Trends and patterns of outpatient and inpatient antibiotic use in China's hospitals: data from the Center for Antibacterial Surveillance, 2012-16.

Abstract

Data surveillance and policy interventions can optimize antibiotic use, but few studies have focused on the changes in antibiotic use after a strict antibiotic stewardship policy was implemented in China in 2012. Based on the Center for Antibacterial Surveillance, data were collected from general hospitals in two provinces of China. Using indicators (e.g. percentage of antibiotic use and proportion of antibiotic costs) recommended by the WHO, this study aimed to identify trends and patterns of systemic antibiotic (Anatomical Therapeutic Chemical code J01) use in hospitals in 2012-16 and to explore inappropriate antibiotic use. This study obtained 282479 outpatient prescriptions and 86070 inpatient records from 52 hospitals. The percentage of antibiotic use in outpatients and non-surgical and surgical inpatients significantly declined from 20.17%, 41.92% and 74.15% in 2012 to 12.94%, 33.88% and 69.03% in 2016, respectively. Among antibiotic prescriptions and records, the percentage of antibiotic combination therapy, the percentage of antibiotic use for prophylaxis and the proportion of antibiotic costs showed a decreasing trend over time. However, in 2016, the percentage of antibiotic use for surgical prophylaxis was still >80%, with more than one-third involving inappropriate timing of antibiotic usage according to the predefined criteria. In non-surgical inpatients, the usage rates in acute upper respiratory infections, diarrhoea in children <5 years and fever or cough symptoms all exceeded 55%. A significant downward trend in antibiotic use was identified in China's hospitals, which indicates that policy intervention might reduce the overuse of antibiotics. Furthermore, strengthening appropriate antibiotic use should be the focus of antibiotic stewardship.