Yin Donghong, Tang Yang, Wang Song, Wang Shuyun, Ren Jian, Zhang Rui, Yang Shucheng, Hou Ruigang, Duan Jinju, Ren Zhihong
Department of Pharmacy, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
Shanxi Provincial Pharmaceutical Quality Control Center, Taiyuan, Shanxi, China.
BMJ Open. 2025 May 30;15(5):e095960. doi: 10.1136/bmjopen-2024-095960.
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.
This was a retrospective observational study of trends in antibiotic use and data reporting trends in the context of antimicrobial stewardship (AMS).
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.
Our study included Shanxi hospitals that reported annual antibiotic data to the NCIS system in any year between 2015 and 2021.
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).
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.
随着抗菌药物耐药性（AMR）的日益普遍，合理使用抗生素至关重要。本研究旨在评估2015年至2021年间山西省医院的抗生素使用模式及依从性影响因素，为抗生素管理提供数据支持。
这是一项关于抗菌药物管理（AMS）背景下抗生素使用趋势和数据报告趋势的回顾性观察研究。
分析涉及中国国家临床改善系统（NCIS）覆盖医院的年度抗生素数据。我们从山西省药品质量控制中心获取了医院特征信息（如城市、匿名医院代码和医院级别）。
我们的研究包括在2015年至2021年期间任何一年向NCIS系统报告年度抗生素数据的山西医院。
报告抗生素数据的医院数量逐年增加。2015年至2021年期间，共分析了11个城市的221家医院。2019年至2021年期间，接受清洁手术并预防性使用抗生素处方的患者比例从45.08%降至40.0%，复合年增长率（CAGR）为-5.80（p = 0.103）。2017年至2021年期间，住院患者抗生素治疗强度从每日42.00限定日剂量降至39.70限定日剂量，CAGR为-1.40（p = 0.015）。2015年至2021年期间，有抗生素处方的住院患者比例从51.42%降至47.14%，CAGR为-1.44（p < 0.001），2016年至2021年期间，有特殊级抗生素处方的住院患者比例从0.74%降至0.49%，CAGR为-2.56（p = 0.998）。多变量逻辑回归分析显示，公立医院、配备处方自动筛查系统（PASS）的医院、开展AMS的医院、A市、G市和I市与接受清洁手术患者预防性使用抗生素的比例独立相关。配备PASS和开展AMS的医院，以及A市、D市、E市和I市的医院与抗生素使用密度独立相关。三级医院和C市与有抗生素处方的住院患者比例独立显著相关。开展AMS的医院和D市与有特殊级抗生素处方的住院患者比例独立显著相关（所有p < 0.05）。
研究期间住院患者抗生素消耗量有所下降。然而，我们需要采取更多措施，以减少接受清洁手术并预防性使用抗生素处方的患者以及有特殊级抗生素处方的住院患者。抗生素使用与多种医院特征和地理位置相关。虽然省级层面在控制抗生素使用方面取得了一定成效，但仍需进一步加强监测计划并在医院层面进行针对性干预，以缓解AMR的升级，并确保为新发传染病提供充足的抗生素供应。
