Application Management of Carbapenems in Tuberculosis Patients of Our Hospital Based on Multi-disciplinary Team / 中国药房

ABSTRACT

OBJECTIVE：To provide reference for the ra tional use of carbap enems in tuberculosis patients. METHODS ：Totally 12 576 tuberculosis inpatients were collected from our hospital. Multi-disciplinary team （MDT） model was adopted for carbapenems management in aspects of policy intervention ，technical support and staff training. Average hospitalization duration ， mortality，nosocomial infective rate ，use and drug resistance of carbapenems were compared before （Mar. 2016-Mar. 2017）and after management （Apr. 2017 to Mar. 2019）. Interrupted time series （ITS）analysis was used to analyze the utilization rate of carbapenems，DDDs，the proportion of carbapenems ’DDDs in the total antibiotics ’DDDs，the proportion of carbapenems ’cost in the total antibiotics ’cost before and after management. Pearson correlation analysis was conducted for DDDs of carbapenems with medical quality indicators and detection rate of carbapenems-resistant bacteria. RESULTS ：After the management ，average hospitalization stay ，the cost of antibiotics ，DDDs of carbapenems ，the proportion of carbapenems ’DDDs in the total antibiotics ’ DDDs，the proportion of carbapenems ’cost in the total antibiotics ’cost，the utilization rate of carbapenems ’，and the drug resistance rate of some bacteria to carbapenems were significantly lower than those before the management （P＜0.05）. ITS analysis results showed that after management ，the utilization rate of carbapenems ，DDDs，the proportion of com carbapenems’DDDs in the total antibiotics ’DDDs and the proportion of carbapenems ’cost in the total antibiotics ’cost hhyyzj@126.com were decrease d by 4.491％ ，220.276，6.535％ ，11.747％ ， with statistical significance （P＜0.05）. Co mpared with before management ，above indexes were decreased by 0.330％，17.625， 0.308％，0.304％ monthly，among which the utilization rate and DDDs of carbapenems were decreased significantly （P＜0.05）. Before management ，drug resistance rate of Pseudomonas aeruginosa to carbapenems was 21.80％，and those of Acinetobacter baumannii to meropenem and imipenem were both 4.60％；after management ，drug resistance rate of P. aeruginosa to imipenem was 13.00％，and those of A. baumannii to meropenem and imipenem were both 16.30％，with statistical significance before and after management （P＜0.05）. There was no statistical significance in drug resistance rate of Enterobacteriaceae （P＞0.05）. Pearson correlation analysis showed that carbapenems ’DDDs was significantly positively correlated with average hospitalization duration and antibiotics ’cost（P＜0.05）；imipenem’s DDDs was positively correlated with drug resistance rate of P. aeruginosa （P＜0.05）. CONCLUSIONS： MDT management can effectively standardize the use of carbapenem in tuberculosis patients ， shorten hospitalization duration ，and reduce drug cost ，DDDs and drug resistance rate of some bacteria.