Evaluation and Analysis of the Rationality of Clinical Use of Carbapenems in Surgical Departments of a Tertiary Hospital in Southwest China

作者全名："Huang, Zhongyue; Yao, Gaoqiong; Zhang, Chengzhi; Zhou, Xin; Zou, Guanyang; Zhuo, Chao"

作者地址："[Huang, Zhongyue] Chinese Acad Med Sci & Peking Union Med Coll, Inst Med Informat, Med Lib, Beijing, Peoples R China; [Yao, Gaoqiong; Zhang, Chengzhi; Zhou, Xin] Chongqing Med Univ, Affiliated Hosp 1, Dept Pharm, Chongqing, Peoples R China; [Zou, Guanyang] Guangzhou Univ Chinese Med, Sch Publ Hlth & Management, Guangzhou, Guangdong, Peoples R China; [Zhuo, Chao] Guangzhou Med Univ, Affiliated Hosp 1, State Key Lab Resp Dis, Guangzhou, Guangdong, Peoples R China; [Zou, Guanyang] 232 Waihuan East Rd, Guangzhou 510006, Guangdong, Peoples R China; [Zhuo, Chao] 195 Dongfeng West Rd, Guangzhou 510030, Guangdong, Peoples R China"

通信作者："Zou, GY (通讯作者)，232 Waihuan East Rd, Guangzhou 510006, Guangdong, Peoples R China.; Zhuo, C (通讯作者)，195 Dongfeng West Rd, Guangzhou 510030, Guangdong, Peoples R China."

来源：INFECTION AND DRUG RESISTANCE

ESI学科分类：IMMUNOLOGY

WOS号：WOS:000972524000001

JCR分区：Q2

影响因子：2.9

年份：2023

卷号：16

期号：　

开始页：2259

结束页：2269

文献类型：Article

关键词：carbapenem; prescription review; surgery

摘要："Purpose: With the increasing frequency and intensity of carbapenem consumption, carbapenem-resistant organisms (CRO) have become a focus of anti-infection research. This study aimed to evaluate the rationality of the clinical use of carbapenems among inpatients in the surgical departments of a tertiary hospital in southwest China. Patients and methods: A point-score system was established for evaluation based on the clinical practices in surgical departments and selected carbapenem prescriptions from June 2020 to June 2021 for hepatobiliary surgery, gastrointestinal surgery, and neurosur-gery in the study hospital. Prescriptions with a total score >= 270 were defined as rational. Descriptive statistics were used to describe the characteristics and rationality of the prescriptions. The chi-square test, Mann-Whitney U-test, and Kruskal-Wallis H-test were used to compare characteristics between rational and irrational prescriptions. Linear regression analysis was used to determine the factors affecting the rationality of carbapenem prescriptions.Results: According to 192 carbapenem prescription records, the median age of patients was 62 years [IQR, 48.0-73.0], and 20% of patients had abdominal infections, 10% had lung infections, 14% had intracranial infections, and 3% had urinary tract infections. 56% of carbapenem prescriptions were irrational. Compared with rational carbapenem prescriptions, irrational prescriptions had a higher proportion of those with inappropriate indications (49% vs 0%, p < 0.05), incorrect variety selection (15% vs 0%, p<0.05), and unreasonable assessment of etiology and efficacy (46% vs 8%, p < 0.05). Linear regression analysis suggested that the diagnosis of cholecystitis (standardized regression coefficient=0.183, p<0.05) and replaced medication (standardized regression coefficient = 0.154, p<0.05) influenced the rationality of carbapenem prescriptions. Conclusion: Our study shows that the irrational use of carbapenems deserves attention, especially in surgical departments. Interventions for carbapenem use that are based on evaluation criteria should be developed to reduce the emergence and spread of carbapenem-resistant bacteria."

基金机构：National Natural Science Foundation of China [81861138056]; National Social Science Foundation of China; Investigator-Initiated Trial Fund of The First Affiliated Hospital of Guangzhou Medical University [20 ZD122]; [DSPC-MPM002]

基金资助正文："This research was funded by the National Natural Science Foundation of China (Grant Number 81861138056), the National Social Science Foundation of China (Grant Number 20 & ZD122), the Investigator-Initiated Trial Fund of The First Affiliated Hospital of Guangzhou Medical University (Grant Number DSPC-MPM002)."