Ye Dan, Yang Caijun, Ji Wenjing, Zheng Jie, Zhang Jingyi, Xue Runqing, Gu Jianli, Chen Minchun, Yan Kangkang, Liu Yongzhong
Department of Pharmacy, Xi'an No.3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China.
Xi'an Key Laboratory of Cardiovascular and Cerebrovascular Diseases, Xi'an No.3 Hospital, The Affiliated Hospital of Northwest University, Northwest University, Xi'an, China.
Front Pharmacol. 2022 Jan 13;12:739960. doi: 10.3389/fphar.2021.739960. eCollection 2021.
Carbapenems are considered the last line of defence against bacterial infections, but their high consumption and the resulting antibacterial resistance are an increasing global concern. In this context, the Chinese health authority issued an expert consensus on the clinical applications of carbapenems. However, the long- and short-term effects of the expert consensus on carbapenem use are not clear. This study was conducted in Shaanxi, a northwest province of China. We collected all available carbapenem procurement data between January 2017 and December 2020 from the Provincial Drug Centralized Bidding Procurement System. A quasi-experimental interrupted time series analysis was used to evaluate the longitudinal effectiveness of expert consensus by measuring the change in the Defined Daily Dosesper 1,000 inhabitants per day (DID), the percentage of carbapenem expenditures to total antimicrobial expenditure, the total carbapenem expenditure, and the defined daily cost (DDDc). We used Stata SE version 15.0 for data analysis, and < 0.05 was considered statistically significant. After the distribution of the expert consensus, the level ( = 0.769) and trend ( = 0.184) of DID decreased, but the differences were not statistically significant. The percentage of carbapenem expenditures to total antimicrobial expenditure decreased abruptly ( < 0.001) after the intervention, but the long-term trend was still upward. There was no statistically significant relationship between the release of the expert consensus and carbapenem expenditure in the long term, but there was a decreasing trend ( = 0.032). However, the expert consensus had a positive impact on the economic burden of carbapenem usage in patients, as the level ( < 0.001), and trend ( = 0.003) of DDDc significantly decreased. The long-term effects of the distribution of the expert consensus on the use and expenditure of carbapenems in public health institutions in Shaanxi Province were not optimal. It is time to set up more administrative measures and scientific supervision to establish a specific index to limit the application of carbapenems.
碳青霉烯类药物被视为对抗细菌感染的最后一道防线，但其高消耗量以及由此产生的抗菌耐药性日益引起全球关注。在此背景下，中国卫生主管部门发布了关于碳青霉烯类药物临床应用的专家共识。然而，该专家共识对碳青霉烯类药物使用的长期和短期影响尚不清楚。本研究在中国西北部省份陕西开展。我们从省级药品集中招标采购系统收集了2017年1月至2020年12月期间所有可用的碳青霉烯类药物采购数据。采用准实验性中断时间序列分析，通过测量每千居民每日限定日剂量（DID）的变化、碳青霉烯类药物支出占抗菌药物总支出的百分比、碳青霉烯类药物总支出以及限定日成本（DDDc），来评估专家共识的纵向有效性。我们使用Stata SE 15.0版本进行数据分析，P<0.05被认为具有统计学意义。在专家共识发布后，DID的水平（P = 0.769）和趋势（P = 0.184）有所下降，但差异无统计学意义。干预后，碳青霉烯类药物支出占抗菌药物总支出的百分比急剧下降（P<0.001），但长期趋势仍呈上升。从长期来看，专家共识的发布与碳青霉烯类药物支出之间无统计学显著关系，但存在下降趋势（P = 0.032）。然而，专家共识对患者使用碳青霉烯类药物的经济负担产生了积极影响，因为DDDc的水平（P<0.001）和趋势（P = 0.003）显著下降。陕西省公共卫生机构中专家共识发布对碳青霉烯类药物使用和支出的长期影响并不理想。是时候制定更多行政措施和科学监管，建立具体指标来限制碳青霉烯类药物的应用了。
