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

Abstract

Purpose

With the increasing frequency and intensity of carbapenem consumption, carbapenem-resistant organisms (CRO) have become a focus of anti-infection research. This study aimed to evaluate the rationality of the clinical use of carbapenems among inpatients in the surgical departments of a tertiary hospital in southwest China.

Patients and methods

A point-score system was established for evaluation based on the clinical practices in surgical departments and selected carbapenem prescriptions from June 2020 to June 2021 for hepatobiliary surgery, gastrointestinal surgery, and neurosurgery in the study hospital. Prescriptions with a total score ≥ 270 were defined as rational. Descriptive statistics were used to describe the characteristics and rationality of the prescriptions. The chi-square test, Mann–Whitney U-test, and Kruskal–Wallis H-test were used to compare characteristics between rational and irrational prescriptions. Linear regression analysis was used to determine the factors affecting the rationality of carbapenem prescriptions.

Results

According to 192 carbapenem prescription records, the median age of patients was 62 years [IQR, 48.0–73.0], and 20% of patients had abdominal infections, 10% had lung infections, 14% had intracranial infections, and 3% had urinary tract infections. 56% of carbapenem prescriptions were irrational. Compared with rational carbapenem prescriptions, irrational prescriptions had a higher proportion of those with inappropriate indications (49% vs 0%, p < 0.05), incorrect variety selection (15% vs 0%, p<0.05), and unreasonable assessment of etiology and efficacy (46% vs 8%, p < 0.05). Linear regression analysis suggested that the diagnosis of cholecystitis (standardized regression coefficient=0.183, p<0.05) and replaced medication (standardized regression coefficient = 0.154, p<0.05) influenced the rationality of carbapenem prescriptions.

Conclusion

Our study shows that the irrational use of carbapenems deserves attention, especially in surgical departments. Interventions for carbapenem use that are based on evaluation criteria should be developed to reduce the emergence and spread of carbapenem-resistant bacteria.

Keywords:

• carbapenem
• prescription review
• surgery

Statement of Ethics

This study followed the guidelines for human studies and complied with the Declaration of Helsinki. Informed consent was obtained from the study participants prior to study commencement. This work obtained ethical approval from the Ethics Committee of the First Affiliated Hospital of Guangzhou Medical University, China (2019-53).

Acknowledgments

The authors thank all participants who participated in this study. The author expresses his gratitude to the First Affiliated Hospital of Chongqing Medical University and State Key Laboratory of Respiratory Disease for their support. We thank Wang Jiong for her work during the concept interpretation.

Disclosure

The authors declare no conflict of interest.

Additional information

Funding

This research was funded by the National Natural Science Foundation of China (Grant Number 81861138056), the National Social Science Foundation of China (Grant Number 20&ZD122), the Investigator-Initiated Trial Fund of The First Affiliated Hospital of Guangzhou Medical University (Grant Number DSPC-MPM002).