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Yao K, Deng J, Ma X, Dai W, Chen Q, Zhou K, Ye J, Shi W, Wang H, Li D, Wang H, Wang J, Zhang J, Wu D, Xie G, Shen K, Zheng Y, Yang Y. The epidemic of erythromycin-resistant Bordetella pertussis with limited genome variation associated with pertussis resurgence in China. Expert Rev Vaccines 2020; 19:1093-1099. [PMID: 33034224 DOI: 10.1080/14760584.2020.1831916] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The resurgence of Bordetella pertussis infections leading to whooping cough is a concern in many parts of the world. The number of pertussis cases in China has increased significantly since 2013. RESEARCH DESIGN AND METHODS In this study, whole-genome sequencing analysis was performed for 388 B. pertussis strains isolated in China from the 1970s to 2018, combining 594 published strains from around the world. RESULTS This study revealed that lineage V diverged about 50 years ago in China, while lineage IV is dominant in the other countries. It also revealed that the erythromycin-resistant sub-lineages Va, Vb, and Vc with limited genomic variation emerged 11 ~ 12 years ago. These three sub-lineages were identified after the co-purified acellular vaccines (cp-ACVs) completely replaced the previous whole cell vaccines (WCVs) after the national immunization program of 2012. It suggests that the cp-ACVs cannot induce immunity that is potent enough to restrict the spread of the lineage V, antibiotic abuse further favors the spread of this lineage in China. CONCLUSIONS These findings demand a reassessment of the immunization strategy and development of new vaccines in China to stop the resurgence and drug resistance of B. pertussis.
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Affiliation(s)
- Kaihu Yao
- Beijing Pediatric Research Institute of Beijing Children's Hospital Affiliated to Capital Medical University , Beijing, China
| | - Jikui Deng
- Department of Infectious Disease and Department of Pulmonology, Shenzhen Children's Hospital , Shenzhen, China
| | - Xiang Ma
- Pediatric Department, Jinan Children's Hospital , Jinan, China
| | - Wenkui Dai
- WeHealthGene Institute , Shenzhen, China
| | - Qiang Chen
- Department of Pulmonology, Jiangxi Provincial Children's Hospital , Nanchang, China
| | - Kai Zhou
- Department of Infectious Disease, Nanjing Children's Hospital , Nanjing, China
| | - Jinyan Ye
- Clinical Laboratory, Jiaxing University Affiliated Women and Children Hospital , Jiaxing, China
| | - Wei Shi
- Beijing Pediatric Research Institute of Beijing Children's Hospital Affiliated to Capital Medical University , Beijing, China
| | - Heping Wang
- Department of Infectious Disease and Department of Pulmonology, Shenzhen Children's Hospital , Shenzhen, China
| | | | - Hongmei Wang
- Department of Infectious Disease and Department of Pulmonology, Shenzhen Children's Hospital , Shenzhen, China
| | - Jingmin Wang
- Beijing Pediatric Research Institute of Beijing Children's Hospital Affiliated to Capital Medical University , Beijing, China.,Pediatric Department, Peking University First Hospital , Beijing, China
| | - Jiaosheng Zhang
- Department of Infectious Disease and Department of Pulmonology, Shenzhen Children's Hospital , Shenzhen, China
| | - Danxia Wu
- Department of Pulmonology, Jiangxi Provincial Children's Hospital , Nanchang, China
| | - Gan Xie
- Beijing Pediatric Research Institute of Beijing Children's Hospital Affiliated to Capital Medical University , Beijing, China.,Department of Infectious Disease and Department of Pulmonology, Shenzhen Children's Hospital , Shenzhen, China
| | - Kunling Shen
- Beijing Pediatric Research Institute of Beijing Children's Hospital Affiliated to Capital Medical University , Beijing, China
| | - Yuejie Zheng
- Department of Infectious Disease and Department of Pulmonology, Shenzhen Children's Hospital , Shenzhen, China
| | - Yonghong Yang
- Beijing Pediatric Research Institute of Beijing Children's Hospital Affiliated to Capital Medical University , Beijing, China.,Department of Infectious Disease and Department of Pulmonology, Shenzhen Children's Hospital , Shenzhen, China.,WeHealthGene Institute , Shenzhen, China
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Antibiotic Sales in Primary Care in Hubei Province, China: An Analysis of 2012-2017 Procurement Records. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183376. [PMID: 31547325 PMCID: PMC6765864 DOI: 10.3390/ijerph16183376] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/01/2019] [Accepted: 09/07/2019] [Indexed: 12/12/2022]
Abstract
The over-use of antibiotics has been identified as a major global challenge, where there is insufficient knowledge about the use of antibiotics in primary healthcare settings, especially at a population level. This study aims to investigate the trends and patterns of antibiotic sales in primary care in Hubei, China over a six-year period from 2012 to 2017. Antibiotic sales were expressed with Defined Daily Doses per 1000 inhabitants per day (DIDs) and compared with European countries using the 12 quality indicators proposed by the scientific advisory board of the European Surveillance of Antimicrobial Consumption (ESAC) project. Antibiotic sales increased from 12.8 DID in 2012 to 15.3 DID in 2013, and then declined afterwards. The most commonly used antibiotics, J01C (beta-lactam antimicrobials, penicillins), accounted for 40.5% of total antibiotic sales. Parenteral administration of antibiotics accounted for over 50% of total antibiotic sales. Total antibiotic sales were almost on a par with the 31 European countries monitored by the ESAC project, but cephalosporin sales were higher than at least three quarters of the compared countries, resulting in a significant higher proportion of third-generation cephalosporin consumption (13.8–19.43%). The relative consumption of Fluoroquinolone (9.26–9.89%) was also higher than at least half of the compared countries. There is a lack of robust evidence to show that antibiotic consumption in primary care is lower in Hubei compared with other countries. The preference of clinicians in China to use broad-spectrum and parenteral antibiotics deserves further study and policy attention.
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Tang Y, Liu C, Liu J, Zhang X, Zuo K. Effects of County Public Hospital Reform on Procurement Costs and Volume of Antibiotics: A Quasi-Natural Experiment in Hubei Province, China. PHARMACOECONOMICS 2018; 36:995-1004. [PMID: 29671132 PMCID: PMC6021466 DOI: 10.1007/s40273-018-0654-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The overuse of antibiotics has become a major public health challenge worldwide, especially in low- and middle-income countries, including China. In 2009, the Chinese government launched a series of measures to de-incentivise over-prescription in public health facilities, including decoupling the link between facility income and the sale of medicines. OBJECTIVES We evaluated the effects of these measures on procurement costs and the volume of antibiotics in county public hospitals. METHODS The study was undertaken in the Hubei province of China, where 64 county public hospitals implemented the reform in sequence at three different stages. A quasi-natural experiment design was employed. We performed generalised linear regressions with a difference-in-differences approach using 22,713 procurement records of antibiotics from November 2014 to December 2016. RESULTS The regression results showed that the reform contributed to a 14.79% increase in total costs for antibiotics (p = 0.013), particularly costs for injectable antibiotics (p = 0.022) and first-line antibiotics (p = 0.030). The procurement prices for antibiotics remained largely comparable to those in the control group, but the reform led to a 17.30% increase in the procurement volume (expressed as defined daily doses) of second-line antibiotics (p = 0.032). CONCLUSIONS County public hospitals procured more antibiotics and greater numbers of expensive antibiotics, such as those administered via injection, to compensate for the loss of income from the sale of medicines, leading to an increased total cost of antibiotics.
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Affiliation(s)
- Yuqing Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Kingsbury Drive, Melbourne, VIC, 3086, Australia
| | - Junjie Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
| | - Keyuan Zuo
- Hubei Public Resource Trading Center, No. 252 Zhongbei Road, Wuhan, 430030, People's Republic of China.
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Zhang Z, Hu Y, Zou G, Lin M, Zeng J, Deng S, Zachariah R, Walley J, Tucker JD, Wei X. Antibiotic prescribing for upper respiratory infections among children in rural China: a cross-sectional study of outpatient prescriptions. Glob Health Action 2017; 10:1287334. [PMID: 28462635 PMCID: PMC5496075 DOI: 10.1080/16549716.2017.1287334] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 01/19/2017] [Indexed: 10/30/2022] Open
Abstract
BACKGROUND Overuse of antibiotics contributes to the development of antimicrobial resistance. OBJECTIVE This study aims to assess the condition of antibiotic use at health facilities at county, township and village levels in rural Guangxi, China. METHODS We conducted a cross-sectional study of outpatient antibiotic prescriptions in 2014 for children aged 2-14 years with upper respiratory infections (URI). Twenty health facilities were randomly selected, including four county hospitals, eight township hospitals and eight village clinics. Prescriptions were extracted from the electronic records in the county hospitals and paper copies in the township hospitals and village clinics. RESULTS The antibiotic prescription rate was higher in township hospitals (593/877, 68%) compared to county hospitals (2736/8166, 34%) and village clinics (96/297, 32%) (p < 0.001). Among prescriptions containing antibiotics, county hospitals were found to have the highest use rate of broad-spectrum antibiotics (82 vs 57% [township], vs 54% [village], p < 0.001), injectable antibiotics (65 vs 43% [township], vs 33% [village], p < 0.001) and multiple antibiotics (47 vs 15% [township], vs 0% [village], p < 0.001). Logistic regression showed that the likelihood of prescribing an antibiotic was significantly associated with patients being 6-14 years old compared with being 2-5 years old (adjusted odds ratio [aOR] = 1.3, 95% CI 1.2-1.5), and receiving care at township hospitals compared with county hospitals (aOR = 5.0, 95% CI 4.1-6.0). Prescriptions with insurance copayment appeared to lower the risk of prescribing antibiotics compared with those without (aOR = 0.8, 95% CI 0.7-0.9). CONCLUSIONS Inappropriate use of antibiotics was high for outpatient childhood URI in the four counties of Guangxi, China, with the highest rate found in township hospitals. A significant high proportion of prescriptions containing antibiotics were broad-spectrum, by intravenous infusion or with multiple antibiotics, especially at county hospitals. Urgent attention is needed to address this challenge.
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Affiliation(s)
- Zhitong Zhang
- China Global Health Research and Development, Shenzhen, China
| | - Yanhong Hu
- School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | - Guanyang Zou
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Mei Lin
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
| | - Jun Zeng
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
| | - Simin Deng
- China Global Health Research and Development, Shenzhen, China
| | - Rony Zachariah
- Medical Department, Operational Research Unit, Médecins sans Frontières, Brussels Operational Center, Luxembourg City, Luxembourg
| | - John Walley
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Joseph D. Tucker
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Xie DS, Xiang LL, Li R, Hu Q, Luo QQ, Xiong W. A multicenter point-prevalence survey of antibiotic use in 13 Chinese hospitals. J Infect Public Health 2014; 8:55-61. [PMID: 25129448 DOI: 10.1016/j.jiph.2014.07.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 05/28/2014] [Accepted: 07/11/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The use of antibiotics is considered a major determinant of the development of resistance in organisms. This study assessed current patterns of antibiotic prescription and provides background for quality improvement in general hospitals in Hubei, China. METHODS A point-prevalence study was performed in November 2008. All inpatients on the day of the survey were included in the analysis. RESULTS On the day of the study, 6904 patients (56%) were receiving antibiotic therapy; the highest rate occurred in the ICU (90%), and the lowest occurred in the medical wards (39%). The most commonly used antibiotics were β-lactam antibiotics, including cephalosporins (40%) and piperacillin (19%), followed by fluoroquinolones (14%). CONCLUSIONS Our data indicated a high rate of antibiotic use in Chinese hospitals. These findings suggest important areas for intervention and the implementation of antibiotic stewardship policies in Chinese hospitals. A multi-faceted strategy should be implemented at the national level in China and should include education, regulation, and greater financial support from the government.
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Affiliation(s)
- Duo-shuang Xie
- Department of Infection Control, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, PR China; Centre of Health Administration and Development Study, Hubei University of Medicine, Shiyan 442000, PR China.
| | - Li-li Xiang
- Department of Infection Control, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, PR China
| | - Rui Li
- Department of Infection Control, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, PR China
| | - Qiao Hu
- Department of Infection Control, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, PR China
| | - Qing-qin Luo
- Department of Infection Control, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, PR China
| | - Wei Xiong
- Department of Infection Control, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, PR China.
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Irwin A, Sharland M. Measuring antibiotic prescribing in hospitalised children in resource-poor countries: a systematic review. J Paediatr Child Health 2013; 49:185-92. [PMID: 21679337 DOI: 10.1111/j.1440-1754.2011.02126.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Antibiotic resistance represents a significant threat to global health. Widespread exposure to antibiotics drives the development of antibiotic resistance. Little is known about the exposure to antibiotics of hospitalised children, particularly in resource-poor countries where the burden of infectious disease is highest. The review sought to identify original research quantifying antibiotic use in hospitalised children in resource countries. The methods used were: A systematic search of the MEDLINE, CINAHL, EMBASE, LILACS and African Index Medicus databases. Eighteen papers were identified and the methodology varied considerably. Only seven used a recognised defined daily dose (DDD) methodology. The studies reveal a high exposure of hospitalised children to antibiotics. With the exception of data from China, the studies were limited by their design. Limited evidence of the variation in drug, dose and total exposure to antibiotic use in hospitalised children in resource-poor countries exists. An international network of surveillance of both antimicrobial prescribing and resistance using a simple standardised methodology in this context remains an important goal. A simplified paediatric version of the adult DDD methodology is required to allow international comparison between populations.
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Affiliation(s)
- Adam Irwin
- Institute of Child Health, Alder Hey Children's Hospital NHS Foundation Trust, Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
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Xiao YH, Giske CG, Wei ZQ, Shen P, Heddini A, Li LJ. Epidemiology and characteristics of antimicrobial resistance in China. Drug Resist Updat 2011; 14:236-50. [PMID: 21807550 DOI: 10.1016/j.drup.2011.07.001] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 07/05/2011] [Indexed: 10/26/2022]
Abstract
A comprehensive surveillance system for bacterial resistance in tertiary hospitals has been established in China that involves tertiary hospitals in distinct regions nationwide, enabling the collection of a large amount of antimicrobial surveillance data. Antimicrobial resistance in China has become a serious healthcare problem, with high resistance rates of most common bacteria to clinically important antimicrobial agents. Methicillin-resistant S. aureus, ESBL-producing Enterobacteriaceae and carbapenem-resistant Acinetobacter baumannii represent more than 50% of microbial isolates. Additionally, bacterial resistance to fluoroquinolones, macrolides and third-generation cephalosporins is of serious concern. The molecular epidemiology and resistance mechanisms of the antimicrobial strains in China exhibited regional specificity, as well as the influence of dissemination of international clonal complexes. The molecular characteristics of MRSA, ESBL- and carbapenemase-producing Enterobacteriaceae, and macrolide-resistant gram-positive Streptococci in China were significantly different from those in other countries and regions, while S. pneumoniae serotypes appear to have been affected by the global spread of prevalent clones in other parts of the world. Moreover, important antimicrobial resistant bacteria such as community-acquired-MRSA, multidrug-resistant P. aeruginosa and extensive-resistant A. baumannii, and the antimicrobial resistance in primary healthcare and outpatient setting should be intensely monitored and investigated in the future.
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Affiliation(s)
- Yong-Hong Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China.
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Liang X, Jin C, Wang L, Wei L, Tomson G, Rehnberg C, Wahlstrom R, Petzold M. Unnecessary use of antibiotics for inpatient children with pneumonia in two counties of rural China. Int J Clin Pharm 2011; 33:750-4. [DOI: 10.1007/s11096-011-9535-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 06/27/2011] [Indexed: 11/30/2022]
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Liem TBY, Krediet TG, Fleer A, Egberts TCG, Rademaker CMA. Variation in antibiotic use in neonatal intensive care units in the Netherlands. J Antimicrob Chemother 2010; 65:1270-5. [DOI: 10.1093/jac/dkq107] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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