Development of a model to reduce antibiotic consumption: a quasi-experimental study in all 202 general hospitals in Zhejiang province, China

Abstract

BackgroundThe overuse of antibiotics is recognised as a major contributor to antimicrobial resistance globally. Levels of antimicrobial resistance in China are among the highest in the world. This study aimed to develop and trial a replicable model to reduce antibiotic consumption in general hospitals in Zhejiang province, China. MethodsThe project was a multicentre before-and-after study that involved a three-stage training programme, conducted in all 202 general hospitals of Zhejiang province, China, from January, 2012, to December, 2017. The three-stage process comprised: (1) raising awareness of antimicrobial resistance among all directors of the hospitals and of infection control departments through workshops to discuss appropriate management strategies for antimicrobial resistance; (2) workshops to improve cooperation across departments, including all clinical, microbiology, IT, and pharmacy departments; and (3) training of all doctors and pharmacists in infection diagnosis and treatment through teleconferencing. Doctors who failed the post-course examination were prevented from prescribing any antibiotics for a fixed period. In addition, annual unannounced random surveillance was carried out by an expert team supported by the Center for Antibacterial Surveillance of Zhejiang province. Annual reports were fed back to each hospital. Routine data on antibiotic prescriptions (number, type, and antibiotic use density) were collected from hospital information systems before the intervention and on an annual basis thereafter. The primary outcome measure was the difference in proportions of antibiotics prescribed at baseline (2012) and after 5 years (2017). FindingsData were obtained from 197 general hospitals (five hospitals were excluded owing to missing data). Between 2012 and 2017, antibiotic prescription decreased in outpatients from 21·1% to 14·1%, in emergency patients from 40·4% to 35·4%, and in inpatients from 63·5% to 53·8%. The percentage of antibiotic prescriptions that were given by intravenous antibiotic infusions decreased from 37·7% to 24·8% in outpatients, and from 59·0% to 53·7% in emergency patients. The percentage of inpatients receiving more than one antibiotic decreased from 25·7% to 16·7%, and the cumulative defined daily doses (DDDs) per 100 inpatient days decreased from 58·4 to 50·9. The cost of antibiotics as a proportion of all drugs prescribed decreased from 18·5% to 15·6%. InterpretationThe project demonstrates that raising awareness and an education programme combined with surveillance can reduce antibiotic use in general hospitals. More work needs to be done to evaluate and promote the model. FundingThis work was supported by the Medical Health Science and Technology Project of Zhejiang Provincial Health (number WKJ201462816) and the Public Welfare Technology Research Project in Zhejiang (number 2015C33107).