Antimicrobial Drug Use and Changing Trends From 2021 to 2023—A Case Study of a General Hospital in Sichuan Province

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES Journal of evaluation in clinical practice Pub Date : 2025-01-08 DOI:10.1111/jep.14306

Lan Shu, Zhen-de Luo, Ming-chao He, Shan Wang

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Abstract

Background

Antibiotic resistance (AR) is a growing concern as a result of the widespread and excessive use of antibiotics. Because of this, China's health authorities have implemented a number of antibiotic control measures, including a requirement that the intensity of antibiotic usage stay within 40.00 DDDs. This study, which used a tertiary general hospital in Sichuan Province as an example, examined the hospital's trend in antibiotic use from 2021 to 2023, the relationship between antibiotic use and hospitalization days and CMI, and the viability of 40.000 DDDs in light of the evolving medical landscape.

Methods

Data were obtained through the hospital information system (HIS) and the hospital DRG system. Boston matrix diagrams were used to find the departments that needed to be focused on control, Cochran-Armitage trend test, and ANOVA to analyze the trends of AUR and antimicrobial use density (AUD) in the hospital over time in the last 3 years and to analyze the factors affecting the changes in antibiotic consumption.

Results

Over the previous 3 years, the hospital's antibiotic use rate varied between 40% and 50%, and its intensity of use varied between 40.000 and 50.000 DDDs, both of which were rather steady. January 2023 had a significant rise, with an AUD of 59.38 DDDs and an AUR of 61.80%. The second quadrant has eight departments. Each department's AUD varied dramatically; neurosurgery saw an increase annually (p < 0.05), abdominal wall surgery and gastrointestinal hernia procedures, obstetrics and gynaecologist, and ophthalmology saw a drop annually (p < 0.05). The average number of preoperative hospitalization days (r = 0.1402, p < 0.01) and the CMI (r = 0.4864, p < 0.001) were strongly connected with the AUD of surgical and nonsurgical departments, respectively.

Conclusions

Hospitals should concentrate on the issue of surgical departments' lengthy preoperative prophylactic medication times. AUD management should also be dynamically modified based on CMI, particularly in departments in the second quadrant (low CMI and high AUD). Furthermore, it is challenging to maintain the hospital AUD target value of 40.00 DDDs under the new medical model, given the decline in hospitalization days of discharged patients and the high prevalence of infectious diseases. It is also unclear whether this target value is still appropriate given the current state of medicine.

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2021 - 2023年抗菌药物使用及变化趋势——以四川省某综合医院为例

背景：由于抗生素的广泛和过度使用，抗生素耐药性（AR）日益受到关注。因此，中国卫生部门实施了一系列抗生素控制措施，包括要求抗生素使用强度保持在40.00 DDDs以内。本研究以四川省某三级综合医院为例，分析了该医院2021 - 2023年抗生素使用趋势、抗生素使用与住院天数和CMI的关系，以及40000个DDDs在医疗环境变化中的生存能力。方法：通过医院信息系统（HIS）和医院DRG系统获取数据。采用波士顿矩阵图寻找需要重点控制的科室，采用Cochran-Armitage趋势检验和方差分析分析该院近3年AUR和抗菌药物使用密度（AUD）随时间变化趋势，分析影响抗菌药物使用变化的因素。结果：该院前3年抗生素使用率在40% ~ 50%之间，使用强度在4万~ 5万DDDs之间，均较为稳定。2023年1月有明显上升，AUD为59.38 DDDs， AUR为61.80%。第二象限有八个部门。每个部门的AUD差异很大；结论：医院应重视外科术前预防性用药时间过长的问题。AUD管理也应根据CMI进行动态修改，特别是在第二象限（低CMI和高AUD）的部门。此外，在出院患者住院天数减少、传染病高发的情况下，新医疗模式下医院AUD目标值保持在40.00 DDDs的难度较大。考虑到目前的医学状况，这个目标值是否仍然合适也不清楚。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of evaluation in clinical practice 医学-卫生保健

CiteScore

4.80

自引率

4.20%

发文量

143

审稿时长

3-8 weeks

期刊介绍： The Journal of Evaluation in Clinical Practice aims to promote the evaluation and development of clinical practice across medicine, nursing and the allied health professions. All aspects of health services research and public health policy analysis and debate are of interest to the Journal whether studied from a population-based or individual patient-centred perspective. Of particular interest to the Journal are submissions on all aspects of clinical effectiveness and efficiency including evidence-based medicine, clinical practice guidelines, clinical decision making, clinical services organisation, implementation and delivery, health economic evaluation, health process and outcome measurement and new or improved methods (conceptual and statistical) for systematic inquiry into clinical practice. Papers may take a classical quantitative or qualitative approach to investigation (or may utilise both techniques) or may take the form of learned essays, structured/systematic reviews and critiques.