Trend Analysis Of Antibiotic Use In China's General Hospitals During 2012-2016

ObjectivesThis study aimed to identify the trends and patterns of antibiotic use in general hospitals from 2012 to 2016 in China,and to provide data support and scientific evidence for the formulation and improvement of antibiotic stewardship.MethodsBased on the Center for Antibacterial Surveillance,data were collected from 59 general hospitals in two provinces of China,including outpatient prescriptions and inpatient medical records.Using indicators(e.g.percentage of antibiotic use,percentage of antibiotic combination use,proportion of antibiotic costs,etc.)recommended by the World Health Organization(WHO)and the International Network of Rational Drug Use(INRUD),this study aimed to identify trends of systemic antibiotic use in hospitals in2012–2016.To explore the use of antibiotics in the different levels of hospitals,the selected hospitals were divided into secondary and tertiary hospitals for stratified analysis.Cochran-Armitage trend test was used to examine the trend of categorical variables over time and linear regression analysis was used to test the trend of continuous variables over time.Analyses were performed using SAS version 9.4.Results1.Characteristic of the sample data.We collected the surveillance data of all59 hospitals,including 39 secondary hospitals and 20 tertiary hospitals.Because the monitoring data of outpatient prescriptions in nine hospitals and inpatient records in seven hospitals were incomplete,these data were excluded in the analysis.A total of282479 outpatient prescriptions,42846 non-surgical inpatient records and 43224 surgical inpatient records were obtained in this study.Among them,44542(15.77%)were antibiotic outpatient prescriptions,15954(37.24%)were antibiotic non-surgical inpatient records and 30374(70.27%)were antibiotic surgical inpatient records.2.Trends of outpatient antibiotic use.From 2012 to 2016,the percentage of antibiotic use and the percentage of antibiotic combination use declined from 20.17%and 13.10% to 12.94% and 10.47%,respectively.Cochran-Armitage trend test showed the trends were statistically significant.The proportion of antibiotic costs decreased from 75.87% to 67.02%,and linear regression analysis indicated that the trend was statistically significant(P=0.014).The stratified analysis showed that the above indicators declined significantly in the secondary and tertiary hospitals.The proportion of antibiotics of different categories prescribed each year had not obviously changed in outpatient prescriptions.In 2012-2016,J01 D far exceeded other antibiotic categories and stably ranked first.The most frequently prescribed antibiotic were levofloxacin(10.72%),cefuroxime(8.95%),and metronidazole(5.80%).3.Trends of non-surgical inpatient antibiotic use.From 2012 to 2016,the percentage of antibiotic use,the percentage of antibiotic combination use and the percentage of antibiotic use for prophylaxis declined from 41.92%,36.58% and 18.15%to 33.88%,32.60% and 15.52%,respectively.Cochran-Armitage trend test showed the decline trends were statistically significant.The proportion of antibiotic costs increased from 31.14% to 32.09%,and linear regression analysis indicated that there was no statistical significance(P=0.500).The stratified analysis showed that the above indicators were basically consistent in the decline trend of the secondary and tertiary hospitals.However,the percentage of antibiotic combination use showed no significantly decline trend in the tertiary hospitals.The proportion of antibiotics of different categories prescribed each year had not obviously changed in non-surgical inpatient records.In 2012-2016,J01 D far exceeded other antibiotic categories and stably ranked first.The most frequently prescribed antibiotic were levofloxacin(14.14%),cefuroxime(7.58%),and ceftazidime(6.53%).4.Trends of surgical inpatient antibiotic use.From 2012 to 2016,the percentage of antibiotic use,the percentage of antibiotic combination use,the percentage of antibiotic use in type I incision,the percentage of antibiotic use for surgical prophylaxis,and the percentage of irrational antibiotic use for surgical prophylaxis declined from 74.15%,25.50%,56.44%,84.19%,and 48.81% to 69.03%,22.36%,41.95%,82.62%,and 34.68%,respectively.Cochran-Armitage trend test showed the decline trends were statistically significant.The proportion of antibiotic costs was 15.95% in 2016,which was lower than that in 2012(25.10%).Linearregression analysis indicated that the trend was statistically significant(P=0.008).The stratified analysis showed that the above indicators were basically consistent in the decline trend of the secondary and tertiary hospitals.However,the percentage of antibiotic combination use and the proportion of antibiotic costs showed no significantly decline trend in the tertiary hospitals.The percentage of antibiotic use for surgical prophylaxis showed no significantly decline trend in the secondary hospitals.The proportion of antibiotics of different categories prescribed each year had not obviously changed in surgical inpatient records.In 2012-2016,J01 D far exceeded other antibiotic categories and stably ranked first.The most frequently prescribed antibiotic were cefazolin(17.49%),cefuroxime(16.46%)and metronidazole(8.81%).ConclusionThe percentage of antibiotic use,the percentage of antibiotic combination use and the proportion of antibiotic costs,etc.showed a significant decreasing trend over time,which indicates that an obvious improvement in antibiotic use can be identified in China's general hospitals.However,the inappropriate use of antibiotics was still widespread.For example,the percentage of antibiotic use for surgical prophylaxis was high.Among these,more than one-third of the surgical patients had inappropriate timing of antibiotic use for surgical prophylaxis.Therefore,strengthening appropriate antibiotic use should be the focus of antibiotic stewardship.Highlights and limitationsThe highlight of this study is that the sampling data came from the Center for Antibacterial Surveillance,which can ensure the quality and representativeness of the data.In addition,the sampling data was large enough and the research interval was long,which can make up for the limitations of previous similar studies.Our study had several limitations.Firstly,the Center for Antibacterial Surveillance mainly covered secondary and tertiary hospitals across China,and primary healthcare settings are not included.Therefore,the results of this study cannot reflect the antibiotic use in primary healthcare settings.Secondly,our study only analyzed the frequency of antibiotic use based on the sampling data.Further studies concentrating on antibiotic consumption are needed to provide a more complete understanding of antibiotic use in China.