Yang Ying, Geng Xin, Liu Xiaojun, Wen Xiaotong, Wu Ruonan, Cui Dan, Mao Zongfu
School of Public Health, Wuhan University, Wuhan, China.
Global Health Institute, Wuhan University, Wuhan, China.
Front Pharmacol. 2022 Feb 14;13:813213. doi: 10.3389/fphar.2022.813213. eCollection 2022.
The overuse of antibiotics is a serious public health problem and a major challenge in China, and China lacks up-to-date evidence on the nationwide antibiotic use in different healthcare settings. The changes of China's antibiotic use under the COVID-19 pandemic are still unknown. This study aimed to investigate the use of antibiotics in China's public medical institutions based on a three-year nationwide surveillance and to examine the impact of the COVID-19 pandemic on China's antibiotic consumption. This study used nationwide drug procurement data from the China Drug Supply Information Platform (CDSIP). We retrospectively analyzed antibiotic procurement data of 9,176 hospitals and 39,029 primary healthcare centers (PHCs) from 31 provinces in mainland China from January 2018 to December 2020. Antibiotic utilization was measured by defined daily doses (DDDs) and DDD per 1,000 inhabitants per day (DID). Generalized linear regression models were established to quantify the impact of the COVID-19 pandemic on antibiotic use. The total antibiotic consumption among all healthcare settings increased from 12.94 DID in 2018 to 14.45 DID in 2019, and then dropped to 10.51 DID in 2020. More than half of antibiotics were consumed in PHCs, especially in central regions (59%-68%). The use of penicillins (J01C) and cephalosporins (J01D) accounted for 32.02% and 28.86% of total antibiotic consumption in 2020. During 2018-2020, parenteral antibiotics accounted for 31%-36% of total antibiotic consumption; the proportion is more prominent in central and western regions and the setting of hospitals. Access category antibiotics comprised 40%-42% of the total utilization. Affected by COVID-19, the antibiotic consumption was significantly dropped both in hospitals ( = -.11, < .001) and PHCs ( = -.17, < .001), as well as in total ( = -.14, < .001). Significant increments were observed in the proportion of total antibiotics ( = .02, = .024) consumed in hospitals (against the consumption in all healthcare settings), as well as parenteral antibiotics ( = 1.73, = .001). The consistent preferred use of penicillin and cephalosporin, as well as injections, among China's public healthcare institutions should draw concern. China's antibiotic consumption significantly declined during the COVID-19 pandemic, which brings opportunities for antibiotic use management in China.
抗生素的过度使用是一个严重的公共卫生问题，也是中国面临的一项重大挑战，而且中国缺乏关于不同医疗环境下全国抗生素使用情况的最新证据。新冠疫情下中国抗生素使用的变化仍不明确。本研究旨在基于一项为期三年的全国监测调查中国公立医疗机构的抗生素使用情况，并考察新冠疫情对中国抗生素消费的影响。本研究使用了来自中国药品供应信息平台（CDSIP）的全国药品采购数据。我们回顾性分析了2018年1月至2020年12月中国大陆31个省份9176家医院和39029个基层医疗中心（PHC）的抗生素采购数据。抗生素使用情况通过限定日剂量（DDD）和每千居民每日DDD数（DID）来衡量。建立广义线性回归模型以量化新冠疫情对抗生素使用的影响。所有医疗环境下的抗生素总消费量从2018年的12.94 DID增加到2019年的14.45 DID，然后在2020年降至10.51 DID。超过一半的抗生素在基层医疗中心消费，尤其是在中部地区（59%-68%）。2020年青霉素（J01C）和头孢菌素（J01D）的使用分别占抗生素总消费量的32.02%和28.86%。在2叭8-2020年期间，注射用抗生素占抗生素总消费量的31%-36%；这一比例在中西部地区和医院环境中更为突出。非处方类抗生素占总使用量的40%-42%。受新冠疫情影响，医院（β = -0.11，P < 0.001）、基层医疗中心（β = -0.17，P < 0.001）以及总体（β = -0.14，P < 0.001）的抗生素消费量均显著下降。医院（相对于所有医疗环境下的消费量）消费的抗生素总量占比（β = 0.02，P = 0.024）以及注射用抗生素占比（β = 1.73，P = 0.001）均出现显著增加。中国公立医疗机构中青霉素、头孢菌素以及注射剂一直以来的优先使用情况应引起关注。新冠疫情期间中国的抗生素消费量显著下降，这为中国的抗生素使用管理带来了机遇。
