Trends and patterns of antibiotic consumption in China’s tertiary hospitals: Based on a 5 year surveillance with sales records, 2011-2015

Abstract

The consumption of antibiotics is a major driver in the development of antimicrobial resistance. This study aims to identify the trends and patterns of the total antibiotic consumption in China’s tertiary hospitals from 2011 to 2015 by retrospectively analyzing aggregated monthly surveillance data on antibiotic sales made to 468 hospitals from 28 provinces. Antibiotic consumption was expressed in DDD per 1,000 inhabitants per day (DID). We compared population weighted antibiotic consumption patterns in China with European countries using indicators from the European Surveillance of Antimicrobial Consumption (ESAC). Total antibiotic consumption, including all the specific antibiotic class except for aminoglycoside antibacterials, were significantly increased during the study period from an average of 7.97 DID in 2011 to 10.08 DID in 2015. In 2015, the eastern regions of China consumed the most antibiotics using population denominator while the western regions consumed the most using inpatient denominator. Cephalosporins accounted for 28.6% of total DID, followed by beta-lactam-beta-lactamase inhibitor combinations (20.0%), macrolides (17.4%), and fluoroquinolones (10.5%). Antibiotic in parenteral form accounted for nearly half of all antibiotics. Although over the past few years major efforts had been made to reduce the risks of excessive antibiotic use through antibiotic stewardship, total antibiotic consumption showed a significant upward trend during the study period. A consistent preference for cephalosporins, macrolides, beta-lactam-beta-lactamase inhibitor combinations, as well as parenteral preparations was observed.

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

“…This leads to a higher usage of antibiotics. The per capita consumption of antibiotics in China is higher than that in at least 75% of 29 European countries, in terms of the consumption of third- and fourth-generation cephalosporin and fluoroquinolones [24]. Thus, increased efforts are needed to curb antibiotic use in China, with particular emphasis placed on the supervision of antibiotic use in national hospitals.…”

“…Although several studies have attempted to assess antibiotic use in China [21–24], none has reported quarterly data and the influencing factors of inpatient antibiotic consumption. Therefore, this study aimed to determine the trends and influencing factors of Chinese inpatient antibiotic consumption over a more detailed observation time and assess differences according to region and hospital ownership.…”

β-lactam Antibiotics Stimulate the Pathogenicity of Methicillin-resistant Staphylococcus aureus Via SarA-controlled Tandem Lipoprotein Expression

“…As antibiotics, β-lactams bind to penicillin-binding proteins (PBPs) and inhibit the transpeptidation and transglycosylation of the cell wall, resulting in a weakened cell wall and inducing cell lysis and death [30]. This type of antibiotics, particularly cephalosporins and β-lactam/β-lactamase inhibitor combinations, has been empirically used for clinical treatments of infectious diseases [31]. The subinhibitory concentrations of antistaphylococcal agents might arise because of antibiotic-resistant microorganisms or pharmacokinetics of antibiotics [13,31].…”

“…This type of antibiotics, particularly cephalosporins and β-lactam/β-lactamase inhibitor combinations, has been empirically used for clinical treatments of infectious diseases [31]. The subinhibitory concentrations of antistaphylococcal agents might arise because of antibiotic-resistant microorganisms or pharmacokinetics of antibiotics [13,31]. For MRSA infections, which are not initially recognized, β-lactams are not only ineffective in the treatment of infections but also likely contributing to poor outcomes by enhancing the pathogenicity of MRSA.…”

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

“…Studies have centered around the impact of SAC and short-term trends of antibiotic consumption in China [13,14]. However, the long-term change of antibiotic consumption, especially after a decade since health system reform, was yet to explore.…”