Chen Rui, Li Jinxi, Wang Chan, Zhou Pengfei, Song Qihua, Wu Jianxiong, Li Qinnan, Li Hui, Gong Yanhong, Zeng Tao, Fang Yu, Yin Xiaoxv
Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
J Glob Health. 2025 Jan 31;15:04023. doi: 10.7189/jogh.15.04023.
The prevalence of antibiotic prescribing among total prescriptions, the percentage of combined antibiotic prescribing among prescriptions containing at least one antibiotic, and factors influencing hospital antibiotic prescribing are currently unknown. In this systematic review, we aimed to summarise antibiotic prescribing in hospitals worldwide and identify the associated factors.
We searched PubMed/MEDLINE, Ovid/Embase, and the Web of Science for articles published between 1 January 2000 and 28 February 2023 that reported antibiotic prescribing in hospitals or the associated factors. Four reviewers independently screened studies, extracted data, and assessed the risk of bias. We used meta-analysis with random-effects models to estimate the pooled effect sizes.
We included 403 studies covering 93 economies. The pooled prevalence of antibiotic prescribing among total prescriptions was 34.3% (95% CI = 29.6-39.3) in outpatient settings and 47.7% (95% CI = 45.8-49.5) in inpatient settings. The pooled percentages of antibiotics in the 'access' group were 48.5% (95% CI = 34.5-62.7) in outpatient settings and 43.8% (95% CI = 39.2-48.5) in inpatient settings. Subgroup analysis showed the prevalence of antibiotic prescribing was significantly higher in low-income compared to high-income economies. Additionally, there was a rising trend of the prevalence in inpatient settings over time. The studies showed that patients' gender, education level, health status, and physicians' work experience were associated with hospital antibiotic prescribing.
The global prevalence of antibiotic prescribing in hospitals is high, with significant disparities across regions. Multifaceted measures with multi-sectoral cooperation are required, such as regulatory interventions, professional training for physicians, and public health education.
PROSPERO: CRD42022354076.
目前尚不清楚抗生素处方在总处方中的占比、至少包含一种抗生素的处方中联合使用抗生素的百分比，以及影响医院抗生素处方的因素。在这项系统评价中，我们旨在总结全球医院的抗生素处方情况并确定相关因素。
我们检索了PubMed/MEDLINE、Ovid/Embase和Web of Science数据库，查找2000年1月1日至2023年2月28日期间发表的报告医院抗生素处方或相关因素的文章。四名评审员独立筛选研究、提取数据并评估偏倚风险。我们使用随机效应模型进行荟萃分析来估计合并效应量。
我们纳入了覆盖93个经济体的403项研究。门诊环境中抗生素处方在总处方中的合并占比为34.3%（95%置信区间=29.6-39.3），住院环境中为47.7%（95%置信区间=45.8-49.5）。“可及性”组门诊环境中抗生素的合并占比为48.5%（95%置信区间=34.5-62.7），住院环境中为43.8%（95%置信区间=39.2-48.5）。亚组分析显示，与高收入经济体相比，低收入经济体中抗生素处方的占比显著更高。此外，住院环境中的占比随时间呈上升趋势。研究表明，患者的性别、教育水平、健康状况以及医生的工作经验与医院抗生素处方有关。
全球医院抗生素处方的占比很高，各地区存在显著差异。需要采取多部门合作的多方面措施，如监管干预、医生专业培训和公共卫生教育。
PROSPERO：CRD42022354076。
