| Background: Carbapenems are a class of atypical β-lactam antibiotics,which are modified from the structure of thiomycin.Carbapenems have broad antibacterial spectrum,strong antibacterial activity,low toxicity and high stability to most β-lactamases.They are the last choice for the treatment of critical infections or complex infections in which initial antimicrobial therapy has failed.With the extensive application of carbapenems,the problem of carbapenem-resistant bacteria infection has been more and more serious all over the world.Medical institutions began to strictly control the use of antibiotics and implemented special rectification of antibiotics across the country since the introduction of "Special Remediation Program for Clinical Application of Antibiotics" issued by the Ministry of Health of the People’s Republic of China in 2011.The General Office of National Health and Family Planning Commission issued the "Further Strengthening the Management of Clinical Application of Antibiotics to Contain Bacterial Drug Resistance" in 2017.Carbapenems are required to focus on monitoring in this document.Objective: This study conducted a comprehensive intervention on the use of carbapenems in a hospital in Baotou.Evaluate the effectiveness of the intervention through comparative analysis of the use of carbapenems before and after intervention,such as the sum of money,utilization rate,antibiotics use density,DDDs,AUD of carbapenems in inpatients,distribution characteristics and drug resistance of pathogenic bacteria,etc.So as to provide bases for rational selection of antibiotics in clinic.Methods:(1)In this study,a rational drug use intervention system was established in a hospital of Baotou in 2017.Through the combination of administrative supervision,pharmaceutical intervention,publicity and education,comprehensive intervention could be implemented on the use of carbapenems in all relevant departments of the hospital.Time division:January 2015 to June 2017(before intervention)as the control group,July 2017 to December 2019(after intervention)as the intervention group.To analyze the indicators of inpatients using carbapenems in two groups,such as statistics the basic personal information(age,gender,length of stay,hospitalization department,disease diagnosis),carbapenems use status(drug variety,drug specification,dose,usage,use time,medical expenses),unreasonable use of carbapenems,the utilization rate of carbapenems,the proportion of drugs,DDDs,AUD,the rate of pathogen samples and other data.(2)The microbial samples of the two groups inpatients were identified by VITEK-2COMPACT automatic microbiological analyzer.The drug sensitivity tests were carried out by Kirby-Bauerdiscagar diffusion method and MIC method.The drug sensitivity tests were interpreted according to the 27 th edition of CLSI M100,American Association for Clinical and Laboratory Standardization.Results:(1)There were 1201 cases in the control group.In this group,the unreasonable rate of drug use was 12.82%.The sum of money for the use of carbapenems accounted for1.36% of the total amount of drugs in the hospital and 9.62% of the total amount of antibiotics.The utilization rate of carbapenems was 2.41%.The DDDs was 7296.25 and the AUD was0.98.The number of pathogenic samples was 950 and the rate was 79.10%.There were 1017 cases in the intervention group.The unreasonable rate of drug use was 3.34%.The sum of money for the use of carbapenems accounted for 1.19% of the total amount of drugs in the hospital and 8.93% of the total sum of money for antibiotics.The utilization rate of carbapenem was 2.19%.The DDDs was 5592 and the AUD was 0.91.The number of pathogenic samples was 980 and the rate was 96.36%.Compared with the control group,the total amount of carbapenems have decreased by 21.06%.The amount of meropenem in the intervention group have increased by 28.70%.The amount of ertapenem remained basically unchanged and the amount of imipenem have decreased significantly by 64.64%.The sum of money for carbapenems have dropped from fourth to fifth place.(2)The total number of bacterial culture samples was 950 in the control group and the number of pathogenic bacteria was 547,with a total positive rate of 57.58%.In the intervention group,the total number of bacterial culture samples was 980 and the number of pathogenic bacteria was 755,with a total positive rate of 77.04%.The main pathogenic bacteria were both gram-negative bacteria in these two groups.Focus on more Monitoring to carbapenem-resistant strains.In the control group,the resistance rates of CRKP,CRPA and CRAB were 11.25%,23.08% and 59.18%.In the intervention group,the resistance rates of these pathogenic bacteria were 6.41%,24.39% and 53.97%.Conclusion:(1)After comprehensive intervention on rational use of carbapenems,the situation of unreasonable drug use have been improved.The sum of money,utilization rate,AUD and DDDs are significantly lower than those before intervention.The rate of examination of pathogenic specimens have been improved.To prove that rational drug use intervention measures are effective.(2)The data of distribution and drug resistance of pathogens in the hospital are the same as those of the national drug resistance in the same period.After the intervention,the resistance rate of infection pathogens to carbapenems has decreased to a certain extent.This study has played a certain role in better controlling nosocomial infection and the spread of drug-resistant bacteria and delaying the development of carbapenem drug resistance to the maximum extent. |
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