Aierken Aizezijiang, Zhu Xiaochen, Wang Ningning, Zhang Jiangtao, Li Weibin, Wushouer Haishaerjiang, Abudukeremu Kaisaier
Department of Pharmacy, Xinjiang Medical University, NO. 393 Xinyi Road, Urumqi 830017, China.
International Research Center for Medicinal Administration, Peking University, Beijing 100191, China.
Antibiotics (Basel). 2024 Aug 5;13(8):732. doi: 10.3390/antibiotics13080732.
The challenge of emerging antimicrobial resistance and variation in antibiotic use across provinces in China call for knowledge on antibiotic utilization at the regional level. This study aims to evaluate the long-term trends and patterns of antibiotic usage in Xinjiang Province, the largest provincial-level division located in the northwest of China, aiming to provide evidence in enhancing provincial antimicrobial stewardship (AMS) and developing policy measures to optimize regional antimicrobial use.
This was an ecological study with temporal trend analysis on inpatient antibiotic utilization, with antibiotic use data from 92 public hospitals covered by Xinjiang's Center for Antibacterial Surveillance from 2012 to 2022. Antibiotic use was measured by the number of daily defined doses per 100 patient days (DDDs/100 pds). Patterns of antibiotic use were described by Anatomical Therapeutic Chemical (ATC) subgroups and the Access, Watch, Reserve (AWaRe) classification. The Average Annual Percent Change (AAPC) of antibiotic use and the corresponding 95% confidence intervals (CIs) were calculated to describe the trend of antibiotic use over time. Joinpoint regression was performed using the Weighted Bayesian Information Criteria (WBIC) model with a parametric method. A pairwise comparison between secondary and tertiary hospitals was conducted to explore disparities in antibiotic use across hospital levels. The most commonly used antibiotics were also analyzed.
The total inpatient antibiotic use in Xinjiang was 27.6 DDDs/100 patient days in 2022, with a significant decreasing trend during 2012-2022 (AAPC, -2.0%; 95% CI, -3.6% to -0.4%). The Watch group antibiotics were the most used AWaRe category, with the Access-to-Watch ratio decreasing significantly from 46.4% to 24.4% (AAPC, -6.8%; 95% CI, -8.4% to -5.1%). No significant difference was found in the trend of total antibiotic use between secondary and tertiary hospitals, but there were disparities across hospital levels in subgroups. Third-generation cephalosporins, second-generation cephalosporins, and fluoroquinolones remained the top three antibiotic class throughout the study period. The number of antibiotics accounting for 90% of the total antibiotic use decreased from 34 antibiotics in 2012 to 18 antibiotics in 2022.
The decreasing trend of inpatient antibiotic use in Xinjiang's public hospitals reflects the effects of continuous AMS implementation. Patterns of antibiotic use underscore the need for further efforts on evidence-based antibiotic selection and for analyses on the appropriateness of antibiotic use.
新出现的抗菌药物耐药性挑战以及中国各省抗生素使用情况的差异，需要了解区域层面的抗生素使用情况。本研究旨在评估中国西北部最大的省级行政区新疆维吾尔自治区抗生素使用的长期趋势和模式，旨在为加强省级抗菌药物管理（AMS）以及制定优化区域抗菌药物使用的政策措施提供依据。
这是一项对住院患者抗生素使用情况进行时间趋势分析的生态学研究，使用了2012年至2022年新疆抗菌药物监测中心覆盖的92家公立医院的抗生素使用数据。抗生素使用情况通过每100个患者日的每日限定剂量数（DDDs/100 pds）来衡量。抗生素使用模式通过解剖学治疗学化学（ATC）亚组和准入、观察、储备（AWaRe）分类来描述。计算抗生素使用的年均百分比变化（AAPC）及其相应的95%置信区间（CIs），以描述抗生素使用随时间的趋势。使用加权贝叶斯信息准则（WBIC）模型和参数方法进行连接点回归。对二级医院和三级医院进行两两比较，以探讨不同医院级别之间抗生素使用的差异。还分析了最常用的抗生素。
2022年新疆住院患者的抗生素总使用量为27.6 DDDs/100患者日，在2012 - 2022年期间呈显著下降趋势（AAPC，-2.0%；95% CI，-3.6%至-0.4%）。观察类抗生素是AWaRe分类中使用最多的类别，准入类与观察类的比例从46.4%显著下降至24.4%（AAPC，-6.8%；95% CI，-8.4%至-5.1%）。二级医院和三级医院在抗生素总使用趋势上没有显著差异，但在亚组中不同医院级别存在差异。在整个研究期间，第三代头孢菌素、第二代头孢菌素和氟喹诺酮类药物一直是使用量排名前三的抗生素类别。占抗生素总使用量90%的抗生素数量从2012年的34种减少到2022年的18种。
新疆公立医院住院患者抗生素使用的下降趋势反映了持续实施AMS的效果。抗生素使用模式凸显了在基于证据选择抗生素以及分析抗生素使用合理性方面需要进一步努力。
