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Objective To analyse trends and patterns in inpatient antibacterial use in China's tertiary and secondary hospitals between 2013 and 2021. Methods The analysis involved quarterly data from hospitals covered by China's Center for Antibacterial Surveillance. We obtained information on hospital characteristics (e.g. province, a de-identified hospital code, hospital level and inpatient days) and antibacterial characteristics (e.g. generic name, drug classification, dosage, administration route and usage volume). We quantified antibacterial use as the number of daily defined doses per 100 patient-days. The analysis took into account the World Health Organization's (WHO's) Access, Watch, Reserve classification of antibiotics. Findings Between 2013 and 2021, overall antibacterial use in inpatients decreased significantly from 48.8 to 38.0 daily defined doses per 100 patient-days (P < 0.001). In 2021, the variation between provinces was almost twofold: 29.1 daily defined doses per 100 patient-days in Qinghai versus 55.3 in Tibet. The most-used antibacterials in both tertiary and secondary hospitals throughout the study period were third-generation cephalosporins, which comprised around one third of total antibacterial use. Carbapenems entered the list of most-used antibacterial classifications in 2015. The most frequently used antibacterials in WHO's classification belonged to the Watch group: usage increased significantly from 61.3% (29.9/48.8) in 2013 to 64.1% (24.4/38.0) in 2021 (P < 0.001). Conclusion Antibacterial use in inpatients decreased significantly during the study period. However, the rising proportion of last-resort antibacterials used is concerning, as is the large gap between the proportion of antibacterials used belonging to the Access group and WHO's global target of no less than 60%. [ABSTRACT FROM AUTHOR]

In the present study, we aimed to assess the development of the antimicrobial stewardship (AMS) program in China's tertiary hospitals to identify the potential challenges for the AMS program and provide references and benchmarks for strategic policymaking. A nationwide cross-sectional study was conducted online by sending questionnaires to tertiary hospitals under China Antimicrobial Resistance Surveillance System (CARSS). The questionnaire included 5 sections regarding structure, technical support, antimicrobial use management, antimicrobial use surveillance, and education. Descriptive statistics were used for data analysis. Of the 1044 tertiary hospitals under CARSS, 13.4% (140) hospitals participated in the study. Among them, 99.3% (139/140) set up the AMS program. The hospital president (82.1%, 115/140) and medical service department (59.3%, 83/140) were responsible for AMS outcomes in most hospitals. Structured antimicrobial formulary restriction management was adopted by 99.3% (139/140) hospitals. Infectious disease department, infection control department, and microbiological laboratories were established in 87.1% (122/140), 99.3% (139/140) and 100% (140/140) hospitals, respectively. Up to 85.6% (124/140) hospitals applied clinical pathways, and 33.6% (47/140) hospitals implemented hospital-specific guidelines for infectious diseases. Outpatient prescription auditing, inpatient prescription auditing, and prophylactic antimicrobial prescription auditing of aseptic operation were performed in 99.3% (139/140), 98.6% (138/140) and 95.7% (134/140) hospitals, respectively. Up to 97.1% (136/140) hospitals participated in antimicrobial use surveillance network, and 99.3% (139/140) hospitals established the specialized management of carbapenem and tigecycline. Staff education and public education were provided with various ways and frequencies in 100% (140/140) and 90.0% (126/140) hospitals, respectively. AMS programs in China's tertiary hospitals were primarily headed by hospital presidents and involved collaboration among various disciplines and administrative departments. More efforts should be put to further promote and strengthen the development of hospital-specific guidelines and the establishment of a progress and outcome evaluation system. [ABSTRACT FROM AUTHOR]