Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University; Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Shaanxi, China; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University; Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Shaanxi, China.
Int J Antimicrob Agents. 2023 Oct;62(4):106936. doi: 10.1016/j.ijantimicag.2023.106936. Epub 2023 Jul 28.
To assess trends and patterns of carbapenem use and to evaluate the effects of a nationwide antibiotic stewardship policy to reduce carbapenem overuse.
In this quasi-experimental study, using longitudinal data from the national drug procurement database and interrupted time-series analyses with carbapenems as the intervention group and possible carbapenem substitutes as the comparison group, we evaluated the effects of a national stewardship policy on carbapenem consumption and expenditures, by region and types of healthcare institutions.
The carbapenem procurement volume declined by -28.8% (95% CI -35.0 to -22.6) (-334.4 thousand defined daily doses [DDDs] per month), and carbapenem expenditures showed a relative reduction of -38.1% (-43.9 to -32.2). The gap between the use of carbapenems and each drug in the comparison group narrowed after the policy intervention, with an increase in tigecycline use (14.9 thousand DDDs [10.8-18.9]) and a slower decrease in use of certain third-generation cephalosporin combinations (-85.7 [-143.0 to -28.4]), penicillin combinations (-200.9 [-421.4-19.6]), and fourth-generation cephalosporins (-116.9 [-219.8 to -14.0]). Consumption was highest during the pre-policy period, and declines were largest following the intervention in the eastern region (-32.1%, -39.8 to -24.4) and among tertiary hospitals (-266.2 [-339.5 to -192.9] thousand DDDs per month).
This population-level drug utilization research represents the first comprehensive evaluation of the effectiveness of China's nationwide carbapenem stewardship. The national policy targeting carbapenem prescribing has led to a sustained reduction in carbapenem use with limited substitution. Effects varied geographically and were concentrated in tertiary and secondary hospitals.
评估碳青霉烯类药物使用的趋势和模式，并评价一项全国性抗生素管理政策对减少碳青霉烯类药物过度使用的效果。
在这项准实验研究中，我们使用国家药物采购数据库的纵向数据和中断时间序列分析，以碳青霉烯类药物为干预组，以可能的碳青霉烯类药物替代品为对照组，评估了一项全国性管理政策对碳青霉烯类药物消费和支出的影响，按地区和医疗机构类型进行评估。
碳青霉烯类药物采购量下降了 -28.8%（95%CI-35.0 至-22.6）（-334.4 千日剂量[DDD]/月），碳青霉烯类药物支出显示相对减少了-38.1%（-43.9 至-32.2）。政策干预后，碳青霉烯类药物与对照组中每种药物的使用差距缩小，其中替加环素的使用增加（14.9 千 DDD[10.8-18.9]），某些第三代头孢菌素联合制剂的使用减少速度减慢（-85.7[-143.0 至-28.4]），青霉素联合制剂（-200.9[-421.4-19.6]）和第四代头孢菌素（-116.9[-219.8 至-14.0]）。在政策实施前，碳青霉烯类药物的使用量最高，在东部地区（-32.1%，-39.8 至-24.4）和三级医院（-266.2[-339.5 至-192.9]千 DDD/月）干预后下降幅度最大。
这项基于人群的药物利用研究代表了对中国全国范围内碳青霉烯类药物管理效果的首次全面评估。针对碳青霉烯类药物处方的国家政策导致碳青霉烯类药物使用持续减少，替代药物有限。影响在地理上有所不同，集中在三级和二级医院。
