Trends and Drivers of Inpatient Antibiotic Consumption among 89 China Tertiary General Hospitals from 2011Q1 to 2015Q4

Abstract

Antibacterial surveillance is an essential measure for strengthening the management of clinical antibiotic use. This study aimed to determine the trends and drivers of inpatient antibiotic consumption in China. A sample of 89 hospitals with complete data from 2011Q1 to 2015Q4 was included. Accumulative defined daily doses (DDDs), antibiotic use density (AUD), and drug variety were calculated to evaluate antibiotic consumption. From 2011Q1 to 2015Q4, the median values of DDDs, AUD, and drug variety dropped by 10.49%, 39.19%, and 27.96%, respectively. Panel regression results showed, for each additional quarter, DDDs reduced by 6.714 DDDs, AUD reduced by 0.013 DDDs per 100 inpatients per day, and drug variety reduced by 0.012 types (p < 0.001). National hospitals were more likely to use antibiotics, with the highest number of DDDs (106 709 DDDs) and AUD (60 DDDs per 100 inpatients per day) and a large number of drug variety (71 types of drug) all reported from national hospitals. Overall, a downward trend of inpatient antibiotic consumption was observed in competitive tertiary general hospitals in China. However, antibiotic use in China, especially in national hospitals, continues to exceed the guidelines set forth by the nationwide antibiotic stewardship program. China must continue to improve surveillance of antibiotic consumption by constructing a more comprehensive, continuous, and targeted stewardship program. Policy interventions in China should be made in consideration of unbalanced regional development and the consequences this may have on antibiotic consumption.

Secular trend analysis of antibiotic utilisation in China’s hospitals 2011–2018, a retrospective analysis of procurement data

“…Although the developed regions with larger populations consumed more antibiotics, significant increases were observed in underdeveloped regions despite having smaller populations (4 out of the top 5 provinces with the highest increase in antibiotic utilisation were underdeveloped). While it can be hard to explain the discrepancy with other studies that describe a decrease in antibiotic use [20][21][22][23], we found evidence that is consistent with the increasing tendency, when considering changes in the pharmaceutical market and inpatient volume. China's anti-infection pharmaceutical market continuously increased from 2011 to 2017 with varying growth rates.…”

Secular trend analysis of antibiotic consumption in China’s hospitals 2011-2018, a retrospective analysis of sales data

“…Although the developed regions with larger populations consumed more antibiotics, significant increases were observed in underdeveloped regions despite having smaller populations (4 out of the top 5 provinces with the highest increase in antibiotic use were underdeveloped). While it can be hard to explain the discrepancy with other studies that describe a decrease in antibiotic use[21][22][23][24], we found evidence that is consistent with the increasing trend, when considering changes in the pharmaceutical marketand inpatient volume. China's anti-infection pharmaceutical market continuously increased from 2011 to 2017 with varying growth rates.…”

<p>Time series analysis of antibacterial usage and bacterial resistance in China: observations from a tertiary hospital from 2014 to 2018</p>

“…The defined daily dose (DDD), which was developed using the ATC index, is the assumed average maintenance dose per day for a drug used for its main indication in adults. According to the 2019 version of the ATC/DDD classification, antibacterial consumption was defined as the number of defined daily doses/100 patient-days (DDDs/100 PDs) and expressed as antimicrobial use density (AUD), which is positively correlated with antibacterial consumption 22. Prophylactic usage and therapeutic medication were not distinguished in this study.…”