Research On Index Evaluation System Of Anti-mrsa Drugs’ Rational Use

Since the 1980 s, gram-positive bacteria(G+) become the most important pathogens in nosocomial infection with a significant increase in the proportion. Most hospital G + cocci infections nowadays are caused by methicillin-resistant staphylococcus aureus(MRSA) and enterococcus[1].And some research shows that the number of MRSA infection has been estimated to almost 6% of the total number[2].It’s closely related to the unrational use of antibiotics[3].The MRSA drug evaluation is lack of unified evaluation standard. We carry out this study to explore and develop an evaluation system which contain each key process of clinical application of anti-MRSA drugs, with the purpose of giving comprehensive evaluation of the rationality and constantly improving rational drug use and medical quality.Objective: Using documentation analysis and expert consultation(Delphi), we explore and establish the evaluation indicator system for rational use of anti-MRSA drugs, then formulate the rational evaluation indicator of each anti-MRSA drug to guide the intervention and judge the value of the index system. It can not only provide references for rational use and scientific management of anti-MRSA drugs, but also constantly promote the standardization and rationalization of the anti-MRSA drugs’ clinical application.Methods: Retrospective case analysis was used at the beginning of the study, to find out problems that may exist in the clinical application of anti-MRSA drugs; The second step is to use documentation analysis to build the framework of anti-MRSA drugs’ rationality evaluation index system, through three indispensable links in rational drug use such as medical indications, preparation process and therapeutical results; Then, on the basis of evaluation system, we construct the detailed evaluation index of various drugs, and do comprehensive evaluation research before and after the intervention using electronic medical record system to extract the 447 cases which used the anti-MRSA drugs(including vancomycin, teicoplanin and linezolid),to evaluate the feasibility of the index system and perfect the index system in practice.Results:1.It is proved by Retrospective study that establishing the rationality index system of the anti-MRSA drugs is feasible and necessary.It can lead to the index system in detail.2.This study established the rationality index system of the anti-MRSA drugs which includes 3 first class indicators and 15 second class indicators. The first class indicators include: medical indications, preparation process and therapeutical results. 15 second class indicators include: indications, combination indications, prescribers permissions,administration route, administration time, solvent selection, drip duration, special provisions, drug dosage and dosing frequency, period of treatment, drug incompatibility and interaction, symptoms, signs, laboratory examination, etiology examination. Through analysis,induction and summary of the development trend in this area,also on the basis of expert advice, The rational evaluation rules of vancomycin,linezolid and teicoplanin are formed.3.Cases using vancomycin, linezolid or teicoplanin are analysized before and after the intervention of using the rational evaluation rules,which conducts clinical validation of the system.We find that the rationality rate is greatly increased after the intervention especially in the combination medication indications, choice of solvent, special provisions, dose and drug dosing frequency.It is proved that intervene by DUE is reliable and feasible.Conclusion: It is proved that this index system has achieved the basic requirement of metrology so that it can comprehensively reflect the level of rationality in using anti-MRSA drugs, and is suitable for comprehensive evaluation.After evaluation rules of the three anti-MRSA drugs are established, the evaluation process is no longer excessively relies on the professionality of practitioners, general pharmacists are also qualified for this work. This method can be generalized to the manage of other special-use antibiotics, which can further improve the quality of clinical medical.