Changes in Antimicrobial Use Prevalence in China: Results from Five Point Prevalence Studies

Chunhui Li,Yixin Lv,Jie Li,Xun Huang,Pengcheng Zhou,Yuhua Chen,Anhua Wu,Ruie Gong,Xin Huang,Zhenru Liu,Li Feng,Hongman Wu,Xinrui Xiong,Wen Xiao ,Xu Xiu-Hua ,Shuang-Yan Zuo ,Chuhan Fu ,Cui Zeng,Nan Ren

doi:10.1371/journal.pone.0082785

Chunhui Li, Yixin Lv + Show 17 more

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https://doi.org/10.1371/journal.pone.0082785

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Abstract

ObjectiveThe abuse of antimicrobials is a serious concern in China. Several measures have been taken to improve the rational use of antimicrobials, including the establishment of a national surveillance network for antimicrobial use. This study describes the dynamic changes in antimicrobial use in China between 2001 and 2010, with the scope of identifying targets to improve the prescription of antimicrobials.MethodsFive point prevalence surveys were performed in hospitals across mainland China in 2001, 2003, 2005, 2008, and 2010. All inpatients who were admitted for at least 24 hours were included in the study. Details regarding antimicrobial use by these patients and the collection of samples for bacterial culture from inpatients administered therapeutic antimicrobials were recorded.ResultsThe surveys encompassed tertiary hospitals from all 31 provinces of mainland China. Antimicrobial use prevalence decreased from 54.79% in 2001 to 46.63% in 2010. While this decline was observed in most hospital departments, antimicrobial use remained stable or increased in others. Antimicrobial use prevalence was relatively high in the Pediatrics departments and general intensive care units, whereas it was lower in the Obstetrics (Neonatal group) departments in each survey. The proportion of patients administered a single antimicrobial increased from 60.78% in 2001 to 70.16% in 2010, while the proportion of administration of two or more antimicrobials declined. The bacterial culture rate increased from 25.22% in 2003 to 34.71% in 2010. Antimicrobial use prevalence (47.96% vs 46.16%), bacterial culture rate (36.40% vs 34.19%), and the proportion of administration of a single antimicrobial (71.41% vs 67.33%) were higher in teaching hospitals than in nonteaching hospitals in 2010.ConclusionAlthough measures for enhancing the rational use of antimicrobials have been effective, further improvements are required. The findings from this study can promote such improvements.

Highlights

Antimicrobial abuse is increasingly becoming an issue of concern worldwide
The most important one is the high prevalence of antimicrobial resistance attributed to the frequent use of antimicrobials [4,5,6,7,8], which presents a serious threat to patients and increases morbidity and mortality [9,10]
The surveyed hospitals were selected from all 31 provinces of mainland China and included teaching and nonteaching hospitals, comprehensive hospitals and specialty hospitals

Summary

Introduction

Antimicrobial abuse is increasingly becoming an issue of concern worldwide. Such misuse results in excessive treatment costs for each patient and causes numerous public health issues [1,2,3]. Monitoring antimicrobial use has become increasingly important. Data describing antimicrobial use in hospitals has only become available since the turn of the century. Since this point in time, many systems for the surveillance of antimicrobial use have been established [4], including the European Surveillance of Antimicrobial Consumption (ESAC) [4,11], the Swedish Strategic Programme Against Antibiotic

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