Abstract
BackgroundThis paper tries to describe prevalence and patterns of antibiotics prescription and bacteria detection and sensitivity to antibiotics in rural China and implications for future antibiotic stewardship.MethodsThe study was implemented in one village clinic and one township health center in each of four rural residential areas in Anhui Province, China. It used mixed-methods comprising non-participative observations, exit-survey and microbiological study. Observations were conducted to record clinical diagnosis and antibiotic prescription. Semi-structured questionnaire survey was used to collect patient’s sociodemographic information and symptoms. Sputum and throat swabs were collected for bacterial culture and susceptibility testing.ResultsA total of 1068 (51.0% male vs 49.0% female) patients completed the study with diagnosis of respiratory tract infection (326,30.5%), bronchitis/tracheitis (249,23.3%), pharyngitis (119,11.1%) and others (374, 35.0%). They provided 683 sputum and 385 throat swab specimens. Antibiotics were prescribed for 88% of the RTI patients. Of all the specimens tested, 329 (31%) were isolated with bacteria. The most frequently detected bacteria were K. pneumonia (24% in all specimens), H. influenza (16%), H. parainfluenzae (15%), P. aeruginosa (6%), S.aureus (5%), M. catarrhalis (3%) and S. pneumoniae (2%).ConclusionsThe study establishes the feasibility of conducting microbiological testing outside Tier 2 and 3 hospitals in rural China. It reveals that prescription of antibiotics, especially broad-spectrum and combined antibiotics, is still very common and there is a clear need for stewardship programs aimed at both reducing the number of prescriptions and promoting single and narrow-spectrum antibiotics.
Highlights
This paper tries to describe prevalence and patterns of antibiotics prescription and bacteria detection and sensitivity to antibiotics in rural China and implications for future antibiotic stewardship
Data from 76 countries including China show that global antibiotics consumption grew by more than 39% between 2000 and 2015 and China consumes the second largest amount of antibiotics in the world [3] with a prescription rate twice that recommended by the World Health Organization (WHO)
This paper reports on descriptive analysis of: a) social demographics of patients recruited; b) antibiotics use by clinical diagnosis; c) percentages of patients identified with specific types of bacteria by groups of clinical diagnosis; and d) prevalence rates of resistance of most frequently identified bacteria to commonly used antibiotics
Summary
This paper tries to describe prevalence and patterns of antibiotics prescription and bacteria detection and sensitivity to antibiotics in rural China and implications for future antibiotic stewardship. Antimicrobial resistance (AMR) has become one of the biggest threats to global health [1, 2] It leads to higher financial costs, prolonged hospital stays and increased patient mortality. According to a survey in rural areas of Shandong and Ningxia, 89% and 77% of the prescriptions contained antibiotics for patients clinically diagnosed as having upper respiratory tract infections (RTIs) [5]. Another survey of prescriptions from village clinics in middle-east China showed that the proportion of antibiotics prescribed for RTIs accounted for 87% [6]. The Chinese government has introduced a number of regulations to control antibiotic use in the last decade, but these have not played a significant role in rural areas [7]
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