Trends and Patterns of Antibiotics Use in China's Urban Tertiary Hospitals, 2016-19

Yulei Zhu; Yang Qiao; Rouli Dai; Xin Hu; Xin Li

doi:10.3389/fphar.2021.757309

Trends and Patterns of Antibiotics Use in China's Urban Tertiary Hospitals, 2016-19

Front Pharmacol. 2021 Nov 3:12:757309. doi: 10.3389/fphar.2021.757309. eCollection 2021.

Authors

Yulei Zhu^{1

2}, Yang Qiao³, Rouli Dai⁴, Xin Hu⁵, Xin Li^{2

6

7}

Affiliations

¹ Office of Scientific Research, the Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China.
² School of Health Policy and Management, Nanjing Medical University, Nanjing, China.
³ First School of Clinical Medicine, Nanjing Medical University, Nanjing, China.
⁴ Medical Office, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, China.
⁵ Department of Pharmacy, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), Beijing, China.
⁶ Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, China.
⁷ Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.

Abstract

Objectives: This study aimed to identify the trends in antibiotics utilization and patients costs, evaluating the effect of the policy and exploring factors associated with the irrational use of antibiotics. Methods: Based on the Cooperation Project Database of Hospital Prescriptions, data were collected from 89 tertiary hospitals in nine cities in China during 2016-2019. The study sample consisted of prescription records with antibiotics for 3,422,710 outpatient and emergency visits and 26, 118, 436 inpatient hospitalizations. Results: For outpatients, the proportion of treated with antibiotics declined from 14.72 to 13.92% significantly (p < 0.01). The proportion of antibiotic costs for outpatients decreased from 5.79 to 4.45% significantly (p < 0.01). For emergency patients, the proportion of treated with antibiotics increased from 39.31 to 43.45% significantly (p < 0.01). The proportion of antibiotic costs for emergency patients decreased from 36.44 to 34.69%, with no significant change (p = 0.87). For inpatients, the proportion of treated with antibiotics increased from 23.82 to 27.25% significantly (p < 0.01). The proportion of antibiotic costs for outpatients decreased from 18.09 to 17.19% with no statistical significance (p = 0.89). Other β-lactam antibacterials (1,663.03 ten thousand DDD) far exceeded other antibiotics categories. Stablely ranked first, followed by Macrolides, lincosamide and streptogramins (965.74 ten thousand DDD), Quinolone antibacterials (710.42 ten thousand DDD), and β-lactam antibacterials, penicillins (497.01 ten thousand DDD). Conclusions: The proportion of treated with antibiotics for outpatients and inpatients meet the WHO standards. The antibiotics use varied by different survey areas, clinical departments, patient gender, patient age and antibiotics categories. More efforts should focus on improving the appropriateness of antibiotics use at the individual level.

Keywords: China; antibiotics use; antimicrobial stewardship; tertiary hospitals; urban hospitals.