Study On The Distribution & Control Strategy Of Antimicrobial Resistance In China

Object:Antimicrobial resistance has been the global crisis, and some experts and scholars have made lots of researches to control it. But most of these researches are orientated in microcosmic point of view and bacteria themselves. The three-dimensional distribution– time, space, antimicrobial agents– is researched in this study, which is from macroscopic point of view and adopt the thoughts and methods of Epidemiology. This study provides a thought for other researchers to promote comprehensive research, and forecasts the development trend of antimicrobial resistance to explore the latent risk of drug use. The feasibility and priority of control strategy are analyzed through stakeholder analysis, to arrive the object of improving the level of control antimicrobial resistance, enhancing the effect of antimicrobial agents, saving the limited health resources.Methods:Literature review, expert consultation, non-contact method, statistical method, clustering analytical method, stakeholder analysis are used in this study. The data include: (1) literatures of antimicrobial resistance in China and abroad. (2) the data of resistance surveillance in 2001-2005 from three-tiered hospitals in the national resistance surveillance net. (3) the data of resistance surveillance about Escherichia Coll. to frequent antimicrobial agents in 2001-2005 from three-tiered hospitals of 8 provinces or cities (Beijing, Tianjin, Guangdong, Guangxi, Liaoning, Sichuan, Hubei, Zhejiang) in the national resistance surveillance net.Results and Conclusions:1. The theoretic study of antimicrobial resistance shows that the producing and spreading of antimicrobial resistance is influced by the specialty of bacteria and drugs but the human fuction as well. The related control policies include the essential drug policy, the rational drug use policy, and the drug classify management policy. Those problems such as not extensive cover, not enough power, lack of communion and cooperation, not enough feedback to clinic exist in the resistance surveillance work in China.2. Comparing the data of resistance surveillance in 2001-2005 from three-tiered hospitals in the national resistance surveillance net, gram-negative bacilli are chief, especially some conditional pathogens such as Escherichia Coll., and the position of clinic separable strains doesn't change too much from the horizontal level.2. The three-dimensional distribution of Escherichia Coll. is researched. (1) Time: the resistance rates of Escherichia Coll. to frequent antimicrobial agents are different from 2001 to 2005, and the wholly strend is rising, especially cefotaxime, ceftazidime, and cefuroxime sodium,whose increasing rates are over 20%. The resistance rates of cefotaxime, cefazolin, ampicillin, cefuroxime sodium, nalidixic acid and levofloxacin will achieve 100% in 2010 through the forecast method. (2) Space: the resistance rates of Escherichia Coll. to frequent antimicrobial agents are different in different areas. The instance in Beijing, Guangxi and Sichuan is better than other areas, Guangdong, Liaoning and Tianjin are similar and Zhejiang is most seriouse. The rates in seaside cities and land cities are different. The rates of imipenem, ceftazidime, ciprofloxacin, aztreonam in seaside cities are higher than those in land cities and the differences have statistical sense. The rates of piperacillin and cefotaxime in land cities are higher than those in seaside cities, and the former difference has statistical sense. (3) Antimicrobial agents: the resistance rates of Escherichia Coll. to frequent antimicrobial agents are different in different antimicrobial agents. These Escherichia Coll. strains have higher resistance rates to penicillins, sulfanilamides, tetracyclines and quinolones, and lower rates to monobactams and aminoglycosides.3. The result of comparatively steady stakeholder analysis is that the government, health management department, drug administration should be explored and corresponded, the management to hospitals should be enhanced, the supervision to agriculture department, health staff, and the related enterprises should be enhanced, and the education to the resistance surveillance agents and sufferers. The result of comparatively mobile stakeholder analysis is that the government should be maintained and increased, agriculture department, hospitals, health staff and the related enterprises should be managed and controlled, health management department, drug administration, the resistance surveillance agents and sufferers should be cooperated and educated. The control strategy should contain 16 measures, and the priority of this strategy may include: taking the result of microbiological testing as the evidence to choose the antimicrobial agents; establishing or confirming the national resistance surveillance center; establishing and developing fast pathogeny diagnosis methods; encouraging the new bacterin and antimicrobial agents.4. The researchers should pay attention to time, country or area, the kind and use of antimicrobial agents when they study on bacterial resistance.5. The macroscopic quantity relationship between the bacterea resistance and the antimicrobial use, and the cause and effect relationship between the bacterea resistance and irrational use of drugs need further studying.Suggestions:1. The government should attach great importance to the problem of bacterial resistance, and take the responsibility for controlling it. (1) Bacterial resistance laws and regulations should be built and strengthened, and the rational use of drug and it's supervision management should be strengthened. (2) The health system reforming in China should continue deepening. (3) Public health departments need funding to build a uniform authoritative information shared surveillance system as soon as possible to organize and correspond other agents and hospitals. (4) The conduct and correspond effect to related departments should be enhanced. (5) The new bacterin and antimicrobial agents should be encouraged.2.Medical institutions and doctors should earnestly fulfill to use antibiotics rationally, including: (1) formulating clinic guidelines and formularies for using antibiotics; (2) establishing pharmacy administration committee, tightening management in hospitals, and establishing security system for clinic use of antibiotics; (3) strengthening the feedback of antibiotics resistance surveillance on the clinic use of antibiotics, and using the surveillance result to guide their clinic use; (4) doctors should take the medical responsibility for treating patients and the social responsibility for maintaining the sensitiveness of bacteria to the antibiotics.3. The education and publicize should be enhanced to advance the realization rate of public of the problems of bacterial resistance and irrational drug use.Innovation and next study:Innovation:1. The three-dimensional distribution– time, space, antimicrobial agents– is researched in this study for the first time in this study, which is from macroscopic point of view and adopt the thoughts and methods of Epidemiology. The view that the researchers should pay attention to time, country or area, the kind and use of antimicrobial agents when they study on bacterial resistance is put forward.2. The feasibility and priority of control strategy are analyzed through stakeholder analysis. To settle antimicrobial resistance, we should not only continue reseaching the mechanism of antimicrobial resistance and manufacturing new antimicrobial agents in microcosmic point, but also enhancing the management and control of antimicrobial agents in macroscopic point, thereinto, the government should take main responsibility, and hospitals and doctors should carry out material measures.Next study: the macroscopic quantity relationship between the bacterea resistance and the antimicrobial use, and the cause and effect relationship between the bacterea resistance and irrational use of drugs need further studying.