Wang Chu-Ning, Tong Jianning, Yi Bin, Huttner Benedikt D, Cheng Yibing, Li Shuangjie, Wan Chaomin, Zhu Qingxiong, Zhou Qionghua, Zhao Shiyong, Zhuo Zhiqiang, Wang Daobin, Jia Chunmei, Shan Qing-Wen, Zhao Yun, Lan Chenfu, Zhao Dongchi, Zhou Yibo, Liu Jing, Zhu Chunhui, Zhu Yu, Li Rui, Wu Xiaodan, Qi Zhenghong, Wang Caihong, Gao Huiling, Ye Wenyu, Zhang Liling, Xu Xiaohong, Hu Hui, Yang Pu, Magrini Nicola, Zeng Mei
Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, China.
Department of Pediatric Gastroenterology and Infectious Diseases, Qingdao Women and Children's Hospital, Qingdao, China.
Front Pharmacol. 2021 Mar 29;12:601561. doi: 10.3389/fphar.2021.601561. eCollection 2021.
Antimicrobial resistance is a significant clinical problem in pediatric practice in China. Surveillance of antibiotic use is one of the cornerstones to assess the quality of antibiotic use and plan and assess the impact of antibiotic stewardship interventions. We carried out quarterly point prevalence surveys referring to WHO Methodology of Point Prevalence Survey in 16 Chinese general and children's hospitals in 2019 to assess antibiotic use in pediatric inpatients based on the WHO AWaRe metrics and to detect potential problem areas. Data were retrieved via the hospital information systems on the second Monday of March, June, September and December. Antibiotic prescribing patterns were analyzed across and within diagnostic conditions and ward types according to WHO AWaRe metrics and Anatomical Therapeutic Chemical (ATC) Classification. A total of 22,327 hospitalized children were sampled, of which 14,757 (66.1%) were prescribed ≥1 antibiotic. Among the 3,936 sampled neonates (≤1 month), 59.2% ( = 2,331) were prescribed ≥1 antibiotic. A high percentage of combination antibiotic therapy was observed in PICUs (78.5%), pediatric medical wards (68.1%) and surgical wards (65.2%). For hospitalized children prescribed ≥1 antibiotic, the most common diagnosis on admission were lower respiratory tract infections (43.2%, = 6,379). WHO Watch group antibiotics accounted for 70.4% of prescriptions ( = 12,915). The most prescribed antibiotic ATC classes were third-generation cephalosporins (41.9%, = 7,679), followed by penicillins/β-lactamase inhibitors (16.1%, = 2,962), macrolides (12.1%, = 2,214) and carbapenems (7.7%, = 1,331). Based on these data, overuse of broad-spectrum Watch group antibiotics is common in Chinese pediatric inpatients. Specific interventions in the context of the national antimicrobial stewardship framework should aim to reduce the use of Watch antibiotics and routine surveillance of antibiotic use using WHO AWaRe metrics should be implemented.
在中国儿科临床实践中，抗菌药物耐药性是一个重大的临床问题。抗生素使用监测是评估抗生素使用质量以及规划和评估抗生素管理干预措施效果的基石之一。2019年，我们参照世界卫生组织（WHO）的点患病率调查方法，在中国16家综合医院和儿童医院开展了季度点患病率调查，以基于WHO的AWaRe指标评估儿科住院患者的抗生素使用情况，并发现潜在问题领域。数据于3月、6月、9月和12月的第二个星期一通过医院信息系统获取。根据WHO的AWaRe指标和解剖治疗化学（ATC）分类，对不同诊断情况和病房类型的抗生素处方模式进行了分析。共抽取了22327名住院儿童样本，其中14757名（66.1%）使用了≥1种抗生素。在3936名抽样新生儿（≤1个月）中，59.2%（=2331名）使用了≥1种抗生素。在儿科重症监护病房（PICU，78.5%）、儿科内科病房（68.1%）和外科病房（65.2%）中，联合使用抗生素治疗的比例较高。在使用≥1种抗生素的住院儿童中，入院时最常见的诊断是下呼吸道感染（43.2%，=6379例）。WHO观察组抗生素占处方的70.4%（=12915例）。处方最多的抗生素ATC类别是第三代头孢菌素（41.9%，=7679例），其次是青霉素/β-内酰胺酶抑制剂（16.1%，=2962例）、大环内酯类（12.1%，=2214例）和碳青霉烯类（7.7%，=1331例）。基于这些数据，在中国儿科住院患者中，广谱观察组抗生素的过度使用很常见。在国家抗菌药物管理框架下，具体干预措施应旨在减少观察组抗生素的使用，并应实施使用WHO的AWaRe指标对抗生素使用情况进行常规监测。
