Medication Using Evaluation Of Carbapenems

Objective(s):The Carbapenems are ultra-wide spectrum antibiotics,used in mixed bacterial infection,infection in patients with immune deficiency and severe infection with uncertain pathogenic bacteria.They serve as the last defense of treatment of Gram-negative bacterial infection.The prevention and the treatment on which is a great challenge for global public hygiene.With the widespread use of Carbapenems,the problem of Carbapenem-Resistant bacterial infection becomes more and more serious.It is also a worldwide concern of governments and society.National Health Commission of the People’s Republic of China issued the "Expert consensus on the clinical use of Carbapenems" and "Rules for the evaluation of the clinical use of Carbapenems in Sep.2018,emphasizing the importance and necessity of the special management of Carbapenems in the health system.This study is to establish an MUE program of Carbapenems,to comprehensively evaluate the rationality,safety,effectiveness and economy of Carbapenems in the hospital.The program could be optimized according to the continuous improvement of PDCA circulation.Methods:This study was carried out in a "Three-A" hospital in Yunnan Province.It designed an MUE program of Carbapenems including data collection,evaluation of clinical use of Carbapenems considering the characteristics of PK/PD,pharmacoeconomic evaluation and analysis risk factors of Carbapenem-resistant.1.Evaluation of Clinical Use of Carbapenems:This study established an evaluation system-《Evaluation of Clinical use of Carbapenems》.The evaluation system consists of 4 grade Ⅰ indexes and 10 grade Ⅱ indexes,including medication indications(indications,contraindications),medication processes(drug selection,route of administration,dosage,drug interactions,laboratory tests),medication outcomes(efficacy evaluation,adverse drug reactions),medication management(prescription rights and consultation).400 cases from 2018 to 2019 were selected to evaluate the clinical use of Carbapenems,and identify problems in practical application.2.Pharmacoeconomic Evaluation of Carbapenems:31 2 adult cases with rational use of Carbapenems entered the study.According to the therapeutic regimen,all of the patients were divided into Imipenem/Cilastatin group(500mg Q12h、500mg Q8h、500mg Q6h、1000mg Q12h)and Meropenem group(500mg Q12h、500mg Q8h、1000mg Q12h、1000mg Q8h、2000mg Q8h).To evaluate the economic effects of different dosage regimens of Carbapenems by the CEA method.3.Analyzing risk factors of Carbapenem-resistant infection:312 patients with a positive results in bacteria culture were divided into Carbapenems sensitive group(n=146),Carbapenems-resistant group(n=33).11 related factors such as gender,age,inpatient days,Carbapenems exposure,combined other antimicrobial agents,glucocorticoids,chronic diseases,surgery,ICU,mechanical ventilation,indwelling catheters were screened to predictors for Carbapenem-resistant infection by logistic regression analysis.Results:1.In 2018,49 cases(98.0%)of Imipenem/Cilastatin,149 cases(99.3%)of Meropenem met the standards for medication indications.23cases(46.0%)of Imipenem/Cilastatin and 97 cases(64.7%)of Meropenem conforms to the evaluation standard conforms to the standard of medication processes.In medication outcomes,50 cases(100.0%)of Imipenem/Cilastatin and 100 cases(100.0%)of Meropenem meet criteria.As for medication management,all cases were evaluated good.In 2019,50 cases(100.0%)of Imipenem/Cilastatin,144 cases(96.0%)of Meropenem met the standards for medication indications.30cases(60.0%)of Imipenem/Cilastatin and 109 cases(72.7%)of Meropenem conforms to the evaluation standard conforms to the standard of medication processes.In medication outcomes,50 cases(100.0%)of Imipenem/Cilastatin and 100 cases(100.0%)of Meropenem meet criteria.As for medication management,all cases were evaluated good.2.The C/E values of Imipenem/Cilastatin 500mg Q12h and Meropenem 500mg Q12h were the lowest.The △C/△E values of Imipenem/Cilastatin 1000mg Q8h and Meropenem 1000mg Q8h were the minimum.3.Logistic regression analysis showed that:ICU(OR=3.526,95%CI:1.525-8.157),and Carbapenems exposure>7d(OR=4.597,95%CI:1.5630-12.959)were independent risk factors for Carbapenem-resistant bacteria infection,with statistically significant differences(P<0.05).Conclusion(s):1.Compared that to 2018,the management of Carbapenems is more reasonable in 2019,but the following problems should need for better management:①strict control of drug indications;②microbiological examination before treatment;③strict implementation of dosage and frequency according to the standard;④blood concentration monitoring for patients combined with valproate and other special drugs;⑤strengthen special file management.Evaluation of rationality of drug use management is a long-term continuous work,which should be included in the daily procedures and management of clinical pharmacy work.2.The drug administration scheme should be determined by the results of pharmacoeconomics and the actual clinical situation.Carbapenems are time-dependent antibiotics.The minimum C/E value does not mean the best dosage regimens.Carbapenems should be administered multiple times a day to make T>MIC,taking into account patient compliance and nurse workload.3.Epidemiology can predict early potential risk factors.Admission to ICU and exposure to Carbapenems for more than 7 days are independent risk factors for Carbapenem-resistant bacteria infection.The hospital should enhance clinical use management of Carbapenems to reduce the spread of drug-resistant bacteria.