Analysis on effect of antimicrobial stewardship based on information technology for 6 years / 中华急诊医学杂志

Objective:To evaluate the effectiveness of antimicrobial stewardship based on self-developed antibiotic clinical decision support system (aCDSS) in the inpatients at a tertiary hospital for consecutive 6 years, and to provide reference for rational use and antimicrobial stewardship.Methods:aCDSS was self-designed based on information technology and applied in clinical use in our hospital from 2015. Data of inpatient information and antibacterial use from January 2015 to December 2020 were collected from HIS and aCDSS. A retrospective study was conducted in all inpatients on the utilization rate and antibiotic use density.Results:Since 2015, with the comprehensive implementation of antimicrobial stewardship based on the aCDSS,there was a significant decline on the annual rate of antibiotic usage from 44.18% in 2015 to 38.70% in 2020, as well as on the usage rate of extended-spectrum antimicrobial agents including carbapenems, broad-spectrum β-lactam/β-lactamase inhibitors, tigecycline, broad-spectrum cephalosporins, fluoroquinolones, as well as glycopeptide and antifungal drugs. Compared with 2015, the usage of carbapenems, tigecycline and broad-spectrum β-lactam/β-lactamase inhibitors was declined nearly 50% in 2020, and the density of carbapenems and tigecycline were decreased by 29.6% and 7.1%, respectively in 2020. On the other side, the utilization rate and use density of narrow-spectrum cephalosporins continued to increase by year, the use density of narrow-spectrum cephalosporins accounting for 28.2% of all antibiotics in 2020.Conclusions:With the comprehensive implementation of aCDSS, the utilization rate and density of broad-spectrum and high-priced antibacterial drugs in our hospital have decreased continuously to decline in the past 6 years, while the proportion of narrow-spectrum antimicrobials has increased year by year, indicating that the structure of antimicrobial use has been continuously optimized and that antimicrobial stewardship based on the information technology have achieved remarkable results.

Investigation on antimicrobial usage in 451 patients with complicated intra-abdominal infection / 中华急诊医学杂志

Objective To investigate the microbiological epidemiology and clinical use of antibiotics in patients complicated intra-abdominal infection (cIAI),therefore to optimize antibiotic use and to promote antimicrobial stewardship.Methods A total of 451 patients with cIAI from a Chinese tertiary hospital between January 2015 and December 2016 were retrospectively reviewed.The infection severity,timing of microbiological specimen sampling,culture results,initial antibiotic selection and later anti-infective regimen adjustment were analyzed.Results Three hundred and sixteen (70.1％,316/451) patients undergone microbiological investigation at infection sites within 3 days and 133 (42.1％) patients had a positive culture,of which 64.5％ were Enterobacteriaceae.Three hundred seventy-four patients (82.9％) initially received broad-spectrum antibiotics against gram-negative bacilli.Sixty-five patients (14.4％) initially received combined antibiotic therapy,of which 30.8％ were deemed as overuse.Among 308 patients who initially received broad-spectrum antibiotic therapy,268 patients (87.0％) clinically improved in five days,while de-escalation was only conducted in 72 cases (26.9％).On average,patients were treated with (2.29±1.30) antibiotics for a duration of (10.6±6.5) days,and 42.4％ received combined antibiotic therapy during hospitalization.Conclusions The major microbiological pathogens in cIAI patients in our hospital were Enterobacteriaceae.However,there are phenomena such as excessive usage with broad-spectrum antibiotics,insufficient awareness of de-escalation,and long course of anti-infective therapy,which needs to be further improved.

Antithrombotic effects of cilostazol combined with clopidogrel and aspirin in senile patients with cerebrovas-cular disease after PCI surgery / 中国基层医药

Objective To analyze the antithrombotic effects of cilostazol combined with aspirin and clopi-dogrel in elderly patients with cerebrovascular disease after PCI .Methods 100 elderly patients with cerebrovascular diseases who treated with coronary artery interventional therapy ( PCI) were randomly divided into the control group and the observation group according to the digital table ,50casess in each group.The two groups were given control of blood pressure ,blood lipids ,blood sugar ,improve circulation and other conventional treatment .The control group was treated with aspirin combined with clopidogrel ,the observation group was treated with cilostazol based on the treatment of control group.Before and after treatment for 1,4 and 8 weeks,the platelet aggregation degree was detected by PL-11 automatic platelet analyzer .During 2 months of follow-up,the degree of platelet aggregation ,the volume of platelets,the efficacy of treatment and the incidence of adverse reactions were compared .Results The platelet aggre-gation rate between the two groups had no statistically significant difference before treatment (t0 =2.782,P>0.05). After treatment,the platelet aggregation rate of the two groups decreased significantly ,but after treatment for 1,4 and 8 weeks,the platelet aggregation rates of the observation group were significantly lower than those of the control group [(51.87 ±9.65)％,(40.85 ±10.24)％,(38.52 ±9.64)％;(69.25 ±8.41)％,(62.43 ±9.22)％,(58.46 ± 10.18)％],the differences were statistically significant (t1 =5.693,t4 =4.846,t8 =6.719,all P<0.05).Before treatment,the mean platelet volume between the two groups had statistically significant difference ( t0 =2.146,P>0.05).After treatment,the platelet volume of the two groups decreased significantly ( t1 =1.656,t4 =1.438,t8 =2.189,all P<0.05).There were no statistically significant differences between the observation group and the control group (t1 =3.716,t4 =1.271,t8 =2.523,all P>0.05).The effective rate of the observation group was 94.00％(47/50),which was significantly higher than that of the control group [82.00％(41/50)],the difference was statis-tically significant (χ2 =4.683,P<0.05).The incidence rates of adverse reactions in the observation group and the control group were 10.00％(5/50) and 8.00％(4/50),respectively,there was no statistically significant difference between the two groups (χ2 =1.947,P=0.136).Conclusion Cilostazol combined with clopidogrel and aspirin in the treatment of elderly patients with cerebrovascular disease after PCI can significantly reduce platelet aggregation rate,improve clinical curative effect ,and has certain clinical value .

Analysis on the Trend of Drug Use in 22 Hospitals in Hangzhou Region during the Period from 2002 to 2004 / 中国药房

OBJECTIVE:To evaluate the trend of drug use in22hospitals in Hangzhou region.METHODS:The medi?cation data obtained from22hospitals in Hangzhou region during the period from2002to2004were statistically analyzed.RESULTS:The total amount of money for drug purchase has been steadily increasing,but the growth rate has begun to de?crease;The amount of money for purchase of anti-infective agents always ranked the first but the percentage declined year by year;The purchase of domestic drugs increased by a wide margin and accounted almost50%of the total market consumption.CONCLUSION:The money used in purchase of anti-malignancy drug,drug for cardiovascular system,and vitamins tends to increase.

Analysis of Agents for Osteoporosis Used in 136 Hospitals of the 6 Cities in the Yangtze Valley during the Period of 1999～2003 / 中国药房

OBJECTIVE:The study was aimed to evaluate the current states and the trend of agents for osteoporosis.METHODS:Information concerning the sales volume,manufacturers and etc.of the agents for osteoporosis in136hospitals of the6cities in the Yangtse Valley during the period of1999～2003was statistically analyzed.RESULTS:Of the total con?sumption kinds during the period of1999～2003,the consumption sum ratio of the agents for osteoporosis was decreasing an?nually and its categories were in a dynamic change.With regard to the sequencing of the consumption sum for the osteoporosis agents,the calcium preparations and active vitamin D ranked the first in each year;there was a big increase in the consumption of diphosphonates and calcitonins;new drugs such as statins and selective estrogen receptor modulators were also used for the treatment of osteoporosis.CONCLUSION:The prospect for the market of agents for osteoporosis is very bright.