Objective: To assess the clinical value of individualized pharmaceutical services for patients receiving vancomycin for severe infections and establish clinical monitoring procedures during vancomycin treatment.
Methods: Data were collected from patients with severe infections who received vancomycin treatment with individualized pharmacy services (test group, 144 cases) or without such services (control group, 884 cases) between January, 2017 and December, 2018. Using propensity score matching, the patients in the two groups with comparable baseline data were selected for inclusion in the study (62 in each group), and the efficacy, safety and economic indicators were compared between the two groups.
Results: The curative effects of the treatment did not differ significantly between the two groups, with the overall response rates of 95.16% in the test group and 91.94% in the control group (P > 0.05). The percentage of neutrophils before vancomycin treatment and calcitonin level after the treatment differed significantly between the two groups (P < 0.05). No significant difference was found in the incidence of adverse events associated with the treatment between the test and control groups (8.06% vs 9.68%, P > 0.05); a significant difference in creatinine level was noted between the two groups after vancomycin treatment (P < 0.05). The number of days of medication, the cost of vancomycin and its proportion in the total expenses differed significantly between the two groups (P < 0.05). Cost-effectiveness analysis showed a better cost-effectiveness in the test group than in the control group (50052.78 vs 57601.23). The intensity of vancomycin use was also lower in the test group than in the control group (0.11 vs 0.36).
Conclusions: The participation of clinical pharmacists during the treatment can improve the clinical benefits of vancomycin in patients with severe infections.
目的: 探讨临床药师开展万古霉素个体化药学服务的临床价值，初步建立万古霉素临床监测流程。
方法: 收集2017年1月~2018年12月期间开展万古霉素个体化药学服务（试验组：144例）和未开展药学服务（对照组：884例）的病例资料，基于纳入排除标准和倾向评分匹配法，筛选出两组基线数据保持基本一致的患者病例纳入研究（每组各62例，共124例），统计比较试验组和对照组之间的疗效、安全性和经济性指标。
结果: 疗效比较时，试验组治疗效果总有效率绝对值（95.16% vs 91.94%）大于对照组，但差异无统计学意义（P>0.05）；两组之间使用万古霉素前中性粒细胞分类比例和使用后降钙素原差异有统计学意义（P < 0.05）。安全性比较时，试验组不良反应发生率绝对值低于对照组（8.06% < 9.68%）但其差异无统计学意义（P>0.05）；两组之间使用万古霉素后肌酐差异有统计学意义（P < 0.05）。经济性比较时，用药天数、万古霉素费用及费用占比差异有统计学意义（P < 0.05）；成本—效果分析试验组经济性优于对照组（50052.78 vs 57601.23）；万古霉素使用强度试验组使用强度低于对照组（0.11 < 0.36）。
结论: 临床药师的参与可提高万古霉素的临床获益，建立的万古霉素临床监测流程值得推荐。
Keywords: clinical value; cost-effectiveness analysis; propensity score matching; vancomycin.