Abstract
Background: Antimicrobial resistance is a significant clinical problem in pediatric practice in China. Surveillance of antibiotic use is one of the cornerstones to assess the quality of antibiotic use and plan and assess the impact of antibiotic stewardship interventions. Methods: We carried out quarterly point prevalence surveys referring to WHO Methodology of Point Prevalence Survey in 16 Chinese general and children’s hospitals in 2019 to assess antibiotic use in pediatric inpatients based on the WHO AWaRe metrics and to detect potential problem areas. Data were retrieved via the hospital information systems on the second Monday of March, June, September and December. Antibiotic prescribing patterns were analyzed across and within diagnostic conditions and ward types according to WHO AWaRe metrics and Anatomical Therapeutic Chemical (ATC) Classification. Results: A total of 22,327 hospitalized children were sampled, of which 14,757 (66.1%) were prescribed ≥1 antibiotic. Among the 3,936 sampled neonates (≤1 month), 59.2% (n = 2,331) were prescribed ≥1 antibiotic. A high percentage of combination antibiotic therapy was observed in PICUs (78.5%), pediatric medical wards (68.1%) and surgical wards (65.2%). For hospitalized children prescribed ≥1 antibiotic, the most common diagnosis on admission were lower respiratory tract infections (43.2%, n = 6,379). WHO Watch group antibiotics accounted for 70.4% of prescriptions (n = 12,915). The most prescribed antibiotic ATC classes were third-generation cephalosporins (41.9%, n = 7,679), followed by penicillins/β-lactamase inhibitors (16.1%, n = 2,962), macrolides (12.1%, n = 2,214) and carbapenems (7.7%, n = 1,331). Conclusion: Based on these data, overuse of broad-spectrum Watch group antibiotics is common in Chinese pediatric inpatients. Specific interventions in the context of the national antimicrobial stewardship framework should aim to reduce the use of Watch antibiotics and routine surveillance of antibiotic use using WHO AWaRe metrics should be implemented.
Highlights
Antimicrobial resistance has become a major public health problem, especially in low and middle income countries like China, where the burden of infectious diseases and the frequency of antibiotic use are very high
These interventions have been associated with a reduction in overall antibiotic prescribing, but the prevalence of infections with antibiotic-resistant WHO priority pathogens remains high in China (National Health Commission of the People’s Republic of China, 2018b)
It is noteworthy that Watch group antibiotics accounted for 73.8% of antibiotic prescriptions and inappropriate combination antibiotic therapy was frequently prescribed in Chinese pediatric inpatients
Summary
Antimicrobial resistance has become a major public health problem, especially in low and middle income countries like China, where the burden of infectious diseases and the frequency of antibiotic use are very high. The carbapenem resistance in Klebsiella pneumoniae and Acinetobacter baumannii is 13.4 and 28.5% in children’s hospital, highlighting the growing challenge of treating pediatric infectious diseases in China (National Health Commission of the People’s Republic of China, 2018b). Since 2011, the Chinese government has initiated a series of national antimicrobial management strategies to supervise and restrict antibiotic use (Xiao and Li, 2013). These interventions have been associated with a reduction in overall antibiotic prescribing, but the prevalence of infections with antibiotic-resistant WHO priority pathogens remains high in China (National Health Commission of the People’s Republic of China, 2018b). According to national surveillance data, antibiotic prescribing rate was 36.7% in 2017 (National Health Commission of the People’s Republic of China, 2018b). Surveillance of antibiotic use is one of the cornerstones to assess the quality of antibiotic use and plan and assess the impact of antibiotic stewardship interventions
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
