JP4262441B2 - Antibacterial drug selection support system - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to a medical information system, and more particularly to a system suitable for supporting selection of an appropriate antibacterial drug in the field of infectious diseases.
[0002]
[Prior art]
In recent years, EBM (Evidence Based Medicine) has been demanded in the general medical field in place of empirical medical care. In particular, in the field of infectious diseases, doctors often have to determine the treatment policy without knowing the pathogenic bacteria causing the onset of infection, so there is a strong demand for information that provides the basis for treatment decisions. .
[0003]
One of the information that can be considered as the basis for treatment judgment is the idea of presenting the patient's resistance to infection as an objective index. If antibacterial drugs can be selected based on this index, EBM in infectious diseases can be supported.
[0004]
On the other hand, in the treatment of infectious diseases, antibacterial agents that act as bactericidal or bacteriostatic against bacteria that cause infections, i.e., pathogenic bacteria, are treated by taking or intravenously administering them to patients. Do. Therefore, a doctor identifies a pathogenic bacterium by a bacterial test, and selects and administers an antibacterial agent having a therapeutic effect against the identified pathogenic bacterium.
[0005]
For example, in the “indicator of antibacterial drug selection” described in “Today's therapeutic drug 2001 (Nan-Edo)”, the effectiveness of the antibacterial drug is ◎ (first selected drug), ○ (effective), △ ( Sensitivity), blank (invalid), etc. indicate their effectiveness or priority. When a pathogenic bacteria is identified as a result of a bacterial test, a doctor selects an antibacterial drug while referring to the priority or effectiveness of the pathogenic bacteria.
[0006]
[Problems to be solved by the invention]
As described above, in the conventional technology, a doctor can select an antibacterial drug based on the identified causative bacteria, but there is a problem that an appropriate antibacterial drug cannot be selected depending on the resistance to infection. It was.
[0007]
In addition, in the conventional technology, when a pneumoniae is identified, a doctor can select an antibacterial agent, but before the pneumoniae is identified, if the pneumoniae is unknown or multiple, There was a problem that an appropriate antibacterial drug could not be selected.
[0008]
[Means for Solving the Problems]
The first problem is that a name for identifying a pathogenic microorganism that causes an infectious disease and a name for identifying an antibacterial agent that acts bactericidal or bacteriostatically against the pathogenic microorganism are described. For each index of resistance to resistance, a knowledge database storing with priority indicating that the antibacterial drug should be preferentially selected against the pathogenic microorganism, and according to the medical information of the subject, from the knowledge database It is composed of an antibacterial drug extraction unit that extracts an antibacterial drug to be administered to a subject and a priority, and an antibacterial drug presentation unit that presents the antibacterial drug extracted by the antibacterial drug extraction unit together with the priority. It can be solved by the antimicrobial selection support system.
[0009]
Further, the second problem is that a name for identifying a pathogenic microorganism causing an infectious disease and a name for identifying an antibacterial agent that acts bactericidal or bacteriostatically against the pathogenic microorganism are described. A knowledge database storing a priority index that is a value obtained by further indexing the priority indicating that the antibacterial drug should be preferentially selected, and the subject from the knowledge database according to the medical information of the subject. Antibacterial index calculation that calculates the antibacterial index, which is the overall priority of antibacterial drugs, based on the antibacterial drug and priority index extracted by the extraction unit An antibacterial drug sorting unit that sorts antibacterial drugs based on the antibacterial index calculated by the antibacterial index calculation unit, and an antibacterial drug that presents the antibacterial drugs in the order sorted by the antibacterial drug sorting unit. The presentation part The antibiotic selection system, characterized in that it can be solved.
[0010]
DETAILED DESCRIPTION OF THE INVENTION
FIG. 1 shows a configuration diagram of an antibacterial drug selection support system 100 according to an embodiment of the present invention. The system 100 includes a control unit 101, a communication unit 102, a basic information acquisition unit 103, an infection risk level acquisition unit 104, a disease acquisition unit 105, a pathogenic bacteria candidate presentation unit 106, a pathogenic bacteria selection unit 107, and an antibacterial drug extraction unit. 108, an antibacterial index calculating unit 109, an antibacterial drug rearranging unit 110, an antibacterial drug presenting unit 111, a knowledge DB 112, and a knowledge DB updating unit 113.
[0011]
Further, the system 100 according to the present embodiment can communicate with another information system 140 such as a clinical examination system, a medical accounting system, an order entry system, and an electronic medical record system via the input / output terminal 120 and the network 130. Here, the network 130 is premised on an in-hospital network, but may be a regional network or a wider area network. The communicable information system 140 may be an appropriate community medical system.
[0012]
The input / output terminal 120 is assumed to be an information device such as a personal computer having a keyboard or mouse as an input function and a CRT or liquid crystal display as an output function, but may have other input / output functions. The input / output terminal 120 may be a terminal equipped with a web browser function. The system 100 and the input / output terminal 120 are described as separate hardware, but the input / output function of the input / output terminal 120 may be integrated with the system 100. In addition, the user of the input / output terminal 130 is assumed to be a doctor in the hospital where the present system is installed, but a doctor outside the hospital may use it via the network 130.
[0013]
Moreover, although this system is described as a hardware configuration, it may be configured as software.
[0014]
In the system 100 of the present embodiment, the knowledge DB 112 has a causative bacteria knowledge base 150 and an antibacterial drug knowledge base 160. The above-mentioned pathogenic bacteria knowledge base 150, for each disease name that identifies an infectious disease, the bacterial name that identifies the causative fungus that causes the infectious disease, together with the separation rate that is the ratio of the causative bacteria for each infectious disease Store. In addition, the antibacterial knowledge base 160 is a value indicating the priority for each name of the antibacterial agent that acts as bactericidal or bacteriostatic, that is, specifies an antibacterial agent having a therapeutic effect. Along with the priority index, it is stored by infection risk level.
[0015]
In the case of the above-mentioned knowledge base 150 for infectious bacteria shown in FIG. 1, “pharyngitis”, “sinusitis”, “pneumonia”, etc., which are respiratory infections, are described as disease names for specifying infectious diseases. Although not shown in FIG. 1, not only respiratory infections but also other infections such as digestive system infections, circulatory system infections, urinary tract infections, urinary system infections are described. In addition, “Diphtheria” which is a Gram-positive gonococcus such as “Staphylococcus” and “Pneumococcus” which are Gram-positive cocci classified by Gram staining test which is one of the bacterial tests, "Mycoplasma", "Legionella", etc. which are not classified by Gram staining and are classified, such as "Koji mold" which is Gram-negative cocci, "Pneumococcus" and "H. influenzae" which are Gram-negative bacteria. Furthermore, the separation rate of pneumococci with respect to pneumonia is “0.230”, that is, “23%”.
[0016]
In the above-mentioned knowledge base 150 for infectious fungi, bacteria are mainly described as infectious causes of infectious diseases, but other microorganisms that cause infectious diseases such as viruses, fungi, parasites other than bacteria are included. .
[0017]
In the antibacterial knowledge base 160, for example, “CFDN”, “AMPC”, “AZM”, “LVFX”, “PA” and the like are described as antibacterial agents. In addition, as the bacteria name for identifying the pathogenic bacteria, as in the above-mentioned pathogenic bacteria knowledge base 150, "staphylococcus""pneumococcus""diphtheria""gonococcus""pneumococcus""influenza""mycoplasma"" Legionella "etc. are described. Furthermore, when the pneumococci are pneumococci, the antibacterial agents AMPC and AZM have a therapeutic effect and “1.01” means a first-line drug that is the first antibacterial agent to be administered, and the antibacterial agent CFDN has a therapeutic effect. “1.00” means the second selected drug to be administered next to the first selected drug, and the antibacterial drug LVFX has a therapeutic effect but is not so high, or has a lower priority because it is higher than necessary. "0.01" which means a medicine is shown.
[0018]
In the antibacterial drug knowledge base 160, antibacterial drugs are mainly described. However, antiviral drugs, antifungal drugs, antiparasitic drugs, vaccination drugs, disinfectants, etc. Includes drugs.
[0019]
FIG. 2 is a flowchart showing the operation of the system 100. First, when the present system is activated, the control unit 101 activates the basic information acquisition unit 103 and executes step 201 in which basic information input by the user using the input / output terminal 120 is acquired. FIG. 3 shows a screen example 300 of the input / output terminal 120 when a user inputs basic information.
[0020]
First, the user inputs a patient ID, age, and sex in a patient ID area 301, an age area 302, and a sex area 303 for identifying a patient on the screen of FIG. Alternatively, the user inputs a patient ID in the patient ID area 301 and presses the basic information acquisition button 304. Thereby, the control unit 101 extracts the age and sex corresponding to the patient ID from the medical information system 140, for example, by the communication function, and presents them in the age area 302 and the sex area 303, respectively.
[0021]
Here, the user selects an infection risk level, which is an index of the patient's resistance to infection, from the infection risk level selection list 305. In addition, the user selects a disease name that identifies the patient's infection from the disease selection list 306.
[0022]
When the user has not selected an infection risk level, the control unit 101 uses the medical information system 140 to obtain medical information corresponding to the patient ID, for example, basic information such as age, lifestyle information such as alcohol consumption and smoking, hypertension Hyperlipidemia, liver disease, diabetes, respiratory disease, collagen disease, cerebrovascular disorder, kidney disease, pancreatitis, anemia, malnutrition, nephrosis, heart disease, burn, hypoglobulinemia, hypocomplementemia, Hematological malignancies, solid malignant tumors, AIDS, neutrophil dysfunction, information on basic diseases such as low birth weight infants, stomach medicines, antihypertensives, broad-spectrum antibacterials, anti-ulcers, steroids, immunosuppressants, anticancer Information on drugs, insulin, etc., information on treatment devices such as catheters, tracheostomy, respirators, drains, radiation therapy, thoracotomy, transplantation, splenectomy, blood transfusion treatment information, bedridden, ICU management required Acquires status information such as the SIRS condition such as to determine the risk of infection levels, it may be presented to the infection risk level selection list 305.
[0023]
Next, the control unit 101 activates the infection risk level acquisition unit 104 and executes step 202 of acquiring the infection risk level selected by the user. Next, the control unit 101 activates the disease acquisition unit 105 and executes step 203 for acquiring the disease name selected by the user.
[0024]
Next, the control unit 101 executes step 204 for determining whether or not the support button 307 has been selected. Here, when the user presses the support button 307, the control unit 101 activates the pathogenic bacteria candidate presentation unit 106, and the infection risk level acquired in step 202 and the disease name acquired in step 203. Step 205 is executed to extract and present the name of the bacteria from the knowledge base 150 of the pathogenic bacteria based on the above.
[0025]
FIG. 4 shows a screen example 400 of the input / output terminal 120 when the user selects “Level 2” as the infection risk level, “pneumonia” as the disease name, and selects the support button 307. In the above screen example 400, “staphylococcus”, “pneumococcus”, “pneumococcus”, “influenza”, “mycoplasma”, and “Legionella” extracted in step 205 are displayed in the pathogenic fungus candidate presentation area 401, respectively. 402 is presented. In the above screen example 400, the bacteria name is presented for each bacteria classification, but may be presented by rearrangement according to the separation rate.
[0026]
Thus, based on the disease which is one of the patient's pathologies selected by the user, the separation rate is extracted from the above-mentioned pathogenic bacteria knowledge base 150 and presented together with the bacteria name. It becomes possible to improve efficiency.
[0027]
Next, the said control part 101 performs step 206 which makes a user select a pathogenic microbe.
[0028]
Next, the control unit 101 executes step 207 for determining whether or not the antimicrobial guide button 403 has been selected.
[0029]
Here, when the user presses the antibacterial drug guide button 403, the control unit 101 activates the antibacterial drug extraction unit 108 and extracts the antibacterial drug knowledge base corresponding to the infection risk level acquired in step 202. Based on the causative fungus selected in step 206, step 208 is executed to extract a priority index for each antibacterial drug and bacteria from the antibacterial drug knowledge base 160.
[0030]
Next, the control unit 101 activates the antibacterial index calculation unit 109, adds a priority index for each bacterium for each antibacterial drug extracted in step 208, and indicates the total priority of the antibacterial drug. Step 209 for calculating the index is executed.
[0031]
Next, the control unit 101 executes step 210 of rearranging antibacterial drugs based on the antibacterial index calculated in step 209.
[0032]
Next, the control unit 101 executes step 211 in which the antibacterial drugs are presented in the order rearranged in step 110.
[0033]
FIG. 5 shows a screen example 500 when the user selects “staphylococcus”, “pneumococcus”, “pneumococcus”, “influenza”, “mycoplasma”, and “legionella”, and selects the antibacterial agent guide button 403. In the screen example 500, the antibacterial drugs “CFDN”, “AMPC”, “AZM”, “LVFX”, and “PA” extracted in step 208 are rearranged in the antibacterial drug presentation area 501 by the respective antibacterial indices 502, Presented with an index. As a result, the user is not limited to staphylococci, pneumococci, and Klebsiella pneumoniae, which are bacterial pneumoniae, but also for mycoplasma and Legionella, which are atypical pneumoniae. An effective antibacterial agent “AZM” can be preferentially selected.
[0034]
Also, FIG. 6 shows a screen example 600 when the user selects “staphylococci”, “pneumococci”, “pneumococci”, “influenza” as bacterial pathogens of bacterial pneumonia, and selects the antibacterial agent guide button 403. Indicates. In the above screen example 600, the antibacterial drugs “CFDN”, “AMPC”, “AZM”, “LVFX”, and “PA” extracted in step 208 are rearranged in the antibacterial drug presentation area 501 by the respective antibacterial indices. Is presented with. Thereby, the user can preferentially select the antibacterial agent “AMPC” effective in a wide area against the causative bacteria of bacterial pneumonia.
[0035]
Furthermore, FIG. 7 shows a screen example 700 when the user selects “pneumococcus” and selects the antibacterial drug guide button 403 when pneumococcus is identified as a causative bacterium as a result of the bacterial test. In the screen example 700, “CFDN”, “AMPC”, “AZM”, and “LVFX” extracted in step 208 are rearranged by the respective antibacterial indices and presented together with the antibacterial indices. At this time, since only one causative fungus is selected, the antibacterial index shows the same value as the priority index of the antibacterial drug knowledge base 160. Thereby, when a causative bacterium is identified, the user can preferentially select an antibacterial drug “AMPC” or “AZM” effective for the causative bacterium.
[0036]
As described above, even when the user wants to select a wide range of antibacterial agents without identifying the pathogenic bacteria, or when the user wants to select a wide range of antibacterial drugs effective against the narrow pathogenic bacteria, it was further identified Even if you want to select an antibacterial agent effective against pneumoniae, the antibacterial index is calculated from the priority of the antibacterial agent knowledge base 160 based on the pneumoniae selected by the user, and the antibacterial agents are rearranged and presented Therefore, the user can easily select an appropriate antibacterial drug.
[0037]
Further, since the antibacterial knowledge base 160 is configured for each infection risk bell, the user can select an appropriate antibacterial drug according to the infection risk level of the patient.
[0038]
If the support button 307 is not selected in step 204, or if the antimicrobial guide button is not selected in step 207, the operation of the system ends.
[0039]
The control unit 101 can also start the knowledge DB update unit 113 and update the knowledge DB 112 based on past case data managed by the medical information system 140.
[0040]
For example, in the case of the above-mentioned pathogenic bacteria knowledge base 150, updating is performed according to the following pathogenic bacteria knowledge base update algorithm.
[Update algorithm for infectious bacteria knowledge base]
(1) For each period of time or for a set number of cases, extract each disease that identifies an infectious disease and the name of the causative fungus identified by the bacterial test.
(2) For each disease, the frequency for each pathogenic bacterium is counted, and the separation rate is calculated by dividing all the frequencies by the added value.
(3) The calculated separation rate is stored in the knowledge base 150 for infectious bacteria.
[0041]
In the case of the antibacterial drug knowledge base 160, for example, the antibacterial drug knowledge base is updated according to the following antibacterial drug knowledge base update algorithm.
[Antimicrobial Drug Knowledge Base Update Algorithm]
(1) For a certain number of cases or a set number of cases, the risk level of infection, the name of the disease, the name of the antibacterial drug administered, and the healing status (healing, (Improvement, deterioration, unchanged) and the name of the causative bacteria identified by the bacterial test.
(2) For each case, the infection risk level, disease name, causative fungus, and priority for each antibacterial drug are set as follows.
a) In case of healing after 3 days, the priority is 1.01
b) In the case of improvement after 3 days and healing after 7 days, priority is 1.00
c) In the case of improvement after 3 days and improvement after 7 days, the priority is set to 0.01.
d) Other than the above, the priority is set to 0.00
(3) The priority with the largest number of cases is stored in the antibacterial knowledge base 160 as a new priority for each infection risk level, disease name, causative fungus, and antibacterial drug.
[0042]
Thus, by configuring the knowledge base 112 for each disease or for each infection risk level and disease, the knowledge base can be easily updated based on the case data.
[0043]
In addition, in this example, the pathogenic bacteria are extracted from the above-mentioned pathogenic bacteria knowledge base 150 based on the disease, but symptoms, findings, and tests that can estimate the pathogenic bacteria are presented and estimated from the results. Inflammatory bacteria may be extracted.
[0044]
Further, in the present embodiment, the above-mentioned pathogenic bacteria knowledge base 150 is configured by one knowledge base without depending on the infection risk level, but may be configured for each infection risk level. Moreover, you may use together the causative bacteria knowledge base which does not depend on an infection risk level, and the causative bacteria knowledge base for every infection risk level. As a result, the user can more efficiently estimate the causative bacteria.
[0045]
In the present embodiment, the antibacterial knowledge base 160 is configured for each infection risk level, but may be configured for each infection risk level and a disease that is one of the patient's pathologies. Further, when there is a severity of a disease, it may be configured according to the infection risk level and the severity of the disease. Moreover, you may comprise according to another disease state. By configuring the antibacterial drug knowledge base according to the pathological condition in this way, the user can select an appropriate antibacterial drug according to the patient's pathological condition.
[0046]
【The invention's effect】
With the antibacterial drug selection support system of the present invention described above, the user can select an appropriate antibacterial drug according to the infection risk level that is an index of resistance to infection.
[0047]
In addition, with the antibacterial drug selection support system described above, the user wants to select a wide range of antibacterial drugs without identifying the pathogenic bacteria, or when he wants to select a wide range of effective antibacterial drugs In addition, when it is desired to select an antibacterial agent effective for the identified pathogenic fungus, the antibacterial index is calculated from the priority of the antibacterial knowledge base 160 based on the fungus selected by the user. Since the drugs are rearranged and presented, the user can easily select an appropriate antibacterial drug.
[Brief description of the drawings]
FIG. 1 is a block diagram showing the configuration of an antibacterial drug selection support system according to an embodiment of the present invention.
FIG. 2 is a flowchart showing the operation of the system according to the embodiment of the present invention.
FIG. 3 is a diagram showing an example of an input / output terminal screen in the system according to the embodiment of the present invention.
FIG. 4 is a diagram showing a screen example of the input / output terminal when a user selects “Level 2” as an infection risk level, “pneumonia” as a disease name, and selects a support button;
FIG. 5 is a diagram showing an example of a screen when the user selects “staphylococcus”, “pneumococcus”, “pneumococcus”, “influenza”, “mycoplasma”, and “legionella”, and selects an antimicrobial guide button.
FIG. 6 is a diagram showing an example of a screen when the user selects “staphylococci”, “pneumococci”, “pneumococci”, “influenza” and selects an antimicrobial guide button.
FIG. 7 is a diagram showing an example of a screen when the user selects “Pneumococcus” and selects an antimicrobial guide button.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 100 ... Antibacterial drug selection support system, 101 ... Control part, 102 ... Communication part, 103 ... Patient information acquisition part, 104 ... Infectious risk level acquisition part, 105 ... Disease acquisition part, 106 ... Infectious disease candidate presentation part, 107 ... Infectious bacteria selection unit, 108 ... Antibacterial drug extraction unit, 109 ..., Antibacterial index calculation unit, 110 ... Antibacterial drug rearrangement unit, 111 ... Antibacterial drug presentation unit, 112 ... Knowledge DB, 113 ... Knowledge DB update unit, 120 ... Input / output terminal, 130 ... network, 140 ... medical information system, 150 ... causative bacteria knowledge base, 160 ... antibacterial drug knowledge base.

Claims (1)

Input / output means for inputting patient information including at least a disease name and an infection risk level;
Bacterial bacteria that store the bacterial name, which is the name of the bacterium that identifies the causative bacteria causing the infection, and the separation rate, which is the ratio of the causative bacteria for each infectious disease, for each disease name that identifies the infectious disease Knowledge base,
Antibacterial names that identify antibacterials that act bactericidal or bacteriostatically against the bacteria, and priority indicating that they should be selected preferentially from the strength of the action were assigned in order of their strength In the antibacterial drug selection support system having at least an antibacterial drug base stored for each infection risk level together with a priority index as a predetermined value, an extraction unit, and a calculation unit
The input / output means accepts input of the patient information;
The extraction unit is configured to obtain a plurality of bacterial names corresponding to the disease name and the separation rate corresponding to the bacterial name from the knowledge base of the pathogenic bacteria based on the disease name information input by the input / output unit. Extract and
The input / output means displays the extracted information of the plurality of bacteria names and the separation rate so as to be selectable by the input / output means, and a plurality of bacteria names selected from the displayed plurality of bacteria names. Accept input,
The extraction means further corresponds to the infection risk level from the antibacterial drug base, based on the information of the plurality of selected bacteria names and the infection risk level information input by the input / output means , And extracting a plurality of antibacterial drug names and priority indices respectively corresponding to the plurality of selected bacteria names for each of the plurality of selected bacteria names,
The arithmetic unit, for each antibacterial drug name extracted for each of the plurality of selected bacterial names, for each antibacterial drug name, add the priority index for each bacterial name,
As a result of the addition, the antibacterial drug selection support system, wherein the antibacterial drug names extracted by the extraction unit are rearranged according to the added value of the priority index and displayed on the input / output means.

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