و تجویز براساس نتایج کشت تفاوت معنی¬داری با قبل از اجرای طرح داشت.
Colistin is used in antimicrobial resistance. The use of colistin has increased with the rise in antibiotic resistant infections. The aim of this study is the investigation of colistin consumption patterns before and after the implementation of the stewardship plan. Records of patients treated with colistin in the intensive care unit, internal, orthopedics and nephrology wards of Besat Hospital were reviewed. 65 cases before the implementation of the plan and 65 cases after the implementation were evaluated and checked for prescription indications, prescribed dosage, drug interactions, prescription based on microbial sensitivity to colistin. Data were analyzed using SPSS version 26. Colistin was prescribed before the plan in 23.1% of cases before microbial sensitivity assay. During the plan, in 9.2% of cases, colistin was prescribed without a culture request (p=0.027). Before the plan, there was no indication for prescribing colistin in 26.2% of patients, and during the plan, there was no indication for prescribing in 7.7% of patients (p=0.004). Before the plan, the dose of colistin was 23.1% more than the standard. During the plan, the dose of colistin was higher than the standard in 9.2% of cases (p=0.032). Before the plan, simultaneous administration of colistin with nephrotoxic drugs was in 10.8% of cases and during the plan, interaction between colistin and nephrotoxic drugs was 4.6% (p=0.16). After the plan, interactions of colistin with nephrotoxic drugs, dosage adjustment, identification of prescription indications and prescription based on culture were significantly different from before the implementation of the plan.
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