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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%. Objectif Analyser les tendances et schemas propres a l'utilisation des antibacteriens en milieu hospitalier dans les hopitaux secondaires et tertiaires en Chine, entre 2013 et 2021. Methodes L'analyse repose sur des donnees trimestrielles provenant d'hopitaux couverts par le Center for Antibacterial Surveillance chinois. Nous nous sommes procure des informations sur les caracteristiques des hopitaux (province, code hospitalier anonymise, niveau de l'etablissement et jours d'hospitalisation par exemple) et des antibacteriens (notamment le nom generique, la classe pharmacologique, le dosage, le mode d'administration et le volume utilise). Nous avons quantifie l'usage d'antibacteriens et le nombre de doses journalieres definies par 100 jours-patients. Lanalyse a pris en compte la classification AWaRe (Access, Watch et Reserve) de Organisation mondiale de la Sante. Resultats Entre 2013 et 2021, le recours global aux antibacteriens en milieu hospitalier a considerablement diminue, passant de 48,8 a 38,0 doses journalieres definies pour 100 jours-patients (P < 0,001). En 2021, les variations entre provinces etaient presque multipliees par deux: 29,1 doses journalieres definies pour 100 jours-patients dans le Qinghai, contre 55,3 au Tibet. Pendant toute la duree de l'etude, les antibacteriens d'usage le plus courant, tant dans les hopitaux secondaires que tertiaires, etaient les cephalosporines de troisieme generation, qui representaient pres d'un tiers de l'usage total d'antibacteriens. Les carbapenemes ont ete ajoutes a la liste des classes d'antibacteriens les plus utilisees en 2015. D'apres la classification de l'OMS, les antibacteriens les plus frequemment employes appartenaient a la categorie Watch: leur usage a sensiblement augmente, passant de 61,3% (29,9/48,8) en 2013 a 64,1% (24,4/38,0) en 2021 (P < 0,001). Conclusion Lemploi d'antibacteriens en milieu hospitalier a connu une forte baisse au cours de la periode d'etude. Cependant, le pourcentage d'utilisation croissant des antibacteriens de dernier recours est inquietant, tout comme l'important decalage entre le pourcentage d'antibacteriens utilises appartenant a la categorie Access et la cible mondiale de l'OMS, qui consiste a ne pas depasser les 60%. Objetivo Analizar las tendencias y patrones en el uso de antibacterianos en pacientes hospitalizados en hospitales de atencion terciaria y secundaria de China entre 2013 y 2021. Metodos El analisis incluyo datos trimestrales de hospitales cubiertos a traves del Center for Antibacterial Surveillance (Centro de Vigilancia Antibacteriana) de China. Se obtuvo informacion sobre las caracteristicas de los hospitales (por ejemplo, la provincia, un codigo de hospital anonimo, el nivel del hospital y los dias de hospitalizacion) y las caracteristicas de los antibacterianos (por ejemplo, el nombre generico, la clasificacion del farmaco, la dosis, la via de administracion y el volumen de uso). Se cuantifico el uso de antibacterianos como el numero de dosis diarias definidas por cada 100 pacientes-dia. El analisis tuvo en cuenta la clasificacion de antibioticos Access (Acceso), Watch (Vigilancia) y Reserve (Reserva) de la Organizacion Mundial de la Salud (OMS). Resultados Entre 2013 y 2021, el uso general de antibacterianos en pacientes hospitalizados disminuyo de manera significativa de 48,8 a 38,0 dosis diarias definidas por cada 100 pacientes-dia (p < 0,001). En 2021, la variacion entre provincias fue de casi el doble: 29,1 dosis diarias definidas por cada 100 pacientes-dia en Qinghai frente a 55,3 en Tibet. Los antibacterianos mas utilizados tanto en hospitales de atencion terciaria como secundaria durante todo el periodo de estudio fueron las cefalosporinas de tercera generacion, que representaron alrededor de un tercio del uso total de antibacterianos. Los carbapenemicos se incorporaron a la lista de antibacterianos mas utilizados en 2015. Los antibacterianos mas utilizados en la clasificacion de la OMS pertenecian al grupo Watch: el uso aumento a un ritmo significativo del 61,3 % (29,9/48,8) en 2013 al 64,1 % (24,4/38,0) en 2021 (p < 0,001). Conclusion El uso de antibacterianos en pacientes hospitalizados disminuyo en gran medida durante el periodo de estudio. Sin embargo, el aumento del porcentaje de antibacterianos de ultimo recurso utilizado es preocupante, al igual que la gran diferencia entre el porcentaje de antibacterianos utilizados pertenecientes al grupo Access y el objetivo global de la OMS de no menos del 60 %., Introduction The use of antibacterial drugs is a key driver of antibiotic resistance. (1) China is one of the largest producers and consumers of antibacterials worldwide and, in recent decades, [...]

Background: The challenge of emerging antimicrobial resistance and variation in antibiotic use across provinces in China call for knowledge on antibiotic utilization at the regional level. This study aims to evaluate the long-term trends and patterns of antibiotic usage in Xinjiang Province, the largest provincial-level division located in the northwest of China, aiming to provide evidence in enhancing provincial antimicrobial stewardship (AMS) and developing policy measures to optimize regional antimicrobial use. Methods: This was an ecological study with temporal trend analysis on inpatient antibiotic utilization, with antibiotic use data from 92 public hospitals covered by Xinjiang's Center for Antibacterial Surveillance from 2012 to 2022. Antibiotic use was measured by the number of daily defined doses per 100 patient days (DDDs/100 pds). Patterns of antibiotic use were described by Anatomical Therapeutic Chemical (ATC) subgroups and the Access, Watch, Reserve (AWaRe) classification. The Average Annual Percent Change (AAPC) of antibiotic use and the corresponding 95% confidence intervals (CIs) were calculated to describe the trend of antibiotic use over time. Joinpoint regression was performed using the Weighted Bayesian Information Criteria (WBIC) model with a parametric method. A pairwise comparison between secondary and tertiary hospitals was conducted to explore disparities in antibiotic use across hospital levels. The most commonly used antibiotics were also analyzed. Results: The total inpatient antibiotic use in Xinjiang was 27.6 DDDs/100 patient days in 2022, with a significant decreasing trend during 2012–2022 (AAPC, −2.0%; 95% CI, −3.6% to −0.4%). The Watch group antibiotics were the most used AWaRe category, with the Access-to-Watch ratio decreasing significantly from 46.4% to 24.4% (AAPC, −6.8%; 95% CI, −8.4% to −5.1%). No significant difference was found in the trend of total antibiotic use between secondary and tertiary hospitals, but there were disparities across hospital levels in subgroups. Third-generation cephalosporins, second-generation cephalosporins, and fluoroquinolones remained the top three antibiotic class throughout the study period. The number of antibiotics accounting for 90% of the total antibiotic use decreased from 34 antibiotics in 2012 to 18 antibiotics in 2022. Conclusions: The decreasing trend of inpatient antibiotic use in Xinjiang's public hospitals reflects the effects of continuous AMS implementation. Patterns of antibiotic use underscore the need for further efforts on evidence-based antibiotic selection and for analyses on the appropriateness of antibiotic use. [ABSTRACT FROM AUTHOR]

Background: In order to relieve the financial burden of the patients in China, the Ministry of Health (MoH) conducted the first national price negotiation and successfully negotiated three expensive medicines including 2 targeted anticancer medicines (TAMs), icotinib and gefitinib. However, little evidence was available to demonstrate the impact of the national negotiation on TAMs use. The purpose of the study is to evaluate the implementation of the national price negotiation policy in China on TAMs use. Methods: We used interrupted time series (ITS) design to examine the changes in the daily cost, the monthly hospital purchasing volume and spending of icotinib and gefitinib with pharmaceutical procurement data from 594 tertiary hospitals in 29 provinces of mainland China between January 2015 and July 2017. The period between May and July 2016 was applied to assess the impact of policy. Results: The daily cost of icotinib and gefitinib decreased by 50.08% (P<.001) and 53.89% (P<.001) 12 months after the national negotiation, respectively. In terms of volume, the negotiation was associated with increases in the trend of the monthly hospital purchasing volume of icotinib and gefitinib by 4.87 thousand defined daily doses (DDDs) (P<.001) and 6.89 thousand DDDs (P<.001). However, the monthly hospital purchasing spending of icotinib and gefitinib decreased rapidly by US$0.51 million (P<.010) and US$0.82 million (P<.050) following policy implementation, respectively. Conclusion: The first national negotiation had successfully cut off the price of two negotiated TAMs and promoted TAMs use in China. In the future, government should conduct further price negotiations and include more medicines with clinical benefits into reimbursement schemes to alleviate patients’ financial burden and promote their access to essential treatment. [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]

Objectives: To identify the patterns of antibiotic use and irrational antibiotic prescriptions in primary healthcare institutions (PHIs) in Dongcheng District of Beijing, China.Materials and Methods: All primary healthcare institutions (7 community healthcare centres and 59 community healthcare stations in total) in Dongcheng District were included in the study. Prescription data from January 2015 to December 2018 was derived from the Beijing Prescription Reviewing System of Primary healthcare institutions and analysed retrospectively. The antibiotic prescription rate was calculated and cases of irrational antibiotic prescriptions were identified.Results: We extracted 11,166,905 prescriptions from the database. Only 189,962 prescriptions were included in the study, among which 9167 (4.8%) contained antibiotics. The antibiotic prescription rate fell from 5.2% in 2015 to 4.1% in 2018 while irrational antibiotic prescription rate increased from 10.4 to 11.8%. Acute Bronchitis was the most prevalent diagnosis (17.6%) for antibiotic prescriptions, followed by Unspecified Acute Respiratory Tract Infection (14.4%), Acute Tonsillitis (9.9%), and Urinary Tract Infection (6.4%). Around 10% of the prescriptions for the top 7 diagnoses identified were rated as irrational. Cephalosporins, fluoroquinolones, and macrolides were the most prescribed antibiotics, which accounted for 89.3% of all antibiotic prescriptions. Of all the antibiotic prescriptions, 7531 were reviewed, among which 939 (12.5%) were rated as irrational because of antibiotic use. Among all the irrational prescriptions, prescriptions with inappropriate antibiotic use and dosage accounted for the majority (54.4%).Conclusion: Although a relatively low level of antibiotic utilization was found in PHIs in Dongcheng District of Beijing, the utilization patterns differed considerably from developed countries and irrational prescriptions remained. Considering the imbalanced allocation of medical resources between primary healthcare setting and secondary and tertiary hospitals, there need to be more efforts invested in regions with different levels of economic development. [ABSTRACT FROM AUTHOR]

The purpose of the study was to investigate the current status quo of self-monitoring of blood glucose (SMBG) levels and to analyze the relationship between demographics and other characteristics of SMBG among people with type 2 diabetes (T2D) in China. In this multicenter, cross-sectional study, 496 individuals with T2D from five provinces across China voluntarily participated in the study and completed a standardized questionnaire that requested information on demographic data, clinic-related information, and glucose monitoring. Data was obtained via face-to-face interviews. Negative binomial regression analysis was used to identify factors associated with SMBG. Of the total sample, 99 (20.0%) participants had never performed SMBG and/or less than once. We found that 104 participants (21.0%) had tested just once. In addition 119 people (24.0%) had tested twice, 89 (18.0%) had tested between three and six times, and 85 participants (17.1%) had tested more than seven times in a week. Univariate analysis and multivariate analysis found that the patients that had high monitoring frequencies were those with URBMI, UEBMI, and GMI insurance; those who had previously experienced complications; inpatients; and those with a knowledge of HbA1c testing. The frequency of SMBG was suboptimal, compared with the once prior to each meal recommendation by the American Diabetes Association (ADA). Several factors influenced SMBG frequency: types of health insurance, complications, impatience, and knowledge of HbA1c. [ABSTRACT FROM AUTHOR]