Assessing the relevance of carbapenem prescriptions by an antibiotic stewardship team

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

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.

Risk factors on healthcare-associated infections among tuberculosis hospitalized patients in China from 2001 to 2020: a systematic review and meta-analysis

Background

China has been still suffering from high burden attributable to tuberculosis (TB) and healthcare-associated infections (HAIs). TB patients are at high risk to get HAIs. Evidence-based guidelines or regulations to constrain the rising HAIs among TB hospitalized patients are needed in China. The aim of this systematic review and meta-analysis is to investigate the risk factors associated with HAIs among TB hospitalized patients in Chinese hospitals.

Methods

Medline, EMBASE and Chinese Journals Online databases were searched. The search was limited to studies published from January 1st 2001 to December 31st 2020. Meta-analyses of ORs of the risk factors between patients with HAIs and patients without HAIs among TB hospitalized patients were estimated. Heterogeneity among studies was assessed based on the \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\widehat{{\uptau }}$$\end{document}τ^² and I² statistics to select the meta-analysis model. Review Manager 5.3 was employed and P < 0.05 was considered as statistical significance.

Results

851 records were filtered from the databases, of which 11 studies were included in the quantitative meta-analysis. A total of 11,922 TB patients were included in the systematic review and meta-analysis, of which 1133 were diagnosed as having HAIs. Age older than 60 years (OR: 2.89 [2.01–4.15]), complications (OR: 3.28 [2.10–5.13]), diabetes mellitus (OR: 1.63 [1.22–2.19]), invasive procedure (OR: 3.80 [2.25–6.42]), longer than 15 hospitalization days (OR: 2.09 [1.64–2.64]), secondary tuberculosis (OR: 2.25 [1.48–3.42]), smoking (OR: 1.40[1.02–1.93]), underlying disease (OR: 2.66 [1.53–4.62]), and use of antibiotics (OR: 2.77 [2.35–3.27]) were the main risk factors associated with HAIs among TB hospitalized patients with a statistical significance (P < 0.05).

Conclusions

Age older than 60 years, presence of complications, presence of diabetes mellitus, invasive procedure, longer than 15 hospitalization days, secondary tuberculosis, smoking, presence of underlying disease, and use of antibiotics were the main risk factors which had a negative impact on HAIs among TB hospitalized patients in Chinese hospitals. These findings provided evidence for policy makers and hospital managers to make effective infection prevention and control measures to constrain the rising HAIs. It is also required that more cost-effective infection prevention and control measures should be widely applied in routinely medical treatment and clinical management to reduce the occurrence of HAIs among TB hospitalized patients.

Supplementary information

The online version contains supplementary material available at 10.1186/s12879-022-07364-9.