Clinical pattern of antibiotic overuse and misuse in primary healthcare hospitals in the southwest of China

Chang, Yi-Fang; Chusri, Sarunyou; Sangthong, Rassamee; McNeil, Edward; Hu, Junjie; Du, Wei; Li, Duan; Fan, Xingying; Zhou, Hanni; Chongsuvivatwong, Virasakdi; Tang, Lei

doi:10.1371/journal.pone.0214779

Cited by 73 publications

(84 citation statements)

References 23 publications

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“…On the other hand, our study found no independent association of P. aeruginosa infection with frequent exacerbations, contradicting the findings from the previous study [ 11 , 12 , 14 , 15 ]. As oral antibiotics and mucolytic are available in many places in China [ 25 ], bronchiectasis patients often take self-prescribed antibiotics irregularly to suppress the symptoms instead of consulting doctors, which potentially underestimates the exacerbation rates and may be the reason we failedto observe the independent effect of P. aeruginosa on frequent exacerbations. Hospitalizations signify a more severe disease condition, heavier disease burden, and high expenditure, despite different admission criteria in different areas.…”

Section: Discussionmentioning

confidence: 99%

The contribution of Pseudomonas aeruginosa infection to clinical outcomes in bronchiectasis: a prospective cohort study

et al. 2021

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Objectives: The impact of Pseudomonas aeruginosa on the prognosis of bronchiectasis remains controversial. This study aimed to explore the prognostic value of P. aeruginosa in adult patients with bronchiectasis in central-southern China. Patients and methods: This prospective cohort study enrolled 1,234 patients with bronchiectasis between 2013 and 2019. The independent impact of P. aeruginosa on all-cause mortality, annual exacerbations, and hospitalizations was assessed. Results: P. aeruginosa was isolated from 244 patients (19.8%). A total of 188 patients died over a follow-up period of 16 (1-36) months. Patients with P. aeruginosa had a longer disease course, poorer lung function, more lung lobe involvement, and more severe Bronchiectasis Severity Index (BSI) stage than those without P. aeruginosa. The independent impact of P. aeruginosa was observed on frequent hospitalizations but not on mortality and frequent exacerbations. Moderate-or high-risk comorbidities increased the risk of mortality (hazard ratio [HR]: 1.93, 95% confidence interval [CI]: 1.26-2.95), and this effect was magnified by the presence of P. aeruginosa (HR: 2.11, 95% CI: 1.28-3.48). Conclusions: P. aeruginosa infection acts as a marker of disease severity as well as predictor of frequent hospitalizations. P. aeruginosa had no independent effect on all-cause mortality. P. aeruginosa combined with moderate-or high-risk comorbidities posed an increased risk of mortality. The management of comorbidities may be a critical target during the treatment of P. aeruginosa infection in bronchiectasis. KEY MESSAGE: 1. P. aeruginosa increased the risk of frequent hospitalizations; however, it had no independent impact on all-cause mortality. 2. P. aeruginosa combined with moderate-or high-risk comorbidities posed an increased risk of mortality. 3. The management of comorbidities may be a critical target during the treatment of P. aeruginosa infection in bronchiectasis.

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Section: Discussionmentioning

confidence: 99%

The contribution of Pseudomonas aeruginosa infection to clinical outcomes in bronchiectasis: a prospective cohort study

et al. 2021

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“…In order to speed up the process of informatization, nursing managers should fully realize the importance of information literacy in clinical nursing work [37,38]. Primary hospitals in China are mainly located in township hospitals and community health service stations, with low information level and lagging medical development [39,40]. The score of information literacy of primary nurses in these hospitals was far lower than that of the secondary and tertiary hospitals.…”

Section: Discussionmentioning

confidence: 99%

Information Literacy of Nurses in Shaanxi Province, China: A Cross-sectional Descriptive and Multicentre Survey

Fan

Zhang

Du³

et al. 2020

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Background: With the advent of the information age, rapid progress has been made in Chinese medical and health services. As the main force to give thorough, systematic and integral services for patients, nurses play an important role in the development of information-based medical care. However, there is a lack of research on the information literacy of nurses in the hospitals of different levels in China.Methods: We selected 30 hospitals in Shaanxi Province by convenient sampling method and distributed 3,480 questionnaires from March to July 2020. The self-reported questionnaire included general information of nurses and their information literacy scale which was filled in the form of anonymity on the Internet. We then performed descriptive analyses, univariate analysis and multiple linear regression analysis on the collected data.Results: We obtained 3,011 valid questionnaires, with the response rate of 94.71% (n=3,296). The total score of information literacy of 3,011 nurses was 114.18 ± 18.62, including 115.39 ± 17.66 for tertiary hospital nurses, 114.65 ± 19.02 for secondary hospital nurses and 105.00 ± 18.68 for primary hospital nurses (F=33.755, P=0.000). The nurses who were in primary hospital, with low education background or at older age, could not use database, had not participated in information literacy training, spent less spare time on learning, read less literature, had lower information literacy level (F＝39.687, P＝0.000). Conclusions: There are differences in nurses' information literacy among hospitals of different levels and several factors are associated with the information literacy. Since the information literacy of nurses in primary hospitals is the lowest, we should pay special attention to improving their information literacy, in particular. The government should strengthen information support and organize information literacy training. The hospitals should offer courses, lectures, seminars to improve the information literacy of nurses. Nurses should improve their information skills, read the latest professional literature, and constantly improve themselves.

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“…Of these two variables, one (sore throat) was not associated with bacteria detection and the other (days since onset of infection) showed an inverse correlation. These differences suggest that the doctors' decision on antibiotics use were not driven mainly by considerations for controlling bacteria pathogens but for assuring the patients or relieving their sense of urgency [28] . Sore throat develops rapidly after onset of infection and is one of the most unpleasant symptoms of RTIs.…”

Section: Determinants Of Antibiotics Use and Bacteria Identi Cationmentioning

confidence: 99%

Clinical symptoms and treatment of common respiratory tract infections in relation to microbiological profiles in rural health facilities in China: implications for antibiotic stewardship

Shen

Pan

et al. 2020

Preprint

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Background This study aims to identify the extent to which current clinical practice in the treatment of common respiratory tract infections (RTIs) is consistent with presenting symptoms and microbiological characteristics at health care settings in rural Anhui Province and implications for future antibiotic stewardship. Methods The study was implemented in one village clinic and one township health center in each of four rural residential areas in Anhui Province, China. Observations, structured and semi-structured interviews in village clinics and township health centers were conducted to investigate antibiotic use. Sputum and throat swabs were collected for bacterial culture and susceptibility testing. Results A total of 1068 (51.0% males and 49.0% females) completed the study. Antibiotics were prescribed for 87.8% of RTI patients. Of all the specimens tested, 329 (30.8%) specimens were isolated with bacteria. The most frequently detected bacteria were K. pneumonia (24.15% in all specimens), H. influenza (16.19%), H. parainfluenzae (14.77%), S.aureus (5.11%), M. catarrhalis (3.41%) and S. pneumoniae (2.27%). The bacteria detection was associated with age (OR = 1.91), season (OR = 0.41 to 0.60), days since infection onset (OR = 1.54 to 1.81), and runny or blocked nose (OR = 1.39 to 1.61), cough with green or white sputum (OR = 1.47 to 1.59). Antibiotic use was only linked with limited non-specific clinical manifestations e.g., days since infection onset (OR = 0.53) and sore throat (OR = 1.64). Conclusions The study reveals that antibiotics prescription is still very common in rural China which is driven mainly by patient reassurance and other non-pathological factors rather than treatment of bacterial infections. The study establishes the feasibility of conducting microbiological testing outside Tier 2 and 3 hospitals in rural China.

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Clinical pattern of antibiotic overuse and misuse in primary healthcare hospitals in the southwest of China

Cited by 73 publications

References 23 publications

The contribution of Pseudomonas aeruginosa infection to clinical outcomes in bronchiectasis: a prospective cohort study

The contribution of Pseudomonas aeruginosa infection to clinical outcomes in bronchiectasis: a prospective cohort study

Information Literacy of Nurses in Shaanxi Province, China: A Cross-sectional Descriptive and Multicentre Survey

Clinical symptoms and treatment of common respiratory tract infections in relation to microbiological profiles in rural health facilities in China: implications for antibiotic stewardship

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