1Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Yanta Western Road No. 277, Xi'an, 710061 China.
2Department of Management of the Economy, Xi'an University of Posts and Telecommunications, Xi'an, 710061 China.
Antimicrob Resist Infect Control. 2019 Jan 7;8:5. doi: 10.1186/s13756-018-0449-3. eCollection 2019.
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.
中国于 2011 年启动了为期 3 年的抗生素临床使用整顿计划，并于 2017 年出台了碳青霉烯类药物使用专项方案。本研究旨在探讨政府政策对碳青霉烯类药物使用的影响及其与耐碳青霉烯类肠杆菌科细菌（CRPA）的相关性。
本研究分为四个阶段：干预前（2010 年）、抗菌药物管理方案实施阶段（2011-2013 年）、抗菌药物管理方案实施后阶段（2014-2016 年）和碳青霉烯类药物管理方案实施阶段（2017 年）。提出了一种碳青霉烯类药物使用合理性评分系统，根据适应证、微生物培养、单次剂量、间隔时间和持续时间进行评估。任何处方未达到总分 10 分均判断为不合理。采用回归分析对趋势进行分析，采用 Spearman 相关分析检验相关性。
2010 年碳青霉烯类药物合理使用率为 29.7%，随后三个阶段分别提高了 55.5%、45.2%和 51.5%。抗菌药物管理方案实施后阶段（2014-2016 年），碳青霉烯类药物合理使用率略有下降，而碳青霉烯类药物消耗量明显增加，2017 年这两个参数略有改善。此外，CRPA 的流行率与碳青霉烯类药物合理使用率显著负相关（系数=-0.553，<0.05），与碳青霉烯类药物消耗量无关（>0.05）。
本研究中，碳青霉烯类药物的合理应用与政府政策有关，不合理使用碳青霉烯类药物可能与 CRPA 的发展有关。目前的评分系统可能是评估的有用工具。
