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The improvement of antibiotic rational use in China was studied by usage analysis of combination antibiotic therapy for type I incisions in 244 hospitals. Five kinds of hospitals, including general hospital, maternity hospital, children's hospital, stomatological hospital and cancer hospital, from 30 provinces were surveyed. A systematic random sampling strategy was employed to select outpatient prescriptions and inpatient cases in 2011 and 2012. A total of 29 280 outpatient prescriptions and 73 200 inpatient cases from 244 hospitals in each year were analyzed. Data were collected with regards to the implementation of the national antibiotic stewardship program (NASP), the overall usage and the prophylactic use of antibiotic for type I incisions. Univariate analysis was used for microbiological diagnosis rate before antimicrobial therapy, prophylactic use of antibiotics for type I incision operation, and so on. For multivariate analysis, the use of antibiotics was dichotomized according to the guidelines, and entered as binary values into logistic regression analysis. The results were compared with the corresponding criteria given by the guidelines of this campaign. The antibiotic stewardship in China was effective in that more than 80% of each kind of hospitals achieved the criteria of recommended antibiotics varieties. Hospital type appeared to be a factor statistically associated with stewardship outcome. The prophylactic use of antibiotics on type I incision operations decreased by 16.22% (P<0.05). The usage of combination antibiotic therapy for type I incisions was also decreased. Region and bed size were the main determinants on surgical prophylaxis for type I incision. This national analysis of hospitals on antibiotic use and stewardship allows relevant comparisons for bench marking. More efforts addressing the root cause of antibiotics abuse would continue to improve the rational use of antibiotics in China.
Subject(s)
Female , Humans , Male , Anti-Bacterial Agents , Therapeutic Uses , China , Epidemiology , Drug Prescriptions , Drug Utilization , Hospitals , Inpatients , Outpatients , Surgical Wound , Epidemiology , Microbiology , TherapeuticsABSTRACT
Objective To investigate effect of antibiotic standardized management on prophylactic application of antimicrobial agents in type I andⅡ incision.Methods The hospital implemented the rule of Clinical Use of Antibiotics Management Approach and 2013 National Clinical Use of Antibiotics Special Rectification Program of Activities, 200 clinical surgery effective surgical cases before implementation and 250 clinical surgical effective surgical cases after implementation were selected.The thyroid surgery and hernia repair surgery were chosen as type I incision, and cesarean section were chosen as type Ⅱ incision.The basic data of surgery classification and antibacterials use were collected, then the antibiotics utilization ratio, the timing of administration of antibiotics, postoperative use of antibiotics time and combination therapy were compared between pre-implementation and post-implementation.Results The condition in accordance with applicable standards of antibiotics post-implementation: the antibiotics utilization ratio of thyroid surgery was 0 and post-operative stopping time was within one day.There was no combination therapy of three types surgery ( thyroid surgery, hernia repair surgery and cesarean section).The application of antimicrobial agents improved significantly but did not reach criteria:antibiotics utilization ratio of hernia repair surgery was 62.00%, which was higher than the criterion of 30% in antibiotic standardized management.Withdrawal time of antimicrobial agents post-operation in hernia repair surgery was (1.01 ±0.15)d which was above the standard of 1d and in cesarean section was (2.02 ±0.25)d which was above the standard of 2d.Conclusion The hospital strengthens management and standardizd regulation of antimicrobial drugs could facilitate standardization in type I and Ⅱ incision, and improve the quality of hospital medication administration of antibiotics.
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Objective To analyze antimicrobial use in the different grades of hospitals within 3 years after the car-rying out of rectification activities of antimicrobial use,and provide basis for making continuous improvement pro-gram of antimicrobial management.Methods Retrospective analysis was performed,outpatient and emergency pre-scriptions and medical records of discharged patients (100 were type Ⅰ incision surgery)were selected from 5 tertia-ry hospitals and 5 secondary hospitals within 3 months,antimicrobial use and management were investigated. Results 200 outpatient prescriptions,100 emergency prescriptions,and 200 medical records of discharged patients were selected from each hospital.In tertiary and secondary hospitals,antimicrobial usage rate in outpatient prescrip-tions was 17.40% and 18.00% respectively,emergency prescriptions was 31 .60% and 40.10% respectively;a-mong inpatients,antimicrobial usage density(AUD)was (28.13±8.04)and (49.67±11 .63)respectively,and anti-microbial usage rate was 41 .30% and 56.20% respectively;pathogenic detection rate of antimicrobial therapeutic cases was 45.70% and 22.70% respectively,therapeutic cases with limit level of antimicrobials was 61 .50% and 27.40% respectively;antimicrobial usage rate in type I incision surgery was 20.00% and 40.40% respectively;The rational rate of antimicrobial types was 94.60% and 59.20% respectively,rational rate of opportunity of antimicro-bial use was 95.20% and 48.20% respectively;combination rate was 8.80% and 36.60% respectively,and rational rate of treatment course was 84.00% and 52.80% respectively.Conclusion In tertiary hospitals,antimicrobial use after 3 years rectification of antimicrobial use conform to the antimicrobial management requirement of Ministry of Health,the overall quality index is better than secondary hospitals,management of antimicrobial in secondary hos-pitals use should be improved.
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Objective:To investigate the improvement in antibiotics use in our hospital by comparing the prophylactic application of antibiotics in type I incision before and after antimicrobial drug special rectification. Methods:The medical records of 100 hospital-ized patients undergoing I incision respectively from May to December in 2011 (before the rectification), from May to December in 2012 ( during the rectification) and from May to December in 2013 ( after the rectification) were withdrawn randomly. The prophylactic application of antibiotics was statistically and comparatively analyzed. Results: After the antimicrobial drug special rectification, the prophylactic application rate of antibiotics was reduced from 100% to 28%, and in 7 kinds of operations stressed by the National Health and Family Planning Commission ( inguinal hernia repair, thyroid disease, breast disease, arthroscopy, carotid endarterectomy, skull tumor resection and endovascular interventional diagnosis) , the prophylactic use rate of antimicrobial drugs was reduced to 11%. The variety choice of antibiotics in type I incision was more reasonable. The irrationality rate of medication time and course was de-creased obviously, and the accuracy of dosage and usage was improved significantly. The combination of antibiotics was also notably decreased. Conclusion:The antimicrobial drug special rectification is effective, which can significantly improve the prophylactic appli-cation rationality of antibiotics for type I incision in our hospital.
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OBJECTIVE: To provide reference for patients with type I incisions about rational use of antibiotics.METHODS: Between Oct.2007 and Mar.2008,a total of 1 024 medical records of patients with type I incisions from orthopaedics,common surgery,department of gynecology in 12 hospitals of Xining area were sampled for analysis of prophylactic use of antibiotics.RESULTS: 100.0% of the type I incision patients received prophylactic antibiotics;28.4% used antibiotics without indication;16.9% used antibiotics at 0.5～2 h before operation;33.4% used antibiotics at more than 2 h before operation;and 49.7% received antibiotics postoperatively rather than preoperatively.The irrational and nonstandard use of antibiotics manifested as improper in the choice of drug variety,nonstandard in drug combination,irrational in dosage and administration,prolonged use of antibiotics,lacking basis for the change of drug variety etc.CONCLUSION: The prophylactic use of antibiotics in patients with type I incisions from 12 hospitals of Xining area is far from perfect,therefore,it is urgent to strengthen the standard management on the use of antibiotics.