The Establishment And Practice Of Carbapenems Evaluation System In Clinical Application

Objective:Carbapenems are known as the last defense of treatment of gram-negative bacteria infection. In order to make carbapenems play a more important role in the treatment of gram-negative bacteria infection and delay their increasing resistance to carbapenems gram-negative bacteria, we need to have more strict management and retional use of carbapenems. This paper tried to establish an evaluation system in clinical application of carbapenems, strengthen their clinical application management and make them be used reasonably and properly.Methods:By applying the methodology of drug use evaluation, this paper established the carbapenems evaluation system in clinical application and designed the carbapenems evaluation table on the basis of its evaluation system in clinical application. Its main content included patient information, laboratory examination, diagnosis, drug information, medication indications and evaluation, the preparation process and evaluation, the result evaluation and management of eight index evaluation. A cross-sectional study of52cases on the use of carbapenems was made, which was dated from September27,2013to December31,2013. Moreover, SPSS17.0software is adopted to establish the database, data statistics and to analyze the result of the evaluation.Results:Carbapenems evaluation system in clinical application included evaluation index, evaluation criterion, evaluation basis and goals. Evaluation index was divided into four primary indexes and17secondary indexes, the former was sequenced as follows: drug index, preparation process, results, and management indexes; the latter is sequenced as indications, contraindications, special use classes of antimicrobial agents application form, laboratory indexes, drug selection, the way of dosing dosage giving and time interval, the special groups, solvent dosage and choice, time intravenous drip, duration of treatment, combination and interaction, records, prescribe right, adverse drug reactions, the improvement and cure of symptoms.Among52cases,8cases completely conforms to the evaluation standard, and the coincidence rate was15.4%.Indications (coincidence rate96.2%), contraindications (coincidence rate1.9%), monitoring vital signs (coincidence rate100.0%), choice of drug delivery system (coincidence rate100.0%), drip time (coincidence rate100.0%), interaction (coincidence rate98.1%), ADR (coincidence rate100.0%), fill out the "special use classes of antimicrobial agents application form"(coincidence rate100.0%) to achieve goals; Etiology examination before medication (coincidence rate80.8%), blood picture monitoring (coincidence rate53.9%), liver and kidney function monitoring (coincidence rate94.2%), drug dosage and time interval (coincidence rate84.6%), the special groups (coincidence rate88.9%), dosage of solvent and selection of solvent(coincidence rate17.3%), course of treatment (coincidence rate73.1%), combination (coincidence rate86.4%), symptoms improved or cured above (coincidence rate65.4%), special circumstances use less than or equal to supplement within24h and24h "special use classes of antimicrobial agents application form"(coincidence rate46.2%), medical records, medical indications (coincidence rate84.6%) and combination indications (coincidence rate63.6%), the right to prescribe (coincidence rate69.2%) did not achieve expected goals.Total of189were etiology specimens in52cases, the sputum specimens of61(32.3%); Blood samples of118(62.4%). Gram-negative bacteria were isolated8strains(72.7%);1gram positive bacteria strains(9.1%); Fungus2strains(18.2%). All52cases of etiology monitoring account for100.0%.52cases were PCT test (100.0%);7cases were sputum smear (bacteria)(13.5%);23cases were sputum smear (fungi)(44.2%);29cases were sputum culture(55.8%);18cases were blood culture(34.6%).Conclusion:1.This paper established the carbapenems evaluation indexes which is scientific, representative and practical. It included four first-level indexes and17secondary indexes.2. The carbapenems evaluation indexes were feasible. It was able to evaluate the carbapenems clinical problems.3.There were some carbapenems clinical problems to be solved in sample hospital.Such as drug dosage and time interval,mamagement indexes,laboratory indexes,the special groups,dosage of solvent and selection of solvent,course of treatment,combination did not achieve expected goals.