Effects of Regulation on Carbapenem Prescription in a Large Teaching Hospital in China: An Interrupted Time Series Analysis, 2016-2018

Lewei Xie; Yaling Du; Xuemei Wang; Xinping Zhang; Chenxi Liu; Junjie Liu; Xi Peng; Xinhong Guo

doi:10.2147/IDR.S322938

Effects of Regulation on Carbapenem Prescription in a Large Teaching Hospital in China: An Interrupted Time Series Analysis, 2016-2018

Infect Drug Resist. 2021 Aug 11:14:3099-3108. doi: 10.2147/IDR.S322938. eCollection 2021.

Authors

Lewei Xie¹, Yaling Du¹, Xuemei Wang¹, Xinping Zhang¹, Chenxi Liu¹, Junjie Liu², Xi Peng³, Xinhong Guo³

Affiliations

¹ School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
² School of Statistics and Mathematics, Central University of Finance and Economics, Beijing, People's Republic of China.
³ First Affiliated Hospital, School of Medicine, Shihezi University, Xinjiang, Shihezi, People's Republic of China.

Abstract

Purpose: Carbapenem resistance due to the overuse of carbapenems has become a public health problem worldwide, particularly in low- and middle-income countries (LMICs). However, there are few policies guiding carbapenem prescription, and their effectiveness is still unclear. A regulation targeting carbapenem prescription was implemented in March 2017 in China. This study aimed to assess the effects of the regulation for providing evidence on the prudent use of carbapenems.

Patients and methods: This was an interventional, retrospective study started in January 2017. The intervention covered establishing performance appraisal indicators, special authorisation, strict prescribing restrictions, and dedicated supervision, particularly in the intensive care unit (ICU). Data on adult inpatients who received at least one carbapenems were extracted from January 2016 to December 2018. Segmented regression analysis was performed to evaluate the effect of the regulation.

Results: A total of 2005 inpatients received carbapenems. Segmented regression models showed an immediate decline in the intensity of antibiotic consumption (IAC) of carbapenems (coefficient = -9.65, p < 0.001), particularly imipenem (coefficient = -6.82, p = 0.002), and the antibiotic consumption of carbapenems (coefficient = -133.60, p = 0.003) in the ICU. And there is a decreasing trend in the IAC of meropenem (coefficient = -0.03, p = 0.008) in all departments. Furthermore, the IAC of carbapenems and imipenem (coefficient = -0.36, p = 0.035; coefficient = -0.49, p = 0.025, respectively), and the average length of stay (ALoS) (coefficient = -0.73, p < 0.001) showed downward trends in the ICU.

Conclusion: The intervention effectively reduced the IAC of carbapenems and imipenem, carbapenem consumption and the ALoS in the ICU, and the IAC of meropenem in all departments. The effects of the intervention were significant in the ICU, which indicated an urgent need for stronger regulations focusing on critical departments in the future.

Keywords: ICU; antimicrobial stewardship; carbapenem prescription; effects assessment; multifaceted intervention; segmented regression.