School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China.
School of Public Health, Hainan Medical University, Haikou, Hainan, P. R. China.
J Antimicrob Chemother. 2019 Jun 1;74(6):1731-1740. doi: 10.1093/jac/dkz062.
Data surveillance and policy interventions can optimize antibiotic use, but few studies have focused on the changes in antibiotic use after a strict antibiotic stewardship policy was implemented in China in 2012.
Based on the Center for Antibacterial Surveillance, data were collected from general hospitals in two provinces of China. Using indicators (e.g. percentage of antibiotic use and proportion of antibiotic costs) recommended by the WHO, this study aimed to identify trends and patterns of systemic antibiotic (Anatomical Therapeutic Chemical code J01) use in hospitals in 2012-16 and to explore inappropriate antibiotic use.
This study obtained 282479 outpatient prescriptions and 86070 inpatient records from 52 hospitals. The percentage of antibiotic use in outpatients and non-surgical and surgical inpatients significantly declined from 20.17%, 41.92% and 74.15% in 2012 to 12.94%, 33.88% and 69.03% in 2016, respectively. Among antibiotic prescriptions and records, the percentage of antibiotic combination therapy, the percentage of antibiotic use for prophylaxis and the proportion of antibiotic costs showed a decreasing trend over time. However, in 2016, the percentage of antibiotic use for surgical prophylaxis was still >80%, with more than one-third involving inappropriate timing of antibiotic usage according to the predefined criteria. In non-surgical inpatients, the usage rates in acute upper respiratory infections, diarrhoea in children <5 years and fever or cough symptoms all exceeded 55%.
A significant downward trend in antibiotic use was identified in China's hospitals, which indicates that policy intervention might reduce the overuse of antibiotics. Furthermore, strengthening appropriate antibiotic use should be the focus of antibiotic stewardship.
数据监测和政策干预可以优化抗生素的使用，但很少有研究关注 2012 年中国实施严格的抗生素管理政策后抗生素使用的变化。
本研究基于抗菌药物监测中心，收集了中国两个省份的综合医院数据。使用世界卫生组织（WHO）推荐的指标（如抗生素使用率和抗生素费用比例），本研究旨在确定 2012-2016 年医院全身用抗生素（解剖治疗学化学分类代码 J01）使用的趋势和模式，并探讨不合理的抗生素使用情况。
本研究从 52 家医院获得了 282479 份门诊处方和 86070 份住院记录。门诊患者和非手术及手术住院患者的抗生素使用率从 2012 年的 20.17%、41.92%和 74.15%分别显著下降到 2016 年的 12.94%、33.88%和 69.03%。在抗生素处方和记录中，抗生素联合治疗的比例、抗生素预防使用率和抗生素费用比例呈下降趋势。然而，2016 年手术预防用抗生素的使用率仍>80%，根据预先设定的标准，超过三分之一的情况存在抗生素使用时机不当的问题。在非手术住院患者中，急性上呼吸道感染、<5 岁儿童腹泻和发热或咳嗽症状的抗生素使用率均超过 55%。
中国医院的抗生素使用呈显著下降趋势，这表明政策干预可能减少了抗生素的过度使用。此外，加强合理使用抗生素应成为抗生素管理的重点。
