Consumption of antibiotics in Chinese public general tertiary hospitals (2011-2014): Trends, pattern changes and regional differences

Qu, Xiaoyuan; Yin, Chang Yi; Sun, Xiujiang; Huang, Shuya; Li, Chaofan; Dong, Panpan; Lu, Xiaofan; Zhang, Zhuo; Yin, Aihua

doi:10.1371/journal.pone.0196668

Cited by 46 publications

(35 citation statements)

References 24 publications

(38 reference statements)

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“…However, the findings of the present study regarding major antibiotic use were different from previous studies based on Chinese tertiary hospitals. This may be related to restrictions on the use of antibiotics by different levels of health care institutions (Wushouer et al, 2017;Qu et al, 2018). In addition, the widespread use of broad-spectrum antibiotics in China is noteworthy.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have focused more on the changes of the number of antibiotic prescriptions and their cost (Liang et al, 2014;Song et al, 2014b;Liu et al, 2015). Few studies have been designed sufficiently to examine the changes in antibiotic consumption based on ATC/DDD methodology, which could demonstrate the epidemiology of antibiotic resistance with a higher resolution (Wushouer et al, 2017;Qu et al, 2018). Moreover, these findings have been mostly limited to tertiary hospitals and thus cannot reflect adequately reflect the actual situation of antibiotic use in China (Wushouer et al, 2017;Qu et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…Few studies have been designed sufficiently to examine the changes in antibiotic consumption based on ATC/DDD methodology, which could demonstrate the epidemiology of antibiotic resistance with a higher resolution (Wushouer et al, 2017;Qu et al, 2018). Moreover, these findings have been mostly limited to tertiary hospitals and thus cannot reflect adequately reflect the actual situation of antibiotic use in China (Wushouer et al, 2017;Qu et al, 2018). Consequently, there is an urgent need for more surveillance data of antibiotic consumption covering various types of health care institutions at different levels and in various regions.…”

Section: Introductionmentioning

confidence: 99%

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Antibiotic Consumption Trends in China: Evidence From Six-Year Surveillance Sales Records in Shandong Province

et al. 2020

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Background: The overuse of antibiotics is a serious public health problem in China, causing a high rate of antimicrobial resistance. This study identified the trends of antibiotic consumption in China to provide evidence for further intervention. Method: The six-year surveillance data on antibiotic sales from 2012 to 2017, which served as a proxy for consumption, were collected from 39 public health care facilities in Shandong province, including three tertiary hospitals, six secondary hospitals, and 30 primary health centers. Based on the Anatomical Therapeutic Chemical (ATC)/DDD methodology, antibiotic consumption was formulated in defined daily doses (DDD) per 1,000 inhabitants per day (DID). Results: The total antibiotic consumption among all health care settings increased from 16.07 DID in 2012 to a peak of 17.44 DID in 2015 and then decreased to 11.35 DID in 2017 with a 34.90% reduction. J01C (beta-lactam antimicrobials, penicillin), the most frequently used antibiotic class, accounted for 36.32% of the total DID. Consumption of carbapenems increased from 0.029 DID in 2012 to 0.08 DID in 2017. Parenteral antibiotics accounted for nearly 40% of the total consumption. Compared with the 2012 figures, the 2017 consumption showed a small increase in hospital sector that was compensated by the decrease in community care. Conclusion: A substantial reduction in total antibiotic consumption was observed in China from 2012 to 2017. However, the extensive consumption of broad-spectrum antimicrobials, high proportion of parenteral antibiotic use, and increased use of lastresort antibiotics attracted public health concerns.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Antibiotic Consumption Trends in China: Evidence From Six-Year Surveillance Sales Records in Shandong Province

et al. 2020

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“…With high levels of multi-drug resistance, including resistance to carbapenems, few therapeutic options are available, and yet there are already examples of colistin resistance in China [27]. A study by Qu XY documented the increasing consumption of carbapenems in China [28]. Resistance to cephalosporin, monobactam and fluoroquinolone has reduced in this study which may be the result of earlier emphasis on appropriate use of these antibiotics and the higher resistance rates to those antibiotics in the past years [29].…”

Section: Discussionmentioning

confidence: 99%

The impact of the national action plan on the epidemiology of antibiotic resistance among 352,238 isolates in a teaching hospital in China from 2015 to 2018

Wang

Little

et al. 2019

Antimicrob Resist Infect Control

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BackgroundWe sought to understand the epidemiology and characteristics of antimicrobial resistance (AMR) and the impact of the National Action Plan (NAP) on AMR. This information will be critical to develop interventions and strengthen antibiotic stewardship in hospital settings in China.MethodsCross-sectional data collection from the hospital information management system from 1 January 2015 to 30 August 2018. Variables included patient age, sex, diagnosis, hospital department and antibiotic sensitivity test. T-test for two samples method was applied to compare the results before and after NAP implementation. Multivariate analysis with binary logistic regression was conducted to examine the associations of risk factors for antimicrobial resistance.ResultsIn total there were 352,238 isolates in the final analysis after excluding contamination strains and isolates with incomplete information. More than 50% of patients were > 66 years old. 62% were male. 40% of the total samples were sputum. Among the total sample, the total resistance rate was 42% among all isolates. The rate of resistance to all antibiotics declined by 5.3% (95% CI 4.96–5.64%, p < 0.0001) and culture positivity rate declined by 9.8% (95% CI 9.22–10.34%, p < 0.0001) after NAP. Logistical regression showed that the NAP had effect with an adjusted odds ratio of 0.76 (95% CI 0.71–0.81, p = 0.002). Being male, age > 65 years, ICU department, diagnosed with certain diseases were more likely to be associated with antimicrobial resistance.ConclusionsAntibiotic resistance rates were high in this teaching hospital. However, the introduction of the China NAP since 2016 followed by hospital policy emphasis was associated with a declining AMR trend. Policies will need to incorporate antimicrobial stewardship with a focus on certain departments, with infection control practices and with increases in vaccination coverage among elderly.

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“…However, the consumption of carbapenems showed a worrying increase [ 8 , 9 ]. Carbapenems are an important class of antibiotic used for serious infections, and they are characterized by their broad antibiotic spectrum and powerful antibiotic action [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of carbapenem use in a tertiary hospital: antimicrobial stewardship urgently needed

Zhang

Cui

et al. 2019

Antimicrob Resist Infect Control

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BackgroundChina launched a 3-year rectification scheme for the clinical use of antibiotics in 2011, and a specific scheme for carbapenem use in 2017. The aim of this study was to investigate the effects of government policies on carbapenem use, and their correlation with carbapenem-resistant Pseudomonas aeruginosa (CRPA).MethodsThe study was divided into four stages: preintervention (2010), antimicrobial programme (2011–2013), post-antimicrobial programme (2014–2016) and carbapenem programme (2017). A point-score system was proposed for evaluating the rationality of carbapenem use, and evaluated based on the indications, microbial culture, single dose, interval, and duration. Any prescription without a global score of 10 points was judged as irrational. The trend was analyzed by regression analysis, and Spearman correlation analysis was used for testing the correlation.FindingsThe rate of rational use of carbapenems was 29.7% in 2010, and increased by 55.5, 45.2, and 51.5% during the subsequent three stages. The rationality declined slightly during the post-antimicrobial programme (2014–2016) while the consumption of carbapenems was markedly increased. These two parameters improved slightly in 2017. Moreover, the prevalence of CRPA was significantly negatively correlated with the rate of rational carbapenem use (Coefficient = − 0.553, P < 0.05), and not with the consumption of carbapenems (P > 0.05).ConclusionsThe rational application of carbapenems was related to government policies in this study, with irrational carbapenem use possibly related to the development of CRPA. The current point-score system could be a useful tool for performing assessments.

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Consumption of antibiotics in Chinese public general tertiary hospitals (2011-2014): Trends, pattern changes and regional differences

Cited by 46 publications

References 24 publications

Antibiotic Consumption Trends in China: Evidence From Six-Year Surveillance Sales Records in Shandong Province

Antibiotic Consumption Trends in China: Evidence From Six-Year Surveillance Sales Records in Shandong Province

The impact of the national action plan on the epidemiology of antibiotic resistance among 352,238 isolates in a teaching hospital in China from 2015 to 2018

Evaluation of carbapenem use in a tertiary hospital: antimicrobial stewardship urgently needed

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