Evaluating antibiotic use patterns and compliance in Shanxi province hospitals: a 7-year retrospective study of national clinical improvement system data (2015-2021).

OBJECTIVE

With the increasing prevalence of antimicrobial resistance (AMR), the rational use of antibiotics is crucial. This study aimed to evaluate the antibiotic use patterns and influencing factors of compliance in Shanxi Province Hospitals between 2015 and 2021 and provide data support for the management of antibiotics.

DESIGN

This was a retrospective observational study of trends in antibiotic use and data reporting trends in the context of antimicrobial stewardship (AMS).

DATA SOURCES

The analysis involved annual antibiotic data from hospitals covered by China's National Clinical Improvement System (NCIS). We obtained information on hospital characteristics (eg, city, a deidentified hospital code and hospital level) from Shanxi Provincial Pharmaceutical Quality Control Centre.

ELIGIBILITY CRITERIA

Our study included Shanxi hospitals that reported annual antibiotic data to the NCIS system in any year between 2015 and 2021.

RESULTS

The number of hospitals reporting antibiotic data has increased annually. Between 2015 and 2021, a total of 221 hospitals in 11 cities were analysed. The proportion of patients undergoing clean surgical procedures with prophylactic antibiotic prescriptions decreased from 45.08% to 40.0% between 2019 and 2021, with a compound annual growth rate (CAGR) of -5.80 (p=0.103). The intensity of antibiotic treatment among inpatients was from 42.00 to 39.70 daily defined dose between 2017 and 2021, with a CAGR of -1.40 (p=0.015). The proportion of inpatients with antibiotic prescriptions decreased from 51.42% to 47.14% between 2015 and 2021, with a CAGR of -1.44 (p<0.001), and the proportion of inpatients with special-grade antibiotic prescriptions decreased from 0.74% to 0.49% between 2016 and 2021, with a CAGR of -2.56 (p=0.998). The multivariable logistic regression analysis showed that public hospitals, hospitals with prescription automatic screening system (PASS), hospitals with AMS, City A, City G and City I were independently associated with the proportion of patients who used prophylactic antibiotics for patients undergoing clean surgical procedures. Hospitals with PASS and AMS, and hospitals in City A, City D, City E and City I were independently associated with the antibiotic use density. Tertiary hospitals and City C were independently significantly associated with the proportion of inpatients with antibiotic prescriptions. Hospitals with AMS and City D were independently significantly associated with the proportion of inpatients with special-grade antibiotic prescriptions (all p<0.05).

CONCLUSIONS

Antibiotic consumption in inpatients decreased during the study period. However, we need to take more measures to reduce patients undergoing clean surgical procedures with prophylactic antibiotic prescriptions and inpatients with special-grade antibiotic prescriptions. Antibiotic use was associated with various hospital characteristics and geographic locations. While the provincial efforts in controlling antibiotic use show some efficacy, further enhancement of surveillance programmes and targeted interventions at the hospital level are necessary to mitigate the escalation of AMR and ensure adequate antibiotic supply for emerging infectious diseases.