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노인층에서 Clostridium difficile 감염 약물사용평가 및 비호전군에 대한 영향인자
노현정,함정연,이자균,이정연 한국임상약학회 2018 한국임상약학회지 Vol.28 No.3
Objective: Clostridium difficile Infection (CDI) is one of the common nosocomial infections. As elderly population increases, theproper treatment has been emphasized. We investigated the risk factors associated with CDI unimprovement in elderly patients. Furthermore, we performed drug use evaluation of old CDI patients and oldest-old CDI patients. Methods: It was a retrospectivestudy using electronic medical record at Kangbuk Samsung Medical Center (KBSMC) from January 2016 to December 2017. Seventythree patients aged 65 years or older, diagnosed with CDI by Clostridium difficile Toxin B Gene [Xpert] were screened and theywere assessed for risk factors regarding unimprovement status. We also evaluated drug use evaluation in old patients (65≤age<80)and oldest-old patients (80≤age) by assessing the use of initial therapy, severity, dose, route, treatment course, days of use, totaldays of use and treatment outcome of initial therapy. Results: Out of 73 patients aged over 65 years, four patients were excludedbecause they did not receive any treatment. There were 31 improved patients and 38 unimproved patients after initial therapy. Wewere able to find out patients with surgical comorbidity or endocrine comorbidity (especially, diabetes mellitus) had 2.885 more riskof becoming unimproved than those patients without surgical comorbidity or endocrine comorbidity. Drug use evaluation for CDIwas generally fair, but vancomycin as initial therapy is more recommended than metronidazole. Conclusion: Although age,antibiotics exposure, use of antacids are all important risk factors for CDI, our result did not show statistical significance for theserisk factors. However, the study is meaningful because the number of elderly population keeps increasing and recently updatedguideline suggests the use of vancomycin as drug of choice for CDI.
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지역기반 상급종합병원 내 카바페넴 내성 장내세균 획득에 관한 위험인자
이연주,강지은,함정연,이자균,이정연 한국임상약학회 2020 한국임상약학회지 Vol.30 No.2
Objective: The rising number of carbapenemase-resistant Enterobacteriaceae (CRE) cases has become a concern worldwidely. This study investigated patient characteristics with CRE and analyzed the risk factors associated with its acquisition. Methods: A retrospective review of the electronic medical records of the Kangbuk Samsung Medical Center from May 2016 to April 2019 was performed. The inclusion criterion was hospitalized patients aged ≥18 years with confirmed CRE acquisition. Patients were divided by CRE acquired and non-required patients. CRE acquired patients were those with CRE confirmed by their active surveillance cultures, while non-acquired patients were those with carbapenemase-sensitive Enterobacteriaceae (CSE). If CRE was isolated more than once during hospitalization, only the first isolation was used for data analysis. Patient characteristics, antibiotic used, and the duration of use were compared between two groups using univariate analysis, and the risk factors associated with CRE were analyzed using multiple logistic regression analysis. Results: Among the 73 CRE acquired patients, 44 (60.3%) were positive for carbapenemase-producing Enterobacteriaceae (CPE). Infection from Klebsiella pneumonia (42 cases, 57.5%), Escherichia coli (17 cases, 23.3%), and Enterobacter cloacae (5 cases, 6.8%). The risk of CRE acquisition was significantly increased by 4.99 times [confidence interval (CI), 1.40-17.78; p=0.013] with mechanical ventilation, 3.86 times (CI, 1.59-9.36; p=0.003) with penicillin administration, and 21.19 times (CI, 6.53-68.70; p<0.001) with carbapenem administration. Conclusions: Proper antibiotic use including the selection, frequency, and duration, and patients on mechanical ventilators need close monitoring.
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Order Communication System과 연동된 Clinical Decision Supporting System의 효과 평가
서지연,이은재,이자균,조경희,함정연 한국병원약사회 2010 病院藥師會誌 Vol.27 No.2
Objectives :We evaluated the effectiveness of Clinical Decision Supporting System (CDSS) which Kangbuk Samsung Medical Center(KBSMC) has developed. Methods: The prescriptions for hospitalized patients during the study period were reviewed before and after the application of two typical CDSS programs interworking with Order Communication System(OCS). The effectiveness of programs which is not applicable to medicinal powder was evaluated by assessing the number of prescriptions of the alternative medicines, Lansoprazole Orally Disintegrating tablets(ODT) and Valproic acid syrup. In the case of the program assessing narcotic drug amount level, the number of prescription was checked for Pethidine 25mg at the specification of 50mg. For the study, the prescription review book of the year 2009 was investigated. Results: After applying the program, Valproic acid usage was increased 6.6 times in terms of the prescription amount: 14,238ml and 82,542ml of year 2006 and 2008, respectively, and 105,122ml at 2009(Annual average 14,238 ml vs 93,832 ml). Annual amount of Lansoprazole prescription increased 7 times after application of the program: 3,140 and 4,189 tablets for year 2008 and 2009, respectively, compared to 524 tablets for year 2006 when the program had not been applied(Annual average 3,664 tablets vs 524 tablets). The number of cases in which Pethidine 50mg was leftover after prescription has decreased after the program application in December 2009: 92 cases for Aug, 57 cases for Sep, 65 cases for Oct, and 71 cases for Nov in the year of 2009 compared to 48 and 9 cases for Dec 2009 and Jan 2010, respectively, with no occur from February to March(Monthly average 71 cases vs 14 cases). The analysis of 2009 prescription review book has shown that simple OCS operational mistakes were mainly found for outpatient prescriptions. In case of inpatient, however, many mistakes were caused by incomplete understanding of the hospital system and prescription drugs as well as the operational errors in OCS. Conclusion: The CDSS programs evaluated in this study were all effective. The prescription of medicines which is not applicable to medicinal powder and the remaining amount of narcotic drug occurred at reduced level. Drug-related CDSS is necessary for all medical institutions. However,the indiscriminate development of the program could drop clinician's acceptance rate and interfere with medical care. Therefore, the information provided must be clinically meaningful and should be constantly updated.
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