Evaluation of carbapenem use in a tertiary hospital: antimicrobial stewardship urgently needed.
Background
China launched a 3-year rectification scheme for the clinical use of antibiotics in 2011, and a specific scheme for carbapenem use in 2017. The aim of this study was to investigate the effects of government policies on carbapenem use, and their correlation with carbapenem-resistant Pseudomonas aeruginosa (CRPA).


Methods
The study was divided into four stages: preintervention (2010), antimicrobial programme (2011-2013), post-antimicrobial programme (2014-2016) and carbapenem programme (2017). A point-score system was proposed for evaluating the rationality of carbapenem use, and evaluated based on the indications, microbial culture, single dose, interval, and duration. Any prescription without a global score of 10 points was judged as irrational. The trend was analyzed by regression analysis, and Spearman correlation analysis was used for testing the correlation.


Findings
The rate of rational use of carbapenems was 29.7% in 2010, and increased by 55.5, 45.2, and 51.5% during the subsequent three stages. The rationality declined slightly during the post-antimicrobial programme (2014-2016) while the consumption of carbapenems was markedly increased. These two parameters improved slightly in 2017. Moreover, the prevalence of CRPA was significantly negatively correlated with the rate of rational carbapenem use (Coefficient = - 0.553, P < 0.05), and not with the consumption of carbapenems (P > 0.05).


Conclusions
The rational application of carbapenems was related to government policies in this study, with irrational carbapenem use possibly related to the development of CRPA. The current point-score system could be a useful tool for performing assessments.
['Zhang|Di|D|', 'Cui|Kai|K|', 'Lu|Wei|W|', 'Bai|Hehe|H|', 'Zhai|Yuyao|Y|', 'Hu|Sasa|S|', 'Li|Hao|H|', 'Dong|Haiyan|H|', 'Feng|Weiyi|W|', 'Dong|Yalin|Y|']
D000900:Anti-Bacterial Agents D000073602:Antimicrobial Stewardship D015780:Carbapenems D002681:China D024881:Drug Resistance, Bacterial D006801:Humans D008826:Microbial Sensitivity Tests D057766:Policy D011552:Pseudomonas Infections D011550:Pseudomonas aeruginosa D012189:Retrospective Studies D062606:Tertiary Care Centers
Carbapenem Antimicrobial stewardship China Carbapenem-resistant Pseudomonas aeruginosa Rationality