Effect Analysis And Economic Evaluation Of Special Rectification Of Antibacterial Drugs In A Hospital ——Taking Carbapenems And β-lactamase Inhibitors As Examples

Objective:Using special antimicrobial drug regulation as a means,analyzed the rationality of the use of four antimicrobial drugs,namely Carbapenems（Meropenem）andβ-lactamase inhibitors（Piperacillin tazobactam,Cefoperazone sulbactam,Amoxicillin clavulanate potassium）in a hospital before and after the special regulation,analyzed the rationality of the use of the above two types of antimicrobial drugs,and compared the effect of the regulation by means of prescription（medical advice）reviews,medication intervention,evaluation of the distribution of pathogenic bacteria and drug compatibility and pharmacoeconomic evaluation.Methods:The inpatient medical orders of a hospital using Meropenem,Piperacillin tazobactam,Cefoperazone sulbactam,and Amoxicillin clavulanate potassium from July 1 to December 31,2020（before special regulation）and from July 1 to December 31,2021（after special regulation）were used for the analysis of antimicrobial drug use data before and after regulation,including antimicrobial drug use rate,use intensity,use amount ranking,perioperative class I incision antimicrobial drug use rate,DUI,pathogenic microorganism delivery rate of patients for treatment（unrestricted class,restricted class,special class）,prescription（doctor’s orders）rational rate,the use of drugs and drug-resistant bacteria in line;statistical software SPSS 17.0 was used to count and analyze the data,the count data is expressed in（%）,and the comparison between groups is done byχ~2test,P<0.05 is the difference The least cost analysis method was used to extract the medical prescriptions of the same disease diagnosis cases for the comparison analysis of the least cost before and after the remediation,and the least cost solution was used as the optimal solution under the premise of the same efficacy and safety,and the cost of the treatment plan of the two groups of patients before and after the remediation was calculated,and the smaller value was superior.Results:（1）Before special rectification:the highest drug utilization rate was Piperacillin tazobactam（11.70%）,the top three departments in use were ICU,Respiratory medicine and Pediatrics,the highest intensity of use was Amoxicillin sodium clavulanate 1.2 g（5.15 DDD）,the highest amount of use was Piperacillin tazobactam 1.25 g（3,629,200 yuan）,perioperative class I The higher utilization rate of incisional prophylaxis application is Piperacillin tazobactam（8.12%）,the better drug utilization index DUI is Amoxicillin clavulanate potassium（1.25）,the prescription rational rate are above 80%,the use of drugs and drug-resistant bacteria consistent with reasonable.（2）After special rectification:only Meropenem increased by 0.02%compared with the previous rate of antimicrobial drug use,and the rest of drugs decreased;only Meropenem increased by 0.27 DDD in use intensity,and the rest of drugs decreased;only Piperacillin tazobactam 2.25 g increased by 423,900yuan in use amount,and the rest of drugs decreased;prescription rational rate increased to more than 95%;no significant change in major pathogenic bacteria compared with the previous rate.The utilization rate of perioperative class I incision prophylaxis application all decreased,and the total cost for treatment and prophylaxis for class I and II incisions decreased by 105,800 yuan and 540,400 yuan;the percentage of using generation cephalosporin for class I and II incisions increased by46.03%and 15.27%,and the total cost for treatment and prophylaxis increased by 0.7million yuan and decreased by 13,700 yuan respectively.Conclusions:A hospital for Carbapenems andβ-lactamase inhibitor drugs special rectification effect is effective at first,the rationalization of drug use increased,the amount decreased,but there are still the following problems:β-lactamase inhibitor drug use of AUD is high;II incision antibacterial drug use rate selected generation cephalosporin ratio is low,perioperative drug selection is not reasonable phenomenon is common,the rationalization of drug selection still needs to be improved,need to strengthen training;for a hospital for carbapenems andβ-lactamase inhibitor drugs still need to strengthen the rectification and management.