Evaluation and Analysis of the Rationality of Clinical Use of Carbapenems in Surgical Departments of a Tertiary Hospital in Southwest China

Figures & data

Table 1 Evaluation Criteria for the Rationality of Clinical Use of Carbapenems

Evaluation Item	Evaluation Indicators	Scoring Instructions	Points
Indications	Severe infection caused by aerobic gram-negative bacilli that are multi-resistant but sensitive to such drugs.^Citation21	Yes	90
	Severely ill patients with mixed infection of anaerobic bacteria such as Bacteroides fragilis and aerobic bacteria.^Citation21	Yes	100
	Empirical treatment of patients with high risk factors for multidrug-resistant gram-negative bacilli infection for whom the pathogen has not been identified and the treatment of enzyme inhibitors or third- or fourth-generation cephalosporins is ineffective (such as agranulocytosis with fever, abdominal surgery, brain surgery with ESBL values, etc.).^Citation21,Citation40	Yes	80
	Carbapenem-resistant Enterobacteriaceae (CRE) infection requires adequate and combined medication.^Citation16,Citation41	Yes	90
	*Points will be awarded if any one of the indicators is satisfied.
Variety selection	Meropenem and panipenem should be used for central nervous system infections. If drug-resistant negative bacteria are considered, meropenem should be used instead of imipenem, biapenem, or ertapenem.^Citation16,Citation42	Yes	50
	CRE infection and severe infection should use imipenem and meropenem with larger recommended doses.^Citation16	Yes	50
	Ertapenem should not be used in infections of non-fermentative bacteria such as Pseudomonas aeruginosa and Acinetobacter.^Citation16	Yes	50
	Pregnant patients are not recommended to use imipenem, panipenem or biapenem.^Citation43	Yes	50
	Children are not recommended to use biapenem.^Citation13	Yes	50
	*Points will be awarded if any one of the indicators is satisfied.
Usage-dosage- compatibility	The usage complies with the recommended usage of carbapenem issued by the National Health Commission of China.^Citation13	Yes	10
	The dosage complies with the recommended dosage of carbapenem issued by the National Health Commission of China.^Citation13	Yes	10
	For patients with renal insufficiency, the dosage regimen should be adjusted according to renal function.^Citation13	Yes	10
	Carbapenem should be avoided in combination with valproic acid.^Citation44,Citation45	Yes	10
	Imipenem should be avoided in combination with ganciclovir.^Citation46	Yes	10
	*Points need to be reviewed for each evaluation indicator.
Etiology and efficacy evaluation	The corresponding etiological examination should be submitted before the use of antibacterial drugs, which refers to bacterial culture.^Citation13	Yes	20
	There should be laboratory examination to evaluate the curative effect during treatment, such as blood routine, procalcitonin, or re-examination of bacterial culture.^Citation13	Yes	10
	When the pathogen and drug susceptibility results are clear, the condition should be assessed in time, and de-escalation treatment should be adopted rationally.^Citation16	Yes	10
	Timely de-escalate when the disease is in remission.^Citation16,Citation21	Yes	10
	*Points need to be reviewed for each evaluation indicator.
Prescription management and consultation	The prescription is issued by a doctor with a senior professional title and must be supported by information technology.^Citation13	Yes	10
	Experts in or out of the hospital are invited for consultation in a timely manner, and have consultation records.^Citation13	Yes	20
	The use of antibiotics beyond the authority is limited to within 24 hours, and there is a corresponding disease course record.^Citation13	Yes	10
	Special-use antibiotics file registration management is carried out in accordance with the provisions of the prescribed documents.^Citation13	Yes	10
	*Points need to be reviewed for each evaluation indicator.
Total score			300

Table 2 Comparison of Rational and Irrational Carbapenem Prescriptions Based on Patient Characteristics

	Total Number of Prescriptions n (%)	Rational Prescriptions n (%)	Irrational Prescriptions n (%)	Statistics/P value
Total (N, %)	192(100)	84(44)	108(56)
Age (Median, IQR)	62(48–73)	58(48–75)	62(48–72)	Z=−0.195/P=0.845
Age				χ^2=0.333/P=0.564
<60	92(48)	41(48)	51(47)
>60	100(52)	43(52)	57(53)
Diagnosis				χ^2=88.177/P<0.05
Abdominal infection	38(20)	17(20)	21(19)
Lung infection	20(10)	9(11)	11(10)
Intracranial infection	27(14)	15(18)	12(11)
Urinary tract infection	5(3)	3(4)	2(2)
Severe ill comorbid cancer	18(9)	6(7)	12(11)
Cholangitis	22(11)	6(7)	16(15)
Cholecystitis	6(3)	5(6)	1(1)
Peritonitis	20(10)	9(11)	11(10)
Pancreatitis	7(4)	2(2)	5(5)
Obstructive jaundice	9(5)	3(4)	6(6)
Sepsis	3(2)	2(2)	1(1)
Prophylaxis of postoperative infection	11(6)	2(2)	9(8)
Septic shock	6(3)	5(6)	1(1)
Department				χ^2=23.844/P<0.05
Hepatobiliary Surgery	93(48)	34(40)	59(55)
Gastrointestinal Surgery	61(32)	29(35)	32(30)
Neurosurgery	38(20)	21(25)	17(15)
Medications				χ^2=84.875/P<0.05
Meropenem	114(59)	47(56)	67(62)
Imipenem	68(36)	31(37)	37(34)
Replaced Medication (Meropenem/Imipenem)	10(5)	6(7)	4(4)

Table 3 Comparison of Rational and Irrational Carbapenem Prescriptions, by Evaluation Criteria

	Total Number of Prescriptions n (%)	Rational Prescriptions n (%)	Irrational Prescriptions n (%)	Statistics/P value
Indication				χ^2=38.521/P<0.05
Yes	139(72)	84(100)	55(51)
No	53(28)	0(0)	53(49)
Selection of variety				χ^2=133.333/P<0.05
Yes	176(92)	84(100)	92(85)
No	16(8)	0(0)	16(15)
Meropenem or panipenem were not selected for central nervous system infections	16(8)	0(0)	16(15)
Usage-dosage-compatibility				χ^2=161.333/P<0.05
Yes	184(96)	81(96)	103(95)
No	8(4)	3(4)	5(5)
Insufficient dose of medication	3(2)	1(1)	2(2)
Exceeded dose of medication	1(1)	0(0)	1(1)
No adjustment to the dosing regimen for patients with renal insufficiency	4(2)	2(3)	2(2)
Assessment of etiology and efficacy				χ^2=13.021/P<0.05
Yes	121(63)	77(92)	58(54)
No	71(37)	7(8)	50(46)
No etiological examination before medication	11(6)	0(0)	11(10)
No laboratory examinations for efficacy evaluation	13(6)	1(1)	12(11)
No de-escalation therapy	36(19)	6(7)	30(28)
No etiological examination before medication and No de-escalation therapy	6(3)	0(0)	6(6)
No laboratory examinations for efficacy evaluation and No de-escalation therapy	4(2)	0(0)	4(4)
No etiological examination before medication, No laboratory examinations for efficacy evaluation and No de-escalation therapy	1(1)	0(0)	1(1)
Prescription management and consultation of special-use antibiotics				χ^2=0.521/P=0.470
Yes	101(53)	73(87)	28(26)
No	91(47)	11(13)	80(74)
No consultation	67(35)	11(13)	56(52)
No medication records	1(1)	0(0)	1(1)
No consultation and No medication records	23(11)	0(0)	23(21)

Table 4 Analysis of Factors Influencing the Rationality of Carbapenem Prescriptions

	Median (IQR) Score	Univariate Analysis			Multicollinearity Test		Multivariable Analysis
		Median (IQR) Score for Rational Prescriptions	Median (IQR) Score for Irrational Prescriptions	Statistics/ P value	Tolerance	VIF	Standardized Regression Coefficients	P value	95% CI
Age				χ^2=7.391/P=0.831
<60 (N=92)	260(200–270)	270(260–280)	260(190–270)		/	/	/	/	/
>60 (N=100)	260(190–270)	270(260–280)	260(200–270)		0.859	1.177	−0.035	P=0.633	−15.019 to 9.153
Diagnosis				χ^2=163.071/P=0.133
Abdominal infection	260(200–270)	270(260–273)	260(190–270)		/	/	/	/	/
Lung infection	260(200–270)	270(260–280)	260(190–270)		0.450	2.221	0.071	P=0.492	−18.153 to 37.595
Intracranial infection	270(260–270)	270(250–270)	270(270–280)		0.876	1.141	0.052	P=0.487	−24.781 to 51.859
Urinary tract infection	270(260–270)	270(270–270)	260(253–260)		0.180	5.545	0.216	P=0.188	−12.812 to 64.587
Severe ill comorbid cancer	260(198–270)	270(260–270)	260(190–270)		0.744	1.344	0.100	P=0.216	−37.024 to 8.420
Cholangitis	260(190–270)	280(270–290)	250(190–270)		0.583	1.717	−0.031	P=0.737	−27.507 to 19.496
Cholecystitis	270(270–280)	270(270–280)	260(260–260)		0.826	1.210	0.183	P<0.05	7.713 to 79.955
Peritonitis	260(200–270)	270(270–280)	260(198–270)		0.638	1.567	−0.083	P=0.339	−34.776 to 12.048
Pancreatitis	240(180–260)	270(270–270)	190(170–240)		0.795	1.258	−0.045	P=0.564	−44.218 to 24.172
Obstructive jaundice	250(183–270)	270(270–280)	190(170–240)		0.762	1.313	0.015	P=0.849	−27.980 to 33.954
Sepsis	260(250–270)	260(250–270)	190(190–190)		0.935	1.070	0.017	P=0.818	−42.085 to 53.216
Prophylaxis of postoperative infection	260(190–270)	270(270–270)	260(190–270)		0.741	1.350	−0.108	P=0.183	−47.920 to 9.215
Septic shock	270(260–270)	270(260–270)	260(260–260)		0.821	1.217	0.142	P=0.065	−2.205 to 70.256
Department				χ^2=54.470/P0.05
Hepatobiliary Surgery	250(190–270)	280(270–290)	240(180–270)		/	/	/	/	/
Gastrointestinal Surgery	260(200–270)	270(270–270)	260(253–268)		0.314	3.180	0.091	P=0.463	−13.734 to 30.032
Neurosurgery	270(260–270)	270(260–273)	260(198–270)		0.167	5.982	0.021	P=0.903	−32.895 to 37.247
Medication				χ^2=25.630/P=0.372
Meropenem	260(190–270)	270(260–270)	260(190–270)		/	/	/	/	/
Imipenem	260(192–277)	270(260–280)	260(200–270)		0.412	2.424	0.085	P=0.430	−11.152 to 26.048
Replaced Medication (Meropenem/Imipenem)	270(260–272)	270(260–270)	270(260–280)		0.811	1.233	0.154	P<0.05	0.462 to 57.577
Evaluation item
Indications	70(0–70)	70(70–80)	70(0–70)	χ^2=192.000/P<0.01	/	/	/	/	/
Variety selection	50(50–50)	50(50–50)	50(50–50)	χ^2=78.523/P<0.01	/	/	/	/	/
Usage-dosage-compatibility	50(50–50)	50(50–50)	50(50–50)	χ^2=26.942/P<0.05	/	/	/	/	/
Etiology and efficacy evaluation	40(40–50)	50(50–50)	50(40–50)	χ^2=100.732/P<0.01	/	/	/	/	/
Prescription management and consultation	40(40–50)	50(40–50)	50(40–50)	χ^2=104.504/P<0.01	/	/	/	/	/

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