Evaluation of carbapenem use in a tertiary hospital: antimicrobial stewardship urgently needed

• Published in: Antimicrobial resistance & infection control Vol. 8; no. 1; p. 5
• Main Authors: Zhang, Di, Cui, Kai, Lu, Wei, Bai, Hehe, Zhai, Yuyao, Hu, Sasa, Li, Hao, Dong, Haiyan, Feng, Weiyi, Dong, Yalin
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 07-01-2019; BioMed Central; BMC
• Subjects: Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - standards; Antibiotics; Antimicrobial agents; Antimicrobial stewardship; Antimicrobial Stewardship - methods; Antimicrobial Stewardship - organization & administration; Carbapenem; Carbapenem-resistant Pseudomonas aeruginosa; Carbapenems - administration & dosage; Carbapenems - standards; China; Correlation analysis; Disease control; Drug dosages; Drug resistance; Drug Resistance, Bacterial; Family planning; Humans; Imipenem; Infections; Infectious diseases; Intensive care; Meropenem; Microbial Sensitivity Tests; Patients; Policy; Pseudomonas aeruginosa; Pseudomonas aeruginosa - drug effects; Pseudomonas aeruginosa - growth & development; Pseudomonas Infections - drug therapy; Pseudomonas Infections - microbiology; Rationality; Regression analysis; Retrospective Studies; Sepsis; Studies; Tertiary Care Centers - standards; Tertiary Care Centers - statistics & numerical data; China; Beijing China; Carbapenem-resistant Pseudomonas aeruginosa; Carbapenem; Antimicrobial stewardship; Rationality; China
• ISSN: 2047-2994; 2047-2994
• DOI: 10.1186/s13756-018-0449-3

China launched a 3-year rectification scheme for the clinical use of antibiotics in 2011, and a specific scheme for carbapenem use in 2017. The aim of this study was to investigate the effects of government policies on carbapenem use, and their correlation with carbapenem-resistant
(CRPA).
The study was divided into four stages: preintervention (2010), antimicrobial programme (2011-2013), post-antimicrobial programme (2014-2016) and carbapenem programme (2017). A point-score system was proposed for evaluating the rationality of carbapenem use, and evaluated based on the indications, microbial culture, single dose, interval, and duration. Any prescription without a global score of 10 points was judged as irrational. The trend was analyzed by regression analysis, and Spearman correlation analysis was used for testing the correlation.
The rate of rational use of carbapenems was 29.7% in 2010, and increased by 55.5, 45.2, and 51.5% during the subsequent three stages. The rationality declined slightly during the post-antimicrobial programme (2014-2016) while the consumption of carbapenems was markedly increased. These two parameters improved slightly in 2017. Moreover, the prevalence of CRPA was significantly negatively correlated with the rate of rational carbapenem use (Coefficient = - 0.553,
 < 0.05), and not with the consumption of carbapenems (
 > 0.05).
The rational application of carbapenems was related to government policies in this study, with irrational carbapenem use possibly related to the development of CRPA. The current point-score system could be a useful tool for performing assessments.