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OBJECTIVE： To analyze the application of antibiotics in 18 community health service centers in Shanghai Chongming district， and to further strengthen rational use of antibiotics. METHODS： By retrospective analysis， statistical analysis was made on the monitoring data of antibiotic use and 21 600 prescriptions reported by 18 community health service centers in Chongming district of Shanghai from Jan. 2016 to Dec. 2018 in respect of antibiotics use， top 5 antibiotics in the list of DDDs， prescription analysis， etc. RESULTS： From 2016 to 2018， the average annual total income of medical treatment， drugs and antibiotics of 18 community health service centers in Chongming district of Shanghai were 490 499 000 yuan， 427 231 500 yuan and 41 602 900 yuan respectively. Annual average incomes of outpatient and inpatient antibiotics were 35 435 700 and 6 262 100 yuan. Annual consumption amount of antibiotics were 2 129 627.71 and 70 829.51 DDD. The proportion of antibiotics was 9.76％. Annual antibiotics use density （AUD） was 29.41 DDD. Compound annual growth rate （CAGR） was negative for antibiotics ratio （－3.27％）， outpatient antibiotics consumption amount （－18.40％）， antibiotics consumption amount for outpatient per time （－17.83％）， inpatient antibiotics consumption amourt （－1.25％） and AUD （－0.98％）. The dosage form of top 5 antibiotics in the list of DDDs within 3 years were oral preparation， among which cefuroxime， cefaclor， levofloxacin and cefpropene were all ranked in the top five in three years. In 21 600 prescriptions， average number of drug per prescriptions was 1.99， the average amount of prescription was 120 yuan， and the number of antibiotics types used accounted for 8.24％ of total drug types； 15.43％ of the prescriptions used antibiotics， the average amount of the prescriptions containing antibiotics was 114.46 yuan， and the total amount of antibiotics accounted for 8.24％ of the total amount of the prescriptions. CONCLUSIONS： The rational use of antibiotics in Chongming community health service center has been continuously improved， and can provide reference for drug management of primary hospitals.
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OBJECTIVE:To provide reference for rational prophylactic application of antibiotics in perioperative period of per-manent cardiac pacemaker implantation. METHODS:600 cases performed permanent cardiac pacemaker implantation in 2010(be-fore rectification),2012(during rectification)and 2014(after rectification)were randomly sampled from our hospital,and divided into control group,intervention group one and intervention group two. The prophylactic application of antibiotics was investigated and analyzed in 3 groups. RESULTS:For control group,intervention group one and intervention group two,the rates of rational type selection of antibiotics for prophylactic use were 7.25%,31.00% and 91.96%,respectively. The rates of rational medication timing of antibiotics for prophylactic use were 0,100% and 100%;average duration of prophylactic use decreased from (3.6 ± 1.2)d before intervention to(1.1±0.5)d and(1.0±0.2)d. There was no statistical significance in the incidence of postoperative infection(P>0.05). Compared with control group,average drug cost,antibiotics cost and drug ratio decreased significantly in in-tervention group,with statistical significane (P<0.05). CONCLUSIONS:Antibiotics special rectification is effective and improve the rational application of antibiotics in our hospital.
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OBJECTIVE:To evaluate the effect of clinical antibiotics use special rectification in our hospital. METHODS:100 discharged medical records of typeⅠincision surgery were randomly sampled from our hospital during May in 2010 to Apr. in 2011,May in 2011 to Apr. in 2012,May in 2012 to Apr. in 2013,May in 2013 to Apr. in 2014,totaling 400 records. And then evaluation indicators were analyzed statistically,such as antibiotics use intensity,perioperative DDDs of antibiotics in typeⅠinci-sion surgery,DUI,types of antibiotics during perioperative period,medication time,etc. RESULTS:Since the implementation of clinical antibiotics use special rectification in May 2011,the utilization ratio of antibiotics in typeⅠincision surgery of our hospital decreased from 96% to 33%;DUI decreased from 1.44 to 0.79;while reasonable rate of drug selection increased from 19.8% to 100%,and that of medication time increased from 43.8% to 100%. CONCLUSIONS:Rational medication evaluation indicators in typeⅠincision surgery of our hospital have been improved after the implementation of clinical antibiotics use special rectification.
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OBJECTIVE:To evaluate the effect of special rectification on the rational use of antibiotics and relieving bacterial resistance. METHODS:It was divided into groups based on the before and after 3 years of special rectification. The data of related index and bacterial resistance of antibiotics in the clinical use in 2 groups were compared. RESULTS:After special rectification, the use rate of antibiotics in inpatients was decreased from 77%to 55%,use intensity was decreased from 86 DDDs/(100 person· d) to 39 DDDs/(100 person·d),the prophylactic use rate of antibiotics for typeⅠincision surgery was decreased from 98% to 27%,the antibiotics prescriptions of patients in outpatient and emergency departments were respectively decreased from 36% to 12% and 49% to 23%. The submission rate of microbiological testing specimens was increased from 20.2% to 38.8%,submission rate of sterile site specimens was increased from 29.8% to 37.6%. The detection rate of fungus was decreased from 14.4% to 11.2%. The detection rates of Escherichia coli and Klebsiella pneumoniae producing extended-spectrum β- lactamases (ESBLs) strains were respectively decreased from 57.3% to 51.3% and 43.2% to 36.1%. The total detection rate of top 5 multi-drug resis-tant bacteria was decreased from 48.4% to 29.3%,however,the detection rate of Acinetobacter baumannii was increased to 80.7%,and the resistance rates of Acinetobacter baumannii to imipenem and meropenem were respectively 66.9% and 69.1%. There was an increasing trend for Klebsiella pneumoniae to 1,2 and 3-generation cephalosporins,piperacillin amoxicillin/tazobac-tam,imipenem,meropenem. CONCLUSIONS:Special rectification of antibiotics has obvious effect on the rational use of antibiot-ics and relieving bacterial resistance in the clinic,and it improves the management of clinical use of antibiotics in hospital. Howev-er,bacterial resistance situation is still grim,it needs to establish a long-term management mechanism of clinical use of antibiotics, strengthen the monitoring pathologic examination and monitoring of bacterial resistance,and strictly perform hand hygiene and dis-infection and isolation system.
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OBJECTIVE:To provide reference for rational use of antibacterials. METHODS:Taking 69 hospitals of Beijing, Tianjin,Shanghai,Hangzhou,Guangzhou,Chengdu as samples,the data about the purchase and application of antibacterials in outpatient department were collected during 2009 to 2013,and analyzed in terms of the proportion of the amount of antibacterials in all chemical drugs,the number of antibacterials among top 80% chemical drugs in the list of consumption sum and their variet-ies number,the utilization rate of antibacterials in outpatient prescription,the percentage of two and more antibiotics combination in outpatient antibiotics prescriptions,the proportion of antibiotics use,etc. RESULTS:The proportion of average purchase amount of antibacterials in chemical drugs decreased from 20.97 % in 2009 to 14.17 % in 2013;the number of antibacterials among top 80% chemical drugs in the list of consumption sum decreased from 43 in 2009 to 34 in 2013;the average utilization rate of outpa-tient antibacterials decreased from 23.22 % in 2009 to 16.11 % in 2013;there was statistical significance(P<0.05). The varieties of antibacterials decreased from 78 kinds in 2009 decreased to 54 kinds in 2012(P<0.05),but rise to 66 kinds in 2013;the per-centage of two and more antibacterials combination in outpatient antibacterials prescriptions decreased fron 9.02% in 2009 to 7.35% in 2012 (P<0.05),rise to 12.89% in 2013. The utilization ratio of antibacterials injection in outpatient antibacterials pre-scriptions had no significant change. The utilization of antibacterials in tertiary hospitals from 6 districts was analyzed;cephalospo-rin had ranked the first place,and almost occupied half part of antibacterials but declined;the utilization rate of antibacterials for special use was on the rise. CONCLUSIONS:After 3 years of antibacterials special rectification,and the utilization of antibacteri-als in 6 districts as Beijing have been improved significantly;however,several index have little improvements,and some rebound-ed in 2013,so this activities needs to establish long-term mechanism of continuous supervision.
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OBJECTIVE:To provide reference for the rational application of antimicrobial drugs. METHODS:Medical records of all acute exacerbation of chronic obstructive pulmonary disease(AECOPD)hospitalized patients were collected from respiration department of our hospital during Sept. 2013 to Apr. 2014 and May 2014 to Dec. 2014,73 and 88 cases respectively. The applica-tion of antimicrobial drug was analyzed comparatively,and the rationality of drug use in AECOPD patients was evaluated. RE-SULTS:After the special rectification activities,the antimicrobial use intensity dropped from 217.74 to 91.58;drug combination rate dropped from 67.12% to 6.82%;no reason to change the antimicrobials conditions dropped from 15.07% to 0;hospital stay shortened from(10.21±3.44)d to(7.13±3.14)d;the total cost of medical treatment dropped from(6 117.73±1 164.52)yuan to (4 574.82±997.28)yuan;percentage of medicine expenses and antimicrobial drug expenses dropped from(61.83±11.49)% and (28.84±9.55)% to(43.52±9.97)% and(20.07±6.43)%,respectively;there was statistical significance(P<0.05),and the clinical treatment effect were uninfluenced. CONCLUSIONS:The special rectification activities of antimicrobial drugs could effec-tively improve the rational application of antimicrobial drugs and enhance the efficacy of antimicrobial drugs and decrease the cost of drug use.
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Objective:To analyze and evaluate the usage and tendency of quinolones before and after the special rectification of antibacterial in one grade III level A hospital in üanjing to provide evidence for the special rectification of antibacterial and manage-ment. Methods:The usage records of quinolones in 2010( before the special rectification)and in 2011-2013( after the special rectifi-cation)were collected,and the sales revenue,DDDs,defined daily cost( DDC),drug resistance and adverse drug reactions( ADR) were analyzed retrospectively. Results:Both the amount and ratio of the sales revenue of quinolones were declined dramatically after the rectification(2011-2013). Among all kinds of quinolones,the sales revenue and DDDs of lomefloxacin aspartate injections was the highest before the rectification while moxifloxacin injections and levofloxacine hydrochloride injections ranked the first and the second respectively in sales revenue after the rectification(2012-2013). As for the DDDs,levofloxacin hydrochloride tablets and levofloxacine hydrochloride injections were the highest after the rectification. Besides,moxifloxacin injections had the highest DDC after the rectifica-tion. Moreover,the drug resistance of the main drug-resistant bacteria( namely staphylococcus,enterobacteriaceae and non fermenta-tion bacteria)to levofloxacin,norfloxacin and ciprofloxacin was declined after the rectification. The adverse drug reactions of levofloxa-cin,lomefloxacin,enoxacin and moxifloxacin were declined year by year after the rectification,and the ADR ratio of quinolones in all anti-bacterial agents was also declined. Conclusion:After the special rectification of antibacterials,the hospital exhibits obvious im-provement in all the application indices of antibacterials,reflecting a good result of the special rectification. However,the hospital still needs to strengthen the inspection over the clinical application of the fourth generation of quinolones.
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Objective:To explore the impact of special rectification on antibiotics application in the patients during perioperative period with gynecologic typeⅡincision in our hospital. Methods:The antibiotics type, use frequency, expense, administration time, dosage, treatment course and combined medication were retrospectively compared between April to September in 2011(before the recti-fication) and April to September in 2013 (after the rectification). Results: After the special rectification, the total DDDs was de-creased from 1 564. 5 to 419. 3, the expense for antibiotics and all drugs was respectively decreased from (297. 5 ± 47. 1) yuan to (108. 3 ± 29. 6) yuan and (806. 4 ± 63. 1)yuan to (498. 1 ± 70. 2) yuan, the proportion of antibiotics was decreased from (36. 9 ± 9.1) % to (21.7 ±6.8) %, and the treatment course was reduced from (3.7 ±1.4)d to (1.5 ±0.6)d(P<0.05). The rational rate of administration time, dosage and combined medication was respectively increased from 67. 7% to 98. 6%, 81. 5% to 100. 0%and 41. 1% to 80. 7%(P<0. 05). Conclusion:Special rectification can effectively improve the rational antibiotics use in gynecology department of our hospital during perioperative period of type Ⅱincision.
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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 The article was to promote the rational use of antibiotics by comparative analysis on antimicrobial us -age before and after the special rectification on clinical application of antibacterial drugs in our hospital . Methods Medical record data of 132 inpatients before the rectification and 167 inpatients after the rectification were randomly collected for the rational compara-tive analysis on microorganism submission rate for treatment , usage of antibiotics and medication for typeⅠandⅡincisions . Results The microorganism submission rate was much higher , especially the special grade antibiotics (81.5 %vs 32.1%).There was also a remarkable decrease in the percentage of antibiotics use , the strength of utilization and the average drug cost .The amount of antibiotic prophylaxis without indication and the length of medication for typeⅠincisions showed a remarkable decrease (P<0.05).Remarkable decrease was also observed in the irrational usage rate of antibiotic prophylaxis , dosage, medication time and drug replacement for typeⅠand Ⅱincisions (P<0.05). Conclusion The special rectification measures are effective and practical , which can promote the rational use of antibiotics .
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Objective To evaluate the effect of special rectification of clinical antimicrobial use in a hospital. Methods Medical records of patients receiving inguinal hernia repair before (in 2011)and after (in 2012)the per-formance of special rectification were reviewed,and the rationality of perioperative antimicrobial prophylaxis was compared.Results Prophylactic antimicrobial usage rate in patients receiving inguinal hernia repair decreased from 53.90%(76/114)in 2011 to 5.59%(10/179)in 2012,the difference was significant (χ2 =93.68,P <0.05);aver-age expense of antimicrobial use per patient decreased by 86.95% (from ￥ 624.73 in 2011 to ￥ 81 .52 in 2012);Combination use and single use was 93.42% and 80.00% respectively.Surgical site infection did not occur in both groups.Conclusion Through the special rectification activities of the clinical antimicrobial use,perioperative anti-microbial prophylaxis and expense of antimicrobial agents in patients receiving inguinal hernia repair is effectively re-duced.