Analysis And Evaluation Of Carbapenem Use In A Tertiary Hospital

Objective:To investigate the preference and problems in clinical use of carbapenem antibiotics in a tertiary hospital（amount、rationality）,which will provide theoretical and scientific basis for further optimizing the management of carbapenems.Methods:1.The use data of carbapenems antibiotics in a tertiary hospital from 2014 to 2019 was collected.An ARIMA model was built to predict the use tendency of carbapenem antibiotics in a tertiary hospital by using the AUD of carbapenem antibiotics as the basic data unit.2.The electronic medical records of carbapenems antibiotics from 2019 to 2020 were sampled by systematic sampling in a tertiary hospital,then the use of carbapenems on management index,medication rationality,medication process and medication efficacy were evaluated by employing the drug utilization evaluation method.3.Based on real-world data,the efficacy and safety of carbapenems andβ-lactamase inhibitor combinations in the initial empirical treatment of febrile neutropenia in hematologic malignancies was evaluated.Results:1.The AUD of carbapenem antibiotics ranges from 2.28 to 3.19 in a tertiary hospital from 2014 to 2019,and the annual amount of carbapenem antibiotics accounts for 7.92%of the total amount of antibiotics in a tertiary hospital.The ARIMA（1,0,0）（1,0,0）₁₂model showed that the use intensity of carbapenem antibiotics in a tertiary hospital increases year by year from 2014 to 2019.2.243 cases of carbapenems medical records were sampled for drug utilization evaluation,including 139 cases in 2019 and 104 cases in 2020.The results shows that 69.78%of them matched our management index,48.20%of them matched our medication indication,80.57%of them matched the corrected medication process,and the effective rate of medication（recovery and impro vement）was 78.90%in 2019.Meanwhile,The results shows that 78.84%of them matched our management index,58,65%of them matched our medication indication,87.50%of them matched the corrected medication process,and the effective rate of medication（recovery and improvement）was 88.65%in 2020.3.A total of 68 patients of febrile neutropenia after chemotherapy in hematologic malignancies were included in the study,including 42 patients in the carbapenem group and26 patients in theβ-lactamase inhibitor combinations.The results showed that the median time of absolute neutrophils recovery（ANC≥0.5×10⁹/L）is respectively 5（4-6）and 6（3-21.5）days in the carbapenems group and theβ-lactamase inhibitor combinations group after initial empirical antimicrobial therapy,which has no statistical difference between them（P≥0.05）.The duration of antibiotics treatment in two groups is respectively 5.59±2.34and 8.65±5.94 days,which has no statistical difference between them（P≥0.05）.The treatment success rate in two groups is respectively 65.4%and 64.3%,which has no statistical difference between them（P≥0.05）.Conclusion:1.The consumption amount of carbapenem atibiotics in a tertiary hospital shows an overall increasing trend year by year from 2014 to 2019.The tendency could be predicted by the ARIMA model,which has high prediction accuracy for the tendency of antibiotics consumption.2.Compared with that in 2019,the rationality of carbapenem antibiotics in 2020 has increased in terms of the compliance rate of management indicators,the correct rate of medication indications,the correct rate of medication process and the treatment success rate.It is necessary to strengthen the management of carbapenem atibiotics by education,training and monitoring of clinical use.3.Based on real-world data,there was no significant difference in the efficacy and safety of carbapenem antibiotics andβ-lactamase inhibitor combinations in the initial empirical treatment of febrile neutropenia in hematologic malignancies.Therefore,β-lactamase inhibitor combinations could be considered as an alternative drug in the initial empirical treatment of febrile neutropenia in hematologic malignancies.