PDF(Pubmed)
Abstract：
UNASSIGNED: Based on the 2017-2020 annual report of the Department of Health-Antimicrobial Resistance Surveillance Program, significant resistance patterns have been observed for common disease-causing pathogens. In the hospital setting, antimicrobial stewardship programs have been implemented to optimize the use of antimicrobials. Drug utilization review studies provide essential feedback to improve prescribing and use of medications.
UNASSIGNED: This study aimed to review drug utilization of monitored parenteral antimicrobials among patients admitted from January to December 2019.
UNASSIGNED: The study employed a retrospective, cross-sectional, descriptive research design. A retrospective chart review of drugs administered to patients was conducted.
UNASSIGNED: A total of 821 patients charts met the inclusion criteria. The patients\' ages ranged from 18 to 98 years old and 52% were females. General Internal Medicine practitioners (28%) were the top prescribers of monitored parenteral antimicrobials primarily for the management of moderate-risk community-acquired pneumonia (39%). They were mostly indicated for empirical treatment of infections (94%) and were given for an average of 5.73 days.Only 58% of the total cases had orders for culture and sensitivity testing. Of which, principally 47% had colony cultures. Blood (29%) and sputum (27%) were the most common specimens taken for culture and sensitivity testing. The microorganisms often isolated were Escherichia coli (19%), Klebsiella pneumoniae (18%), and Staphylococcus aureus (9%). In addition, extended-spectrum beta lactamase-producing gram-negative pathogens (4%) and methicillin-resistant S. aureus (1%) were also isolated. All the microorganisms isolated showed most resistance to ampicillin (81%) and most susceptibility to colistin (100%). There were drug therapy-related problems encountered. There was one case of an adverse drug reaction (0.1%) and two cases of contraindications (0.2%). Therapeutic duplication was also observed in 5% of the cases. Moreover, 39% had instances of drug-drug interactions.Piperacillin-tazobactam had the highest consumption (79.50 defined daily doses/1,000-patient days) among the monitored parenteral antimicrobials.Some prescriptions were deemed inappropriate upon evaluation. 12% of cases were inappropriate based on the justification indicator. As for the critical indicators, duration of therapy (78%) was the main reason. Only four components of the DUE criteria indicators have met or exceeded the established threshold level.The cost analysis indicated that the total actual cost of therapy with the monitored parenteral antimicrobials amounted to ₱17,645,601.73. Considering Department of Health National Antibiotic Guidelines recommendations, ideal total cost of treatment was ₱14,917,214.29. Potential cumulative cost savings of ₱2,728,387.44 could have been achieved for patients admitted last 2019.
UNASSIGNED: Consumption of piperacillin-tazobactam was relatively high as compared to the other monitored parenteral antimicrobials covered in this study. Physicians at the study site seldom prescribe monitored parenteral antimicrobials as recommended by the National Antibiotic Guidelines. This is evidenced in the incidence of inappropriate therapy regimens, with inapt duration of therapy as the leading explanation.From the patient\'s perspective, the main economic implication was on the direct medical costs, particularly the increased cost of the actual antimicrobial therapy prescribed to manage various infections. Adherence of physicians to the established guidelines and selection of the most cost-effective therapy could have resulted in considerable cost savings.
UNASSIGNED: This study aimed to review drug utilization of monitored parenteral antimicrobials among patients admitted from January to December 2019.
UNASSIGNED: The study employed a retrospective, cross-sectional, descriptive research design. A retrospective chart review of drugs administered to patients was conducted.
UNASSIGNED: A total of 821 patients charts met the inclusion criteria. The patients\' ages ranged from 18 to 98 years old and 52% were females. General Internal Medicine practitioners (28%) were the top prescribers of monitored parenteral antimicrobials primarily for the management of moderate-risk community-acquired pneumonia (39%). They were mostly indicated for empirical treatment of infections (94%) and were given for an average of 5.73 days.Only 58% of the total cases had orders for culture and sensitivity testing. Of which, principally 47% had colony cultures. Blood (29%) and sputum (27%) were the most common specimens taken for culture and sensitivity testing. The microorganisms often isolated were Escherichia coli (19%), Klebsiella pneumoniae (18%), and Staphylococcus aureus (9%). In addition, extended-spectrum beta lactamase-producing gram-negative pathogens (4%) and methicillin-resistant S. aureus (1%) were also isolated. All the microorganisms isolated showed most resistance to ampicillin (81%) and most susceptibility to colistin (100%). There were drug therapy-related problems encountered. There was one case of an adverse drug reaction (0.1%) and two cases of contraindications (0.2%). Therapeutic duplication was also observed in 5% of the cases. Moreover, 39% had instances of drug-drug interactions.Piperacillin-tazobactam had the highest consumption (79.50 defined daily doses/1,000-patient days) among the monitored parenteral antimicrobials.Some prescriptions were deemed inappropriate upon evaluation. 12% of cases were inappropriate based on the justification indicator. As for the critical indicators, duration of therapy (78%) was the main reason. Only four components of the DUE criteria indicators have met or exceeded the established threshold level.The cost analysis indicated that the total actual cost of therapy with the monitored parenteral antimicrobials amounted to ₱17,645,601.73. Considering Department of Health National Antibiotic Guidelines recommendations, ideal total cost of treatment was ₱14,917,214.29. Potential cumulative cost savings of ₱2,728,387.44 could have been achieved for patients admitted last 2019.
UNASSIGNED: Consumption of piperacillin-tazobactam was relatively high as compared to the other monitored parenteral antimicrobials covered in this study. Physicians at the study site seldom prescribe monitored parenteral antimicrobials as recommended by the National Antibiotic Guidelines. This is evidenced in the incidence of inappropriate therapy regimens, with inapt duration of therapy as the leading explanation.From the patient\'s perspective, the main economic implication was on the direct medical costs, particularly the increased cost of the actual antimicrobial therapy prescribed to manage various infections. Adherence of physicians to the established guidelines and selection of the most cost-effective therapy could have resulted in considerable cost savings.
摘要：
■根据卫生部抗菌素耐药性监测计划的2017-2020年度报告，已经观察到常见致病病原体的显著耐药模式。在医院环境中，已经实施了抗菌药物管理计划，以优化抗菌药物的使用。药物利用审查研究提供了必要的反馈，以改善药物的处方和使用。
■本研究旨在回顾2019年1月至12月收治的患者中监测的肠胃外抗菌药物的药物利用情况。
■这项研究采用了回顾性研究，横截面,描述性研究设计。对给予患者的药物进行回顾性图表审查。
■共有821例患者符合纳入标准。患者年龄在18至98岁之间，52％为女性。普通内科医师（28％）是主要用于中等风险社区获得性肺炎管理的监测肠胃外抗菌药物的主要处方（39％）。他们主要用于经验性治疗感染（94％），平均给予5.73天。在所有病例中，只有58％的病例有培养和敏感性测试的订单。其中，主要有47％的人有殖民地文化。血液（29％）和痰（27％）是最常见的标本，用于培养和敏感性测试。经常分离的微生物是大肠杆菌(19%)，肺炎克雷伯菌（18%），和金黄色葡萄球菌(9%)。此外,还分离了产超广谱β内酰胺酶的革兰氏阴性病原体(4%)和耐甲氧西林金黄色葡萄球菌(1%).所有分离出的微生物对氨苄青霉素的耐药性最高（81％），对粘菌素的敏感性最高（100％）。遇到了与药物治疗相关的问题。有1例药物不良反应（0.1％）和2例禁忌症（0.2％）。在5%的病例中也观察到治疗重复。此外，39%有药物-药物相互作用。在监测的肠胃外抗菌药物中，哌拉西林-他唑巴坦的消费量最高（79.50定义的每日剂量/1,000名患者天）。一些处方在评估时被认为是不合适的。根据正当性指标，12%的案件是不适当的。至于关键指标，治疗持续时间（78%）是主要原因。只有DUE标准指标的四个组成部分达到或超过了既定的阈值水平。成本分析表明，使用监测的肠胃外抗菌药物治疗的实际总费用为17,645,601.73比索。考虑到卫生部国家抗生素指南的建议，理想的治疗总费用为14,917,214.29。去年2019年收治的患者可能实现了2,728,387.44的潜在累计成本节省。
■哌拉西林-他唑巴坦的消耗量与本研究涵盖的其他监测的肠胃外抗菌药物相比相对较高。研究地点的医生很少按照国家抗生素指南的建议开出监测的肠胃外抗菌药物。这在不适当的治疗方案的发生率上得到了证明，以不恰当的治疗持续时间为主要解释。从病人的角度来看,主要的经济影响是直接医疗费用，特别是用于管理各种感染的实际抗菌疗法的成本增加。医生坚持既定的指南和选择最具成本效益的治疗方法可能会节省大量的成本。
■本研究旨在回顾2019年1月至12月收治的患者中监测的肠胃外抗菌药物的药物利用情况。
■这项研究采用了回顾性研究，横截面,描述性研究设计。对给予患者的药物进行回顾性图表审查。
■共有821例患者符合纳入标准。患者年龄在18至98岁之间，52％为女性。普通内科医师（28％）是主要用于中等风险社区获得性肺炎管理的监测肠胃外抗菌药物的主要处方（39％）。他们主要用于经验性治疗感染（94％），平均给予5.73天。在所有病例中，只有58％的病例有培养和敏感性测试的订单。其中，主要有47％的人有殖民地文化。血液（29％）和痰（27％）是最常见的标本，用于培养和敏感性测试。经常分离的微生物是大肠杆菌(19%)，肺炎克雷伯菌（18%），和金黄色葡萄球菌(9%)。此外,还分离了产超广谱β内酰胺酶的革兰氏阴性病原体(4%)和耐甲氧西林金黄色葡萄球菌(1%).所有分离出的微生物对氨苄青霉素的耐药性最高（81％），对粘菌素的敏感性最高（100％）。遇到了与药物治疗相关的问题。有1例药物不良反应（0.1％）和2例禁忌症（0.2％）。在5%的病例中也观察到治疗重复。此外，39%有药物-药物相互作用。在监测的肠胃外抗菌药物中，哌拉西林-他唑巴坦的消费量最高（79.50定义的每日剂量/1,000名患者天）。一些处方在评估时被认为是不合适的。根据正当性指标，12%的案件是不适当的。至于关键指标，治疗持续时间（78%）是主要原因。只有DUE标准指标的四个组成部分达到或超过了既定的阈值水平。成本分析表明，使用监测的肠胃外抗菌药物治疗的实际总费用为17,645,601.73比索。考虑到卫生部国家抗生素指南的建议，理想的治疗总费用为14,917,214.29。去年2019年收治的患者可能实现了2,728,387.44的潜在累计成本节省。
■哌拉西林-他唑巴坦的消耗量与本研究涵盖的其他监测的肠胃外抗菌药物相比相对较高。研究地点的医生很少按照国家抗生素指南的建议开出监测的肠胃外抗菌药物。这在不适当的治疗方案的发生率上得到了证明，以不恰当的治疗持续时间为主要解释。从病人的角度来看,主要的经济影响是直接医疗费用，特别是用于管理各种感染的实际抗菌疗法的成本增加。医生坚持既定的指南和选择最具成本效益的治疗方法可能会节省大量的成本。
