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Han L, Zhang Y, Jin X, Ren H, Teng Z, Sun Z, Xu J, Qin T. Changing epidemiologic patterns of typhus group rickettsiosis and scrub typhus in China, 1950-2022. Int J Infect Dis 2024; 140:52-61. [PMID: 38163619 DOI: 10.1016/j.ijid.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/22/2023] [Accepted: 12/28/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVES We conducted a systematic analysis of the notifiable rickettsial diseases in humans in China during 1950-2022. METHODS We utilized descriptive statistics to analyze the epidemiological characteristics, clinical manifestations, and diagnostic characteristics of typhus group rickettsiosis (TGR) and scrub typhus (ST) cases. RESULTS Since the 1950s, there have been variations in the incidence rate of TGR and ST in China, with a downtrend for TGR and an uptrend for ST. The South became a high-incidence area of TGR, whereas the North was previously the high-incidence area. ST cases were concentrated in the South and the geographic area of ST spread northward and westward. The seasonality of TGR and ST were similar in the South but distinct in the North. Most TGR and ST cases were reported by county-level medical institutions, whereas primary institutions reported the least. Delayed diagnosis was associated with fatal outcomes of TGR and ST. Cases in low-incidence provinces, confirmed by laboratory tests and reported from county/municipal-level institutions had higher odds of delayed diagnoses. CONCLUSIONS Our study revealed significant changes in the epidemiological characteristics of TGR and ST in China, which can provide useful information to enhance the control and prevention strategies of rickettsial diseases in China.
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Affiliation(s)
- Ling Han
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yunfei Zhang
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaojing Jin
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hongyu Ren
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhongqiu Teng
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhaobin Sun
- State Key Laboratory of Severe Weather, Chinese Academy of Meteorological Sciences, China Meteorological Administration, Beijing, China
| | - Jianguo Xu
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tian Qin
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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Yang K, Zhu R, Li Z, Shuang S, Zhai Y, Dong C. Label-free colorimetric detection of tetracycline using gold nanoparticles with different surface charge. Talanta 2024; 266:125077. [PMID: 37595526 DOI: 10.1016/j.talanta.2023.125077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 08/20/2023]
Abstract
Visual detection assay based on aptamer unmodified gold nanoparticles shows great potential in biotechnology. Here, we reported a visible, salt-free and highly sensitive tetracycline (TC) assay based on a colloidally stable mixture of AuNPs that contains poly (diallyl dimethylammonium chloride) capped AuNPs ((+)AuNPs) and tetracycline-specific aptamer capped AuNPs (Apt-capped AuNPs). This reported TC assay was visible and salt-free that did not need any salt during TC detection. With naked eyes, nanomolar tetracycline concentrations could be identified within 20 min. A detection limit of tetracycline down to a concentration of 1.0 fM with a broad detection range of 8 order of magnitudes (5 × 10-14 M to 5 × 10-6 M) was reached. Furthermore, the reported TC assay also exhibited good selectivity for tetracycline over other antibiotics, metal cations, proteins and amino acids. These findings clearly demonstrated the high potential of the reported TC assay for TC detection and monitoring.
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Affiliation(s)
- Kai Yang
- School of Materials Engineering, Taiyuan Institute of Technology, Taiyuan, 030008, China
| | - Ruiqi Zhu
- Institute of Environment Science, and School of Chemistry and Chemical Engineering, Shanxi University, Taiyuan, 030006, China
| | - Zhongping Li
- Institute of Environment Science, and School of Chemistry and Chemical Engineering, Shanxi University, Taiyuan, 030006, China
| | - Shaomin Shuang
- Institute of Environment Science, and School of Chemistry and Chemical Engineering, Shanxi University, Taiyuan, 030006, China
| | - Yan Zhai
- School of Materials Engineering, Taiyuan Institute of Technology, Taiyuan, 030008, China.
| | - Chuan Dong
- Institute of Environment Science, and School of Chemistry and Chemical Engineering, Shanxi University, Taiyuan, 030006, China.
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Alzahrani KO, Alshahrani SM, Alajel SM. Evaluating the effectiveness of the Ministry of Health restriction policy on seasonal antibiotic consumption trends in Saudi Arabia, 2016-2020. Front Pharmacol 2023; 14:1242087. [PMID: 38099146 PMCID: PMC10720327 DOI: 10.3389/fphar.2023.1242087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 11/17/2023] [Indexed: 12/17/2023] Open
Abstract
Background: Understanding antibiotic consumption patterns over time is essential to optimize prescribing practices and minimizing antimicrobial resistance. This study aimed to determine whether the antibiotics restriction policy launched by the Saudi Ministry of Health in April 2018 has impacted antibiotic use by assessing changes and seasonal variations following policy enforcement. Methods: Quarterly sales data of J01 antibacterial for systemic use in standard units were obtained from the IQVIA-MIDAS database, spanning from the first quarter of 2016 to the last quarter of 2020. Antibiotics consumption was measured in defined daily doses per 1,000 inhabitant per day- in a quarter (DDDdq). A comparative analysis of antibiotic consumption pre- and post-policy periods introduction was conducted by computing the average consumption values for each period. Statistical comparison of the mean differences between the two periods were then made using independent samples t-test, Mann-Whitney U Test where needed. Time series analysis was employed to estimate the projected antibiotic consumption in the post-policy period if the restriction policy had not been implemented, which was then compared to actual consumption values to evaluate the effectiveness of the restriction policy. Results: During the pre-policy, there were seasonal trends of the total and oral antibiotic consumption through quarters, with higher consumption observed in the first and fourth quarters. In contrast, parenteral antibiotic consumption did not appear to follow a clear seasonal pattern. Following the restriction policy, there was a significant reduction in total and oral antibiotic use, with mean reductions of -96.9 DDDdq (p-value = 0.002) and -98 DDDdq (p-value = 0.002), respectively. Conversely, a significant increase in parenteral antibiotic consumption was observed with a mean increase of +1.4 DDDdq (p-value < 0.0001). The comparison between the forecasted and actual models showed that the actual antibiotics consumption for total, oral, and parenteral were lower than the corresponding forecasted values by 30%, 31%, and 34%, respectively. Conclusion: Overall, our analysis of antibiotics consumption from 2016 to 2020 displays great success for the policy implemented by the Saudi Ministry of Health in significantly reducing the total and oral use of antibiotics. However, future studies are needed to explore the increased consumption of the parenteral antibiotics as well as the persistent high consumption patterns during the fall and winter months even after the implementation of the restriction policy.
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Affiliation(s)
- Khaloud O. Alzahrani
- Molecular Biology Division, Reference Laboratory for Microbiology, Executive Department of Reference Laboratories, Research and Laboratories Sector, Saudi Food and Drug Authority (SFDA), Riyadh, Saudi Arabia
| | - Saeed M. Alshahrani
- Department of Public Health, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Sulaiman M. Alajel
- Reference Laboratory for Microbiology, Executive Department of Reference Laboratories, Research and Laboratories Sector, Saudi Food and Drug Authority (SFDA), Riyadh, Saudi Arabia
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Xiao Y, Xin X, Chen Y, Yan Q. A comprehensive point prevalence survey of the quality and quantity of antimicrobial use in Chinese general hospitals and clinical specialties. Antimicrob Resist Infect Control 2023; 12:127. [PMID: 37974231 PMCID: PMC10652455 DOI: 10.1186/s13756-023-01334-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023] Open
Abstract
Antimicrobial resistance (AMR) is a serious, worldwide public health crisis. Surveillance of antimicrobial use forms part of an essential strategy to contain AMR. We aimed to conduct a national point prevalence survey (PPS) on antimicrobial use, and to compare this data with similar international surveillance programs to provide a reference for future AMR strategy development in China. Twenty general hospitals encompassing 10,881 beds and 10,209 inpatients around the country participated the survey using a standardized protocol, at 8am of someday from October 10th to November 31st, 2019. Of the patients, 37.00% (3777/10209) received antimicrobial agents, 31.30% (1630/5208) had surgical operations, and 76.63% (1249/1630) received prophylactic antibiotic. The prevalence of antimicrobial use in medical, surgical, and intensive care units (ICU) patients was 38.84% (1712/4408), 32.07% (1670/5208), and 66.61% (395/593), respectively. Of prescriptions, 5.79% (356/6151) were made in the absence of indication. The intensity of antimicrobial use was 61.25 DDDs/100 patient days, while the intensity of use in internal medicine, surgery, and ICU were 67.79, 45.81, 124.45 DDDs/100 patient days, respectively. Only 11.62% (715/6151) of prescriptions had a reason described in the patient record. Furthermore, 8.44% (210/2487), 14.19% (424/2989), and 12% (81/675) of the prescriptions in internal medicine, surgery, and ICU had a recorded indication, respectively. The review and stop date recorded for antimicrobial therapy was 43.73% (1976/4518). Of the patients, 38.07% (1438/3777) received combination therapy. The classes of antimicrobials prescribed were limited, and the proportion of prescriptions encompassed by the top 20 antimicrobial agents was 75.06% (4617/6151). The prevalence of antimicrobial use in China is close to that of Sweden, the UK, and Canada, but lower than that in India, and higher than that in Switzerland. The data described in this report indicate that the quality of antimicrobial prescriptions requires improvement in China. Further, hospitals should implement professional interventions to improve the rational use of antimicrobials.
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Affiliation(s)
- Yonghong Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
- Research Units of Infectious Disease and Microecology, Chinese Academy of Medical Sciences, Beijing, China.
| | - Xing Xin
- Department of Infection Control, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yunbo Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qing Yan
- National Institute of Hospital Administration, National Health Commission of China, Beijing, China
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Yu X, Zhao W, Lyu S, Cai Z, Yu G, Wang H, Barceló D, Sui Q. Estimating the Mass of Pharmaceuticals Harbored in Municipal Solid Waste Landfills by Analyzing Refuse Samples at Various Ages and Depths. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2023; 57:6063-6071. [PMID: 36988440 DOI: 10.1021/acs.est.2c09455] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Pharmaceuticals have been detected at high concentrations in municipal solid waste (MSW) landfill leachates, which are recognized as an underestimated source of pharmaceutical residues in the environment. However, limited efforts have been made to characterize pharmaceuticals in MSW landfill refuse, which is also of significant concern given the potential long-term environmental impact. Herein, we excavated landfill refuse from six cells with landfill ages of 7-27 years in the largest MSW landfill in Shanghai (in each cell, landfill refuse was collected from different depths of 2-8 m) and analyzed samples for the presence of 55 pharmaceuticals, including antibiotics and non-antibiotics. The results reveal the presence of 42 pharmaceuticals in landfill refuse, with median concentrations ranging from 0.30 to 116 μg/kg. Antibiotic and non-antibiotic pharmaceuticals exhibited diverse concentration trends with age, related to changes in policy intervention and consumption over time. Different concentration variations of individual pharmaceuticals were observed in refuse samples excavated at different depths and positively correlated to their sorption ability. The mass of pharmaceuticals in the investigated landfill was estimated from the obtained concentrations to be 80-220 tons with 95% probability, based on Monte Carlo analysis. To the best of our knowledge, this study provides the first estimate of pharmaceutical mass in an MSW landfill. The results will be helpful for understanding the potential long-term environmental impact of pharmaceuticals in landfills.
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Affiliation(s)
- Xia Yu
- State Environmental Protection Key Laboratory of Environmental Risk Assessment and Control on Chemical Process, School of Resources and Environmental Engineering, East China University of Science and Technology, Shanghai 200237, China
| | - Wentao Zhao
- State Key Laboratory of Pollution Control and Resource Reuse, College of Environmental Science and Engineering, Tongji University, Shanghai 200092, China
| | - Shuguang Lyu
- State Environmental Protection Key Laboratory of Environmental Risk Assessment and Control on Chemical Process, School of Resources and Environmental Engineering, East China University of Science and Technology, Shanghai 200237, China
- Shanghai Institute of Pollution Control and Ecological Security, Shanghai 200092, China
| | - Zhenxiao Cai
- MicroHAOPs Inc., University of Washington, Seattle, Washington 98195, United States
| | - Gang Yu
- School of Environment, Tsinghua University, Beijing 100084, China
| | - Hualin Wang
- State Environmental Protection Key Laboratory of Environmental Risk Assessment and Control on Chemical Process, School of Resources and Environmental Engineering, East China University of Science and Technology, Shanghai 200237, China
| | - Damià Barceló
- Department of Environmental Chemistry, Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research (CSIC), Barcelona 08034, Spain
| | - Qian Sui
- State Environmental Protection Key Laboratory of Environmental Risk Assessment and Control on Chemical Process, School of Resources and Environmental Engineering, East China University of Science and Technology, Shanghai 200237, China
- Shanghai Institute of Pollution Control and Ecological Security, Shanghai 200092, China
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Hinchliffe P, Calvopiña K, Rabe P, Mojica M, Schofield C, Dmitrienko G, Bonomo R, Vila A, Spencer J. Interactions of hydrolyzed β-lactams with the L1 metallo-β-lactamase: Crystallography supports stereoselective binding of cephem/carbapenem products. J Biol Chem 2023; 299:104606. [PMID: 36924941 PMCID: PMC10148155 DOI: 10.1016/j.jbc.2023.104606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 03/15/2023] Open
Abstract
L1 is a dizinc subclass B3 metallo-β-lactamase (MBL) that hydrolyzes most β-lactam antibiotics and is a key resistance determinant in the Gram-negative pathogen Stenotrophomonas maltophilia, an important cause of nosocomial infections in immunocompromised patients. L1 is not usefully inhibited by MBL inhibitors in clinical trials, underlying the need for further studies on L1 structure and mechanism. We describe kinetic studies and crystal structures of L1 in complex with hydrolyzed β-lactams from the penam (mecillinam), cephem (cefoxitin/cefmetazole) and carbapenem (tebipenem, doripenem and panipenem) classes. Despite differences in their structures, all the β-lactam-derived products hydrogen bond to Tyr33, Ser221 and Ser225 and are stabilized by interactions with a conserved hydrophobic pocket. The carbapenem products were modelled as Δ1-imines, with (2S)-stereochemistry. Their binding mode is determined by the presence of a 1β-methyl substituent: the Zn-bridging hydroxide either interacts with the C-6 hydroxyethyl group (1β-hydrogen-containing carbapenems), or is displaced by the C-6 carboxylate (1β-methyl-containing carbapenems). Unexpectedly, the mecillinam product is a rearranged N-formyl amide rather than penicilloic acid, with the N-formyl oxygen interacting with the Zn-bridging hydroxide. NMR studies imply mecillinam rearrangement can occur non-enzymatically in solution. Cephem-derived imine products are bound with (3R)-stereochemistry and retain their 3' leaving groups, likely representing stable endpoints, rather than intermediates, in MBL-catalyzed hydrolysis. Our structures show preferential complex formation by carbapenem- and cephem-derived species protonated on the equivalent (β) faces, and so identify interactions that stabilize diverse hydrolyzed antibiotics. These results may be exploited in developing antibiotics, and β-lactamase inhibitors, that form long-lasting complexes with dizinc MBLs.
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Affiliation(s)
- Philip Hinchliffe
- School of Cellular and Molecular Medicine, University of Bristol, Biomedical Sciences Building, University Walk, Bristol BS8 1TD, United Kingdom
| | - Karina Calvopiña
- Chemistry Research Laboratory, Department of Chemistry and the Ineos Oxford Institute for Antimicrobial Research, University of Oxford, 12 Mansfield Road, Oxford, OX1 3TA, United Kingdom
| | - Patrick Rabe
- Chemistry Research Laboratory, Department of Chemistry and the Ineos Oxford Institute for Antimicrobial Research, University of Oxford, 12 Mansfield Road, Oxford, OX1 3TA, United Kingdom
| | - MariaF Mojica
- Department of Molecular Biology and Microbiology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA; CWRU-Cleveland VA Medical Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, OH, USA; Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH; Grupo de Resistencia Antimicrobiana y Epidemiología Hospitalaria, Universidad El Bosque, Bogotá, Colombia
| | - ChristopherJ Schofield
- Chemistry Research Laboratory, Department of Chemistry and the Ineos Oxford Institute for Antimicrobial Research, University of Oxford, 12 Mansfield Road, Oxford, OX1 3TA, United Kingdom
| | - GaryI Dmitrienko
- Department of Chemistry, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada; School of Pharmacy, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada
| | - RobertA Bonomo
- CWRU-Cleveland VA Medical Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, OH, USA; Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH; Departments of Medicine, Biochemistry, Pharmacology, and Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, OH
| | - AlejandroJ Vila
- CWRU-Cleveland VA Medical Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, OH, USA; Instituto de Biología Molecular y Celular de Rosario (IBR, CONICET-UNR), Rosario, Argentina; Área Biofísica, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina
| | - James Spencer
- School of Cellular and Molecular Medicine, University of Bristol, Biomedical Sciences Building, University Walk, Bristol BS8 1TD, United Kingdom.
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Hu XY, Xia RY, Moore M, Stuart B, Wen LZ, Graz B, Lai L, Liu JP, Fei YT, Willcox M. Use of antibiotics and other treatments in Chinese adults with acute cough: An online survey. Integr Med Res 2023; 12:100920. [PMID: 36684827 PMCID: PMC9850188 DOI: 10.1016/j.imr.2022.100920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Background This study aimed to identify use of various treatments and their association with the use of antibiotics and patient reported clinical recovery in Chinese adults with acute cough. Methods An online survey recruiting people who had recently experienced cough was conducted. Their sociodemographic, clinical characteristics, treatments received and their perceived changes in symptoms were collected. Factors influencing avoidance of antibiotics and improvement in symptoms were explored. Results A total of 22,787 adults with recent acute cough completed the questionnaire, covering all 34 province-level administrative units in China. Most respondents were male (68.0%), young (89.4%, aged 18-45), educated to university/degree or postgraduate level (44.6%), with a median cough severity of 6/10 on a numerical rating scale. Nearly half of the participants (46.4%) reported using antibiotics, among which 93.1% were for presumed upper respiratory tract infections (URTIs). Pharmacies (48.8%) were the most common source of antibiotics. Fewer patients took antibiotics after taking CHM (14.9%), compared to those who started with home remedies (18.0%), or allopathic non-antibiotic medication (25.0%). Antibiotics, allopathic non-antibiotic medications, CHM and home remedies were all perceived beneficial in relieving cough. Conclusions Chinese adult responders report use of a considerable variety of treatments alone or in combination for acute cough. Patient-reported clinical recovery was similar regardless of treatment. There is likely a high proportion of inappropriate use of antibiotics for treatment of simple acute cough. As the majority of respondents did not use antibiotics as a first-line, and use of CHM was associated with relief of cough symptoms and reduction in the use of antibiotics, this presents an important opportunity for prudent antibiotic stewardship in China.
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Affiliation(s)
- Xiao-Yang Hu
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Ru-Yu Xia
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Michael Moore
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Beth Stuart
- Pragmatic Trial Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Ling-Zi Wen
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | | | - Lily Lai
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Jian-Ping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Yu-Tong Fei
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China,Corresponding authors at: Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, 11N 3rd Ring E Road, Chaoyang 100013, China (Y.-T. Fei); Primary Care, Population Sciences and Medical Education, University of Southampton, Aldermoor Health center, Southampton SO16 5ST, UK (M. Willcox).
| | - Merlin Willcox
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK,Corresponding authors at: Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, 11N 3rd Ring E Road, Chaoyang 100013, China (Y.-T. Fei); Primary Care, Population Sciences and Medical Education, University of Southampton, Aldermoor Health center, Southampton SO16 5ST, UK (M. Willcox).
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Cao W, Feng H, Ma Y, Zhao D, Hu X. Long-term trend of antibiotic use at public health care institutions in northwest China, 2012-20 -- a case study of Gansu Province. BMC Public Health 2023; 23:27. [PMID: 36604660 PMCID: PMC9814306 DOI: 10.1186/s12889-022-14944-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 12/26/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Over the past 20 years, excessive antibiotic use has led to serious antimicrobial resistance (AMR) worldwide, and the phenomenon is particularly serious in China. To this end, the Chinese health sector took a series of measures to promote rational antibiotic use. In this study, to reveal the impact of policies on antibiotic use, we explored the long-term trend and patterns of antibiotic use at public health care institutions from 2012 to 2020 in northwest China, taking Gansu Province as an example. METHODS Antibiotic procurement data were obtained from the provincial centralized bidding procurement (CBP) platform between 2012 and 2020. Antibiotic use was quantified using the Anatomical Therapeutic Chemical (ATC)/defined daily doses (DDD) methodology and standardized using the DDD per 1000 inhabitants per day (DID). Twelve relevant quality indicators were calculated for comparison with the European Surveillance of Antimicrobial Consumption (ESAC) project monitoring results. RESULTS Total antibiotic use increased from 18.75 DID to 57.07 DID and then decreased to 19.11 DID, a turning point in 2014. The top three antibiotics used were J01C (beta-lactam antibacterials, penicillins), J01F (macrolides, lincosamides and streptogramins), and J01D (other beta-lactam antibacterials, cephalosporins), accounting for 45.15%, 31.40%, and 11.99% respectively. The oral antibiotics used were approximately 2.5 times the parenteral antibiotics, accounting for 71.81% and 28.19%, respectively. Different use preferences were shown in public hospitals and primary health care centres (PHCs), and the latter accounted for more than half of total use. The absolute use of all classes of antibiotics in Gansu is almost higher than any of the 31 European countries included in the ESAC, but the relative use of some focused antibiotics is lower than theirs. CONCLUSIONS The intervention policies of the health department reduced antibiotic use in Gansu Province, but the proportion of broad-spectrum and parenteral antibiotics was still high. It is necessary to further improve the quality of antibiotic prescriptions and pay more attention to the rationality of antibiotic use in PHCs.
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Affiliation(s)
- Wenxuan Cao
- grid.32566.340000 0000 8571 0482School of Public Health, Lanzhou University, Lanzhou, 730000 China
| | - Hu Feng
- grid.32566.340000 0000 8571 0482School of Public Health, Lanzhou University, Lanzhou, 730000 China
| | - Yongheng Ma
- Division of Pharmaceutical Procurement, Gansu Public Resources Trading Center, Lanzhou, 730000 China
| | - Defang Zhao
- Division of Pharmaceutical Procurement, Gansu Public Resources Trading Center, Lanzhou, 730000 China
| | - Xiaobin Hu
- grid.32566.340000 0000 8571 0482School of Public Health, Lanzhou University, Lanzhou, 730000 China
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Huang Z, Yao G, Zhang C, Zhou X, Zou G, Zhuo C. Evaluation and Analysis of the Rationality of Clinical Use of Carbapenems in Surgical Departments of a Tertiary Hospital in Southwest China. Infect Drug Resist 2023; 16:2259-2269. [PMID: 37090035 PMCID: PMC10120811 DOI: 10.2147/idr.s403787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/22/2023] [Indexed: 04/25/2023] Open
Abstract
Purpose With the increasing frequency and intensity of carbapenem consumption, carbapenem-resistant organisms (CRO) have become a focus of anti-infection research. This study aimed to evaluate the rationality of the clinical use of carbapenems among inpatients in the surgical departments of a tertiary hospital in southwest China. Patients and methods A point-score system was established for evaluation based on the clinical practices in surgical departments and selected carbapenem prescriptions from June 2020 to June 2021 for hepatobiliary surgery, gastrointestinal surgery, and neurosurgery in the study hospital. Prescriptions with a total score ≥ 270 were defined as rational. Descriptive statistics were used to describe the characteristics and rationality of the prescriptions. The chi-square test, Mann-Whitney U-test, and Kruskal-Wallis H-test were used to compare characteristics between rational and irrational prescriptions. Linear regression analysis was used to determine the factors affecting the rationality of carbapenem prescriptions. Results According to 192 carbapenem prescription records, the median age of patients was 62 years [IQR, 48.0-73.0], and 20% of patients had abdominal infections, 10% had lung infections, 14% had intracranial infections, and 3% had urinary tract infections. 56% of carbapenem prescriptions were irrational. Compared with rational carbapenem prescriptions, irrational prescriptions had a higher proportion of those with inappropriate indications (49% vs 0%, p < 0.05), incorrect variety selection (15% vs 0%, p<0.05), and unreasonable assessment of etiology and efficacy (46% vs 8%, p < 0.05). Linear regression analysis suggested that the diagnosis of cholecystitis (standardized regression coefficient=0.183, p<0.05) and replaced medication (standardized regression coefficient = 0.154, p<0.05) influenced the rationality of carbapenem prescriptions. Conclusion Our study shows that the irrational use of carbapenems deserves attention, especially in surgical departments. Interventions for carbapenem use that are based on evaluation criteria should be developed to reduce the emergence and spread of carbapenem-resistant bacteria.
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Affiliation(s)
- Zhongyue Huang
- Institute of Medical Information/Medical Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Gaoqiong Yao
- Department of Pharmacy, First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Chengzhi Zhang
- Department of Pharmacy, First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Xin Zhou
- Department of Pharmacy, First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Guanyang Zou
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, People’s Republic of China
- Correspondence: Guanyang Zou, No. 232, Waihuan East Road, Panyu District, Guangzhou, Guangdong Province, 510006, People’s Republic of China, Email
| | - Chao Zhuo
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, People’s Republic of China
- Chao Zhuo, 195 Dongfeng West Road, Yuexiu District, Guangzhou, Guangdong Province, 510030, People’s Republic of China, Email
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10
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Xue T, Liu C, Li Z, Liu J, Tang Y. Weighing patient attributes in antibiotic prescribing for upper respiratory tract infections: A discrete choice experiment on primary care physicians in Hubei Province, China. Front Public Health 2022; 10:1008217. [PMID: 36605239 PMCID: PMC9807867 DOI: 10.3389/fpubh.2022.1008217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives This study aimed to determine how primary care physicians weigh intervenable patient attributes in their decisions of antibiotic prescribing for upper respiratory tract infections (URTIs). Methods A discrete choice experiment (DCE) was conducted on 386 primary care physicians selected through a stratified cluster sampling strategy in Hubei province, China. The patient attributes tested in the DCE were identified through semi-structured interviews with 13 primary care physicians, while the choice scenarios were determined by a D-efficient design with a zero prior parameter value. Conditional logit models (CL) and mixed logit models (MXL) were established to determine the preference of the study participants in antibiotic prescribing for URTI patients with various attributes. Relative importance (RI) was calculated to reflect the influence of each attribute. Results In addition to age and duration of symptoms, the interventionable patient attributes were also considered by the primary care physicians in their antibiotic prescribing decisions. They preferred to prescribe antibiotics for URTI patients with difficulties to schedule a follow-up appointment (p < 0.001) and for those without a clear indication of refusal to antibiotics (p < 0.001). Patient request for antibiotics had an RI ranging from 15.2 to 16.3%, compared with 5.1-5.4% for easiness of follow-up appointment. The influence of these two interventionable patient attributes was most profound in the antibiotic prescribing decisions for patients aged between 60 and 75 years as indicated by their interaction effects with age (β = 0.69 for request for antibiotics, p < 0.01; β = -1.2 for easiness of follow-up, p < 0.001). Conclusion Reducing patient pressure and improving accessibility and continuity of care may help primary care physicians make rational antibiotic prescribing decisions for URTIs.
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Affiliation(s)
- Tianqin Xue
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China,Key Research Institute of Humanities and Social Sciences of Hubei Provincial Department of Education, Wuhan, Hubei, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Zhuoxian Li
- Medical Record Management Department, Yueyang Maternal and Child Health-Care Hospital, Yueyang, Hunan, China
| | - Junjie Liu
- School of Statistics and Mathematics, Central University of Finance and Economics, Beijing, China
| | - Yuqing Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China,Key Research Institute of Humanities and Social Sciences of Hubei Provincial Department of Education, Wuhan, Hubei, China,*Correspondence: Yuqing Tang ✉
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11
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Yang L, Zhang Q, Zhai H. Comparative efficacy of different concentrations of chlorhexidine for prevention of
ventilator‐associated
pneumonia in intensive care units: A systematic review and network
meta‐analysis. Nurs Crit Care 2022. [DOI: 10.1111/nicc.12849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Li Yang
- The First People's Hospital of Lianyungang, The First Affiliated Hospital of Kangda College of Nanjing Medical University Lianyungang China
| | - Qin Zhang
- The First People's Hospital of Lianyungang, The First Affiliated Hospital of Kangda College of Nanjing Medical University Lianyungang China
| | - Huaixiang Zhai
- The First People's Hospital of Lianyungang, The First Affiliated Hospital of Kangda College of Nanjing Medical University Lianyungang China
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12
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Wang JK, He Y, Chen LL, Zhang HX, Qi XJ, Sun L, Zhang SF, Chen J, Zhang RH. A population-based survey of the prevalence of self-reported acute gastrointestinal illness in Zhejiang Province, China. PLoS One 2022; 17:e0268717. [PMID: 35584149 PMCID: PMC9116671 DOI: 10.1371/journal.pone.0268717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/05/2022] [Indexed: 11/19/2022] Open
Abstract
Acute gastrointestinal illness (AGI) is a prevalent public health concern worldwide. This study investigated the magnitude, distribution and burden of self-reported AGI among residents of Zhejiang Province, China. A face-to-face household survey was conducted using a multi-stage stratified random sampling method in 10 counties in Zhejiang Province between July 2018 and June 2019. In total, 12,021 participants were recruited. The prevalence of AGI 28 days after standardization was 1.8% (95% confidence interval (CI), 1.6–2.1), with an incidence rate of 0.24 episodes of AGI per person-year and an estimated 14 million cases of AGI in Zhejiang Province. Univariate and multivariable analyses showed a higher AGI prevalence among people who performed housework and were unemployed in summer and autumn among respondents living in western or northern cities (p < 0.05). More than 50% of AGI cases were attributed to the consumption of contaminated food. The disease burden caused by AGI in Zhejiang Province was approximately 975 million Chinses yuan (CNY). These results indicated that the disease burden of AGI in Zhejiang Province should be addressed and highlights the need for an improved active surveillance system of foodborne diseases to assess the impact of AGI on society and health.
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Affiliation(s)
- Ji-Kai Wang
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Yue He
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Li-Li Chen
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - He-Xiang Zhang
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Xiao-Juan Qi
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Liang Sun
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Shuang-Feng Zhang
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Jiang Chen
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Rong-Hua Zhang
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
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13
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Yang Y, Geng X, Liu X, Wen X, Wu R, Cui D, Mao Z. Antibiotic Use in China’s Public Healthcare Institutions During the COVID-19 Pandemic: An Analysis of Nationwide Procurement Data, 2018–2020. Front Pharmacol 2022; 13:813213. [PMID: 35237164 PMCID: PMC8882946 DOI: 10.3389/fphar.2022.813213] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The overuse of antibiotics is a serious public health problem and a major challenge in China, and China lacks up-to-date evidence on the nationwide antibiotic use in different healthcare settings. The changes of China’s antibiotic use under the COVID-19 pandemic are still unknown. Objective: This study aimed to investigate the use of antibiotics in China’s public medical institutions based on a three-year nationwide surveillance and to examine the impact of the COVID-19 pandemic on China’s antibiotic consumption. Methods: This study used nationwide drug procurement data from the China Drug Supply Information Platform (CDSIP). We retrospectively analyzed antibiotic procurement data of 9,176 hospitals and 39,029 primary healthcare centers (PHCs) from 31 provinces in mainland China from January 2018 to December 2020. Antibiotic utilization was measured by defined daily doses (DDDs) and DDD per 1,000 inhabitants per day (DID). Generalized linear regression models were established to quantify the impact of the COVID-19 pandemic on antibiotic use. Results: The total antibiotic consumption among all healthcare settings increased from 12.94 DID in 2018 to 14.45 DID in 2019, and then dropped to 10.51 DID in 2020. More than half of antibiotics were consumed in PHCs, especially in central regions (59%–68%). The use of penicillins (J01C) and cephalosporins (J01D) accounted for 32.02% and 28.86% of total antibiotic consumption in 2020. During 2018–2020, parenteral antibiotics accounted for 31%–36% of total antibiotic consumption; the proportion is more prominent in central and western regions and the setting of hospitals. Access category antibiotics comprised 40%–42% of the total utilization. Affected by COVID-19, the antibiotic consumption was significantly dropped both in hospitals (β = −.11, p < .001) and PHCs (β = −.17, p < .001), as well as in total (β = −.14, p < .001). Significant increments were observed in the proportion of total antibiotics (β = .02, p = .024) consumed in hospitals (against the consumption in all healthcare settings), as well as parenteral antibiotics (β = 1.73, p = .001). Conclusion: The consistent preferred use of penicillin and cephalosporin, as well as injections, among China’s public healthcare institutions should draw concern. China’s antibiotic consumption significantly declined during the COVID-19 pandemic, which brings opportunities for antibiotic use management in China.
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Affiliation(s)
- Ying Yang
- School of Public Health, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Xin Geng
- School of Public Health, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Xiaojun Liu
- Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Xiaotong Wen
- School of Public Health, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Ruonan Wu
- School of Public Health, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Dan Cui
- School of Public Health, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Zongfu Mao
- School of Public Health, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
- Dong Fureng Economic and Social Development School, Wuhan University, Wuhan, China
- *Correspondence: Zongfu Mao,
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14
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Systematic review and meta-analysis of environmental Vibrio species - antibiotic resistance. Heliyon 2022; 8:e08845. [PMID: 35265752 PMCID: PMC8899705 DOI: 10.1016/j.heliyon.2022.e08845] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 03/09/2021] [Accepted: 01/24/2022] [Indexed: 01/30/2023] Open
Abstract
Adequate comprehension of the genomics of microbial resistance to an antimicrobial agent will advance knowledge on the management of associated pathologies and public health safety. However, continued emergences and reemergence of pathogens, including Vibrio species, hallmarks a potential knowledge gap. A clear understanding of the process and forecast of the next trend should be in place to nip in the bud, microbial acquisition of resistance to antibiotics. Therefore, this two-decade (1 January 2000 to 31 December 2019) systematic review and meta-analytical study articulated the prevalence and incidence of antibiotics resistance genes in Vibrio species isolated from environmental samples. Articles from the Web of Science and PubMed electronic databases was engaged. Heterogeneity of the data and bias were analyzed with random effect model meta-analysis and funnel plot. A total of 1920 Vibrio sp. were reported by the ten selected articles included in this study; out of which 32.39% of identified isolates displayed antimicrobial resistance and associated genes. The distribution of antibiotics resistance genes in Vibrio sp., reported within six countries was 21% tetracycline (tet), and 20% sulphonamide (sul) and β-lactamase (bla) respectively. The quinolone, tetracycline and sulfonamide resistance genes showed 32.97% (95% CI 0.18–0.53) prevalence while chloramphenicol, macrolides and aminoglycoside resistance genes are expressed in percentages as 28.67% (95% CI 0.15–0.47) and β-lactamase resistance genes 27.93% (95% CI 0.11–0.56) respectively. The Vibrio antibiotics resistance genes (V-ARG) distribution depicts no regular trend or pattern from the analyzed data. Consequently, more studies would be required to articulate the structure of cohesion in the distribution of the resistance determinants in microbes.
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15
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Wu D, Jin L, Xie J, Liu H, Zhao J, Ye D, Li XD. Inhalable antibiotic resistomes emitted from hospitals: metagenomic insights into bacterial hosts, clinical relevance, and environmental risks. MICROBIOME 2022; 10:19. [PMID: 35086564 PMCID: PMC8796446 DOI: 10.1186/s40168-021-01197-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/15/2021] [Indexed: 05/21/2023]
Abstract
BACKGROUND Threats of antimicrobial resistance (AMR) to human health are on the rise worldwide. Airborne fine particulate matter (PM2.5), especially those emitted from hospitals, could serve as a substantial yet lesser-known environmental medium of inhalable antibiotic resistomes. A genome-centric understanding of the hosting bacterial taxa, mobility potential, and consequent risks of the resistomes is needed to reveal the health relevance of PM2.5-associated AMR from clinical settings. RESULTS Compared to urban ambient air PM2.5, the hospital samples harbored nearly twice the abundance of antibiotic resistantance genes (ARGs, ~ 0.2 log10(ARGs/16S rRNA gene)) in the summer and winter sampled. The profiled resistome was closely correlated with the human-source-influenced (~ 30% of the contribution) bacterial community (Procrustes test, P < 0.001), reflecting the potential antibiotic-resistant bacteria (PARB), such as the human commensals Staphylococcus spp. and Corynebacterium spp. Despite the reduced abundance and diversity of the assembled metagenomes from summer to winter, the high horizontal transfer potential of ARGs, such as the clinically relevant blaOXA and bacA, in the human virulent PARB remained unaffected in the hospital air PM samples. The occurring patterns of β-lactam resistance genes and their hosting genomes in the studied hospital-emitting PM2.5 were closely related to the in-ward β-lactam-resistant infections (SEM, std = 0.62, P < 0.01). Featured with more abundant potentially virulent PARB (2.89 genome copies/m3-air), the hospital samples had significantly higher resistome risk index scores than the urban ambient air samples, indicating that daily human exposure to virulent PARB via the inhalation of PM2.5 was ten times greater than from the ingestion of drinking water. CONCLUSIONS The significance of AMR in the studied hospital-emitting PM2.5 was highlighted by the greater abundance of ARGs, the prevalence of potentially virulent PARB, and the close association with hospital in-ward β-lactam infections. A larger-scale multi-source comparison of genome-resolved antibiotic resistomes is needed to provide a more holistic understanding to evaluate the importance of airborne AMR from the "One-Health" perspective. Video Abstract.
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Affiliation(s)
- Dong Wu
- Department of Civil and Environmental Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
- Shanghai Engineering Research Center of Biotransformation of Organic Solid Waste, School of Ecological and Environmental Science, East China Normal University, Shanghai, 200241 China
| | - Ling Jin
- Department of Civil and Environmental Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Jiawen Xie
- Department of Civil and Environmental Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Hang Liu
- University Research Facility in Chemical and Environmental Analysis, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Jue Zhao
- Department of Civil and Environmental Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Dan Ye
- The First Affiliated Hospital of Guangzhou Medical University, 151 West Yanjiang Road, Guangzhou, 440104 China
| | - Xiang-dong Li
- Department of Civil and Environmental Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
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16
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Jia J, Liu M, Feng L, Wang Z. Comparative genomic analysis reveals the evolution and environmental adaptation of Acinetobacter johnsonii. Gene 2022; 808:145985. [PMID: 34600047 DOI: 10.1016/j.gene.2021.145985] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/07/2021] [Accepted: 09/27/2021] [Indexed: 11/04/2022]
Abstract
Genome plasticity is a key determinant that Acinetobacter johnsonii could widely distribute in natural and clinical environments. However, little attention has been paid to figure out the changes in the genome during A. johnsonii's evolution. Here, a comparative genomic analysis of A. johnsonii isolated from clinical and environmental sources was conducted. In this study, we found A. johnsonii has an open pan-genome and has great adaptability to different environments. Based on the results of the phylogenetic tree, ANI value and the distribution of accessory genes, we found that strains from the same habitat had a high degree of similarity. Though genes associated with the fundamental process were mostly conserved in evolution, clinical-derived isolates accumulate more genes associated with translational modification, β-lactamase and defense mechanisms, whereas environmental-derived isolates enriched more genes related to substances degradation. In addition, clinical-derived strains harbored some "strong" virulence islands and resistance islands. This study highlights the evolutionary relationship of A. johnsonii isolates from clinical and environmental sources.
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Affiliation(s)
- Jia Jia
- College of Animal Science and Technology, Northwest A&F University, Yangling, Shaanxi 712100, China
| | - Mengyu Liu
- College of Animal Science and Technology, Northwest A&F University, Yangling, Shaanxi 712100, China
| | - Leilei Feng
- College of Animal Science and Technology, Northwest A&F University, Yangling, Shaanxi 712100, China
| | - Zaizhao Wang
- College of Animal Science and Technology, Northwest A&F University, Yangling, Shaanxi 712100, China.
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17
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Antibiotic Stewardship Program Experience in a Training and Research Hospital. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2021; 55:253-261. [PMID: 34349604 PMCID: PMC8298082 DOI: 10.14744/semb.2020.96337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 12/02/2020] [Indexed: 11/20/2022]
Abstract
Objectives Antibiotic Stewardship Programs (ASP) have been developed for the spread of rational antibiotic use. Our hospital is one of the first centers where ASP applications were launched in Turkey. In this study, we aimed to share our experience with ASP which has been applied in our hospital since 2013. Methods We adapted ASP to our hospital program from Centers for Disease Control and Prevention's ASP checklist. Revisions on surgical prophylaxis guidelines and practices were performed. Surgical prophylaxis was evaluated from hospital infection surveillance and antibiotic usage by point prevalence surveys. Antibiotic consumption indexes (ACI) were calculated from hospital pharmacy records. Rapid antigen detection test (RADT) for Group A beta-hemolytic streptococcus and influenza rapid antigen test were started to be used. Cumulative antibiotic susceptibility results were prepared annually. Results Surgical prophylaxis was started to be administered in the operating room within 60 min of incision. Third-generation cephalosporin usage for surgical prophylaxis could be restricted in all clinics but the duration could only be shortened in neurosurgery and general surgery. There was no statistically significant change in antibiotic usage rates and appropriateness between 2014 and 2018. ACI for the class J01 in adult wards was 80.5 daily defined doses (DDD) per 100 patient days in 2014 and reduced to 64.8 DDD per 100 patient days in 2018. 22.445 pediatric patients presenting with complaints of the upper respiratory tract were evaluated with RADT and 75.1% were treated without antibiotics. Conclusion In this global antimicrobial resistance era, all hospitals should have motivated antimicrobial stewardship teams. Each hospital should establish its own stewardship program and often revise it. Improvement in rational antibiotic use is hard to achieve without multidisciplinary involvement.
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18
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Risk factors for antibiotic resistance development in healthcare settings in China: a systematic review. Epidemiol Infect 2021; 149:e141. [PMID: 34078502 PMCID: PMC8220497 DOI: 10.1017/s0950268821001254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Antibiotic resistance (ABR) threatens the effectiveness of infectious disease treatments and contributes to increasing global morbidity and mortality. In this study, we systematically reviewed the identified risk factors for ABR among people in the healthcare system of mainland China. Five databases were systematically searched to identify relevant articles published in either English and Chinese between 1 January 2003 and 30 June 2019. A total of 176 facility-based references were reviewed for this study, ranging across 31 provinces in mainland China and reporting information from over 50 000 patients. Four major ABR risk factor domains were identified: (1) sociodemographic factors (includes migrant status, low income and urban residence), (2) patient clinical information (includes disease status and certain laboratory results), (3) admission to healthcare settings (includes length of hospitalisation and performance of invasive procedures) and (4) drug exposure (includes current or prior antibiotic therapy). ABR constitutes an ongoing major public health challenge in China. The healthcare sector-associated risk factors was the most important aspect identified in this review and need to be addressed. Primary health care system and ABR surveillance networks need to be further strengthened to prevent and control the communicable diseases, over-prescription and overuse of antibiotics.
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Wang L, Situ S, Rainey JJ, He B, Su X, Moolenaar RL, Cui Y. Using Weibo and WeChat social media channels to assess public awareness and practices related to antimicrobial resistance, China, 2019. BMC Public Health 2021; 21:921. [PMID: 33990188 PMCID: PMC8120725 DOI: 10.1186/s12889-021-10648-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 03/18/2021] [Indexed: 12/04/2022] Open
Abstract
Background Antimicrobial resistance (AMR) is a global healthcare problem, including in China where high rates of resistance to common bacterial infections have been documented. In 2016, the National Health and Family Planning Commission (NHFPC) in China established a comprehensive strategic plan to increase awareness about AMR through education programs. Methods We conducted an online survey to assess changes in public knowledge, awareness and practices related to AMR in China since 2016. The survey was administered using China’s national and provincial level 12320 Health Hotline Weibo (micro-blog site) and WeChat (text messaging service) social media accounts from April 12, 2019 to May 7, 2019. All persons ≥16 years of age able to read Chinese were eligible to participate. Results A total of 2773 respondents completed the survey. Of the 2633 respondents indicating recent use of antibiotics, 84% (2223) reported obtaining their course of antibiotics from a hospital or pharmacy, 9% (246) of respondents reported using antibiotics saved from a previous prescription or treatment course, and 42% (1115) of respondents reported that they had stopped taking antibiotics as soon as they started feeling better. Most respondents correctly indicated that antibiotics can effectively treat urinary tract infections (86% [2388]) and skin infections (76% [2119]), but many incorrectly indicated that antibiotics can also treat viral infections such as measles (32% [889]) or a cold or flu (26% [726]). Of all respondents, 95% (2634) had heard of ‘antibiotic resistance’. Almost half (47% [1315]) reported using antibiotics within the last 6 months. Conclusion While awareness of AMR was high in this survey of social media users in China, inappropriate antibiotic use remains common, including the believe that antibiotics can effectively treat viral infections. Multiple interventions targeting the correct use of antibiotics and information on the cause AMR are likely needed. The 12320 Health Hotline provides a platform for conducting routine surveys to monitor antibiotic use and knowledge about AMR. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10648-5.
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Affiliation(s)
- Lei Wang
- Health Communication Center (National 12320 Health Hotline Management Office), Chinese Center for Disease Control and Prevention, No.155 Changbai Rd, Changping District, Beijing, China
| | - Sujian Situ
- Division of Global Health Protection, Center for Global Health, United States Centers for Disease Control and Prevention, Beijing, China
| | - Jeanette J Rainey
- Division of Global Health Protection, Center for Global Health, United States Centers for Disease Control and Prevention, Beijing, China
| | - Bin He
- Health Communication Center (National 12320 Health Hotline Management Office), Chinese Center for Disease Control and Prevention, No.155 Changbai Rd, Changping District, Beijing, China
| | - Xiaoge Su
- Health Communication Center (National 12320 Health Hotline Management Office), Chinese Center for Disease Control and Prevention, No.155 Changbai Rd, Changping District, Beijing, China
| | - Ronald L Moolenaar
- Division of Global Health Protection, Center for Global Health, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ying Cui
- Health Communication Center (National 12320 Health Hotline Management Office), Chinese Center for Disease Control and Prevention, No.155 Changbai Rd, Changping District, Beijing, China.
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20
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Sipos M, Farcas A, Leucuta DC, Bucsa C, Huruba M, Mogosan C. Second-Generation Cephalosporins-Associated Drug-Induced Liver Disease: A Study in VigiBase with a Focus on the Elderly. Pharmaceuticals (Basel) 2021; 14:ph14050441. [PMID: 34067178 PMCID: PMC8151124 DOI: 10.3390/ph14050441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 11/23/2022] Open
Abstract
Background: The objective of this study was to characterize individual case safety reports (ICSRs) and adverse drug reactions (ADRs) related to second-generation cephalosporins and resulting in hepatobiliary disorders, in VigiBase, WHO global database. Methods: All second-generation cephalosporins hepatobiliary ADRs reported up to July 2019 were included. Characteristic of cephalosporins and ADRs, aside from disproportionality data were evaluated. Results: A total of 1343 ICSRs containing 1585 ADRs were analyzed. Cefuroxime was suspected to have caused hepatobiliary disorders in most cases—in 38% of adults and in 35% of elderly. Abnormal hepatic function was the most frequent ADR, followed by jaundice and hepatitis. For 49% of the ADRs reported in the elderly and 51% in the adult population, the outcome was favorable, with fatal outcome for 2% of the adults and 10% of the elderly. Higher proportional reporting ration (PRR) values were reported in the elderly for cefotetan-associated jaundice, cefuroxime-associated acute hepatitis and hepatitis cholestatic as well as for cefotiam and cefmetazole-associated liver disorder. Conclusion: Hepatobiliary ADRs were reported for 2nd generation cephalosporins, with over 50% of cases in adults, without gender differences. Cholestatic hepatitis was predominately reported in the elderly and this category was more prone to specific hepatic reactions.
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Affiliation(s)
- Mariana Sipos
- Department of Pharmacology, Physiology and Physiopathology, Faculty of Pharmacy, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania; (M.S.); (M.H.); (C.M.)
| | - Andreea Farcas
- Drug Information Research Center, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
- Correspondence: ; Tel.: +40-724238587
| | - Daniel Corneliu Leucuta
- Department of Medical Informatics and Biostatistics, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
| | - Camelia Bucsa
- Drug Information Research Center, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
| | - Madalina Huruba
- Department of Pharmacology, Physiology and Physiopathology, Faculty of Pharmacy, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania; (M.S.); (M.H.); (C.M.)
| | - Cristina Mogosan
- Department of Pharmacology, Physiology and Physiopathology, Faculty of Pharmacy, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania; (M.S.); (M.H.); (C.M.)
- Drug Information Research Center, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
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Lucic A, Hinchliffe P, Malla TR, Tooke CL, Brem J, Calvopiña K, Lohans CT, Rabe P, McDonough MA, Armistead T, Orville AM, Spencer J, Schofield CJ. Faropenem reacts with serine and metallo-β-lactamases to give multiple products. Eur J Med Chem 2021; 215:113257. [PMID: 33618159 PMCID: PMC7614720 DOI: 10.1016/j.ejmech.2021.113257] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/23/2021] [Accepted: 01/30/2021] [Indexed: 11/30/2022]
Abstract
Penems have demonstrated potential as antibacterials and β-lactamase inhibitors; however, their clinical use has been limited, especially in comparison with the structurally related carbapenems. Faropenem is an orally active antibiotic with a C-2 tetrahydrofuran (THF) ring, which is resistant to hydrolysis by some β-lactamases. We report studies on the reactions of faropenem with carbapenem-hydrolysing β-lactamases, focusing on the class A serine β-lactamase KPC-2 and the metallo β-lactamases (MBLs) VIM-2 (a subclass B1 MBL) and L1 (a B3 MBL). Kinetic studies show that faropenem is a substrate for all three β-lactamases, though it is less efficiently hydrolysed by KPC-2. Crystallographic analyses on faropenem-derived complexes reveal opening of the β-lactam ring with formation of an imine with KPC-2, VIM-2, and L1. In the cases of the KPC-2 and VIM-2 structures, the THF ring is opened to give an alkene, but with L1 the THF ring remains intact. Solution state studies, employing NMR, were performed on L1, KPC-2, VIM-2, VIM-1, NDM-1, OXA-23, OXA-10, and OXA-48. The solution results reveal, in all cases, formation of imine products in which the THF ring is opened; formation of a THF ring-closed imine product was only observed with VIM-1 and VIM-2. An enamine product with a closed THF ring was also observed in all cases, at varying levels. Combined with previous reports, the results exemplify the potential for different outcomes in the reactions of penems with MBLs and SBLs and imply further structure-activity relationship studies are worthwhile to optimise the interactions of penems with β-lactamases. They also exemplify how crystal structures of β-lactamase substrate/inhibitor complexes do not always reflect reaction outcomes in solution.
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Affiliation(s)
- Anka Lucic
- Chemistry Research Laboratory, The Department of Chemistry and the Ineos Oxford Institute for Antimicrobial Research, 12 Mansfield Road, Oxford, OX1 3TA, United Kingdom
| | - Philip Hinchliffe
- Cellular and Molecular Medicine, Biomedical Sciences Building, University Walk, Bristol, BS8 1TD, United Kingdom
| | - Tika R Malla
- Chemistry Research Laboratory, The Department of Chemistry and the Ineos Oxford Institute for Antimicrobial Research, 12 Mansfield Road, Oxford, OX1 3TA, United Kingdom
| | - Catherine L Tooke
- Cellular and Molecular Medicine, Biomedical Sciences Building, University Walk, Bristol, BS8 1TD, United Kingdom
| | - Jürgen Brem
- Chemistry Research Laboratory, The Department of Chemistry and the Ineos Oxford Institute for Antimicrobial Research, 12 Mansfield Road, Oxford, OX1 3TA, United Kingdom
| | - Karina Calvopiña
- Chemistry Research Laboratory, The Department of Chemistry and the Ineos Oxford Institute for Antimicrobial Research, 12 Mansfield Road, Oxford, OX1 3TA, United Kingdom
| | | | - Patrick Rabe
- Chemistry Research Laboratory, The Department of Chemistry and the Ineos Oxford Institute for Antimicrobial Research, 12 Mansfield Road, Oxford, OX1 3TA, United Kingdom
| | - Michael A McDonough
- Chemistry Research Laboratory, The Department of Chemistry and the Ineos Oxford Institute for Antimicrobial Research, 12 Mansfield Road, Oxford, OX1 3TA, United Kingdom
| | - Timothy Armistead
- Cellular and Molecular Medicine, Biomedical Sciences Building, University Walk, Bristol, BS8 1TD, United Kingdom
| | - Allen M Orville
- Diamond Light Source, Harwell Science and Innovation Campus, Didcot, OX11 0DE, United Kingdom.
| | - James Spencer
- Cellular and Molecular Medicine, Biomedical Sciences Building, University Walk, Bristol, BS8 1TD, United Kingdom.
| | - Christopher J Schofield
- Chemistry Research Laboratory, The Department of Chemistry and the Ineos Oxford Institute for Antimicrobial Research, 12 Mansfield Road, Oxford, OX1 3TA, United Kingdom.
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22
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Xu R, Mu T, Jian W, Xu C, Shi J. Knowledge, Attitude, and Prescription Practice on Antimicrobials Use Among Physicians: A Cross-Sectional Study in Eastern China. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2021; 58:469580211059984. [PMID: 34873939 PMCID: PMC8661115 DOI: 10.1177/00469580211059984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Over-prescription of antimicrobials for patients is a major driver of bacterial resistance. The aim of the present study was to assess the knowledge, attitude, and prescription practices regarding antimicrobials among physicians in the Zhejiang province in China, and identify the determining factors. A total of 600 physicians in public county hospitals and township health institutions were surveyed cross-sectionally using a structured electronic questionnaire. The questionnaire was completed by 580 physicians and the response rate was 96.67%. The mean score of 11 terms related to antimicrobial knowledge was 6.81, and an average of 32.1% of patients with upper respiratory tract infections (URTIs) were prescribed antimicrobials. Multivariate analysis indicated that young general practitioners with less training are more likely to contribute to more frequent antimicrobial prescriptions ( P < .05). In contrast, older physicians with more training are more willing to provide patients with the correct knowledge regarding antimicrobials and less likely to prescribe antimicrobials for URTIs. Correlation analysis showed that the level of physician's knowledge, attitude, and prescription practice is related ( P < .05). In conclusion, proper prescription of antimicrobials depends on adequate knowledge and regular training programs for physicians.
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Affiliation(s)
- Rixiang Xu
- School of Humanities and Management, Zhejiang Chinese Medical University, Hangzhou China
- School of Pharmacy, Hangzhou Medical Collage, Hangzhou, China
- Zhejiang Drug Policy Research Center, Hangzhou, China
| | - Tingyu Mu
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
| | - Wang Jian
- School of Pharmacy, Hangzhou Medical Collage, Hangzhou, China
| | - Caiming Xu
- School of Humanities and Management, Zhejiang Chinese Medical University, Hangzhou China
| | - Jing Shi
- School of Pharmacy, Hangzhou Medical Collage, Hangzhou, China
- Zhejiang Drug Policy Research Center, Hangzhou, China
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23
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Chen Y, Shen W, Wang B, Zhao X, Su L, Kong M, Li H, Zhang S, Li J. Occurrence and fate of antibiotics, antimicrobial resistance determinants and potential human pathogens in a wastewater treatment plant and their effects on receiving waters in Nanjing, China. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2020; 206:111371. [PMID: 32979719 DOI: 10.1016/j.ecoenv.2020.111371] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 05/23/2023]
Abstract
Antibiotics, antimicrobial resistance determinants and human pathogens are new types of environmental pollutants that pose a great threat to human health. Wastewater treatment plants (WWTPs) are important sources of novel pollutants; however, few studies have investigated their impact on surrounding natural water. Therefore, this study used a WWTP as the entry point to explore WWTP removal efficiency of antibiotics, antimicrobial resistance determinants and human pathogens and further analyze the impact of WWTP effluent on receiving waters. The investigated WWTP had a good removal effect on fluoroquinolones, macrolides, lincomycin, sulfanilamide, tetracycline and chloramphenicol antibiotics in wastewater, and the concentration of antibiotics in the WWTP's effluent was reduced by >80% relative to the influent. In addition to cmlA, the effect of the WWTP on antimicrobial resistance determinants removal was poor, although the effluent from the WWTP had no effect on the abundance of antimicrobial resistance determinants in the receiving water. However, with the dilution of receiving water, the abundance of antimicrobial resistance determinants gradually decreased. The WWTP could reduce the abundance of bacteria by 1000 times from influent water to effluent water. The major bacteria in the influent and effluent were Bacteroidetes and Proteobacteria. After effluent is discharged into receiving water, Cyanobacteria proliferate in large quantities, which can affect the microbial structure in the environment.The abundance of Acinetobacter, which was the predominant potential human pathogen in local wastewater, decreased dramatically after wastewater treatment. We also conducted an ecological risk assessment of the antibiotics identified and found that the ecological risk AZM and CLR posed to aquatic organisms was high. Overall, we identified the efficiency of WWTP control of antibiotics, antimicrobial resistance determinants and potential human pathogens and the impact of WWTP effluent on receiving water and provided data to support the control of the investigated pollutants.
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Affiliation(s)
- Yu Chen
- College of Resources and Environmental Engineering, Guizhou University, Guiyang, 5500254, China; Nanjing Institute of Environmental Sciences, Ministry of Ecology and Environment, Nanjing, 210042, China
| | - Weitao Shen
- Nanjing Institute of Environmental Sciences, Ministry of Ecology and Environment, Nanjing, 210042, China; Key Laboratory of Environment Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, 210009, China
| | - Bo Wang
- Nanjing Institute of Environmental Sciences, Ministry of Ecology and Environment, Nanjing, 210042, China
| | - Xin Zhao
- Nanjing Institute of Environmental Sciences, Ministry of Ecology and Environment, Nanjing, 210042, China
| | - Lianghu Su
- Nanjing Institute of Environmental Sciences, Ministry of Ecology and Environment, Nanjing, 210042, China
| | - Ming Kong
- Nanjing Institute of Environmental Sciences, Ministry of Ecology and Environment, Nanjing, 210042, China
| | - Hui Li
- Inner Mongolia Baogang Group Environmental Engineering Research Institute Limited Company, Baotou, 014010, China
| | - Shenghu Zhang
- Nanjing Institute of Environmental Sciences, Ministry of Ecology and Environment, Nanjing, 210042, China.
| | - Jiang Li
- College of Resources and Environmental Engineering, Guizhou University, Guiyang, 5500254, China.
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24
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Long S, Yang Y, Pavlostathis SG, Xiang F, Sun P, Li N, Zhao L. Toxicity of tetracycline and its transformation products to a phosphorus removing Shewanella strain. CHEMOSPHERE 2020; 246:125681. [PMID: 31896014 DOI: 10.1016/j.chemosphere.2019.125681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/10/2019] [Accepted: 12/16/2019] [Indexed: 06/10/2023]
Abstract
Tetracycline (TC) as an emerging contaminant has raised serious concerns about its toxicity and removal in wastewater treatment processes. The more toxic transformation products of TC, 4-epitetracycline (ETC), anhydrotetracycline (ATC) and 4-epianhydrotetracycline (EATC) are also widely detected. This study investigated the antibacterial and bactericidal activity of TC, ETC, ATC, EATC against Shewanella sp, using Escherichia coli and Pseudomonas aeruginosa strains as quality controls. Further, batch assays were conducted to investigate the inhibition of these antibiotics on the phosphorus removal of the Shewanella strain, and removal mechanisms of TC and its transformation products (TCs). The inhibition on phosphorus removal by the Shewanella strain at 20 mg L-1 was in the order of ATC > EATC > TC > ETC. COD removal, poly-P accumulation and glycogen synthesis by the Shewanella strain were also inhibited. Biodegradation was the main removal mechanism of TC and ETC, while adsorption was the main one of ATC and EATC. This study helps to further understand the structure-activity relationship of TC.
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Affiliation(s)
- Sha Long
- School of Environmental Science and Engineering, Tianjin University, Tianjin, 300072, China; School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA, 30332-0512, USA
| | - Yongkui Yang
- School of Environmental Science and Engineering, Tianjin University, Tianjin, 300072, China
| | - Spyros G Pavlostathis
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA, 30332-0512, USA
| | - Feng Xiang
- School of Environmental Science and Engineering, Tianjin University, Tianjin, 300072, China
| | - Peizhe Sun
- School of Environmental Science and Engineering, Tianjin University, Tianjin, 300072, China
| | - Na Li
- Central Laboratory of Tianjin Academy of Agricultural Sciences, Tianjin, 300381, China
| | - Lin Zhao
- School of Environmental Science and Engineering, Tianjin University, Tianjin, 300072, China.
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25
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Song Y, Han Z, Song K, Zhen T. Antibiotic Consumption Trends in China: Evidence From Six-Year Surveillance Sales Records in Shandong Province. Front Pharmacol 2020; 11:491. [PMID: 32362828 PMCID: PMC7181956 DOI: 10.3389/fphar.2020.00491] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/30/2020] [Indexed: 11/13/2022] Open
Abstract
Background The overuse of antibiotics is a serious public health problem in China, causing a high rate of antimicrobial resistance. This study identified the trends of antibiotic consumption in China to provide evidence for further intervention. Method The six-year surveillance data on antibiotic sales from 2012 to 2017, which served as a proxy for consumption, were collected from 39 public health care facilities in Shandong province, including three tertiary hospitals, six secondary hospitals, and 30 primary health centers. Based on the Anatomical Therapeutic Chemical (ATC)/DDD methodology, antibiotic consumption was formulated in defined daily doses (DDD) per 1,000 inhabitants per day (DID). Results The total antibiotic consumption among all health care settings increased from 16.07 DID in 2012 to a peak of 17.44 DID in 2015 and then decreased to 11.35 DID in 2017 with a 34.90% reduction. J01C (beta-lactam antimicrobials, penicillin), the most frequently used antibiotic class, accounted for 36.32% of the total DID. Consumption of carbapenems increased from 0.029 DID in 2012 to 0.08 DID in 2017. Parenteral antibiotics accounted for nearly 40% of the total consumption. Compared with the 2012 figures, the 2017 consumption showed a small increase in hospital sector that was compensated by the decrease in community care. Conclusion A substantial reduction in total antibiotic consumption was observed in China from 2012 to 2017. However, the extensive consumption of broad-spectrum antimicrobials, high proportion of parenteral antibiotic use, and increased use of last-resort antibiotics attracted public health concerns.
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Affiliation(s)
- Yan Song
- Shandong Institute of Medicine and Health Information, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China.,School of Health Care Management, Shandong University, Jinan, China
| | - Zhiyan Han
- Shandong Institute of Medicine and Health Information, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Kuimeng Song
- Shandong Institute of Medicine and Health Information, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Tianmin Zhen
- Shandong Institute of Medicine and Health Information, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
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26
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Wushouer H, Zhou Y, Zhang X, Fu M, Fan D, Shi L, Guan X. Secular trend analysis of antibiotic utilisation in China's hospitals 2011-2018, a retrospective analysis of procurement data. Antimicrob Resist Infect Control 2020; 9:53. [PMID: 32295639 PMCID: PMC7160954 DOI: 10.1186/s13756-020-00709-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 03/24/2020] [Indexed: 12/23/2022] Open
Abstract
Background This study was aimed to explore the secular trends of antibiotic utilisation in China’s hospitals over an 8-year period. Methods We retrospectively analysed aggregated monthly antibiotic procurement data of 586 hospitals from 28 provinces in China from January 2011 to December 2018. Information including generic name, procurement amount, dosage form, strength, the route of administration, and geographical data were collected. Population weighted antibiotic utilisation were expressed in DDD per 1000 inhabitants per day (DID). WHO’s ‘Access, Watch, Reserve’ categorization was also adopted to analyse antibiotic utilisation. Results Between 2011 and 2018, total antibiotic utlisation in China’s hospitals increased by 39.6% (from 4.8 DID in 2010 to 6.7 DID in 2018). Antibiotic utilisation was stable or had moderately decreased in 13 provinces, while in the other 15 provinces they had substantially increased. Cephalosporins were the most consumed antibiotics, accounting for 26.9% of the total antibiotic utilisation (1.8 DID/6.7 DID). In 2018, antibiotics in the Access category comprised 19.4% of the total utilisation (1.3 DID/6.7 DID), where antibiotics in the Watch category comprised the largest proportion of 71.6% (4.8 DID/6.7 DID). Population-weighted antibiotic utlisation was greater in secondary hospitals than in tertiary hospitals (7.3 DID vs 6.6 DID). The utilisation of oral forms was almost two times the amount of parenteral forms in secondary hospitals, whereas in tertiary hospitals the amounts were about the same. Conclusions Despite efforts have been made towards restricting antibiotic use by the Chinese government, antibiotic utilisation demonstrated an upward trend after the medical reform. The increase of last-resort antibiotics raises serious concern for public health. Current patterns of antibiotic utilisation demonstrated that gaps are existed towards the global target set up by the WHO. To better facilitate proper antibiotic use, more efforts are needed to explore the appropriateness of antibiotic use at the individual level.
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Affiliation(s)
- Haishaerjiang Wushouer
- Center for Strategic Studies, Chinese Academy of Engineering, No.2 Bingjiaokou HuTong, Xicheng District, Beijing, 100088, China.,School of Medicine, Tsinghua University, No.30 Shuangqing Road, Haidian District, Beijing, 100084, China.,International Research Center for Medicinal Administration (IRCMA), Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Yue Zhou
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Xi Zhang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Mengyuan Fu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Daiming Fan
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Air Force Military Medical University, No. 15 Changlexi Road, Xincheng District, Xi'an, 710032, China
| | - Luwen Shi
- International Research Center for Medicinal Administration (IRCMA), Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China. .,Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China.
| | - Xiaodong Guan
- International Research Center for Medicinal Administration (IRCMA), Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China. .,Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China. .,Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, Boston, MA, 02215, USA.
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27
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Liu KY, Zhang JJ, Geng ML, Zhu YT, Liu XJ, Ding P, Wang BL, Liu WW, Liu YH, Tao FB. A Stable Isotope Dilution Assay for Multi-class Antibiotics in Pregnant Urines by LC–MS/MS. Chromatographia 2020. [DOI: 10.1007/s10337-020-03866-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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28
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Qin X, Zhao Y, Chen W, Wu X, Tang S, Li G, Yuqi Y, Cao W, Liu X, Huang J, Yang J, Chen W, Tang W, Zheng H. Changing antimicrobial susceptibility and molecular characterisation of Neisseria gonorrhoeae isolates in Guangdong, China: in a background of rapidly rising epidemic. Int J Antimicrob Agents 2019; 54:757-765. [PMID: 31425792 PMCID: PMC8179728 DOI: 10.1016/j.ijantimicag.2019.08.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/03/2019] [Accepted: 08/12/2019] [Indexed: 11/13/2022]
Abstract
The prevalence of Neisseria gonorrhoeae infections has increased rapidly since 2015 in China. Antimicrobial resistance and molecular mobilisation in N. gonorrhoeae are two important factors driving this increasing prevalence. This study explored changes in antimicrobial susceptibility and molecular characteristics of N. gonorrhoeae collected in Guangdong, China (2013-2017). A total of 704 isolates were collected in two cities in Guangdong. MICs of major antimicrobials were determined. Penicillinase-producing N. gonorrhoeae (PPNG) and tetracycline-resistant N. gonorrhoeae (TRNG) were characterised, and N. gonorrhoeae multiantigen sequence typing (NG-MAST) was performed. High resistance to penicillin (68.2%), tetracycline (85.7%) and ciprofloxacin (98.2%) was observed. Spectinomycin, ceftriaxone and azithromycin appeared effective, with susceptibilities of 100%, 96.4% and 90.7%, respectively. Resistance to penicillin decreased significantly from 78.4% to 73.6% and to azithromycin from 11.9% to 3.7%. Total prevalence of PPNG, TRNG and PPNG/TRNG was 25.4%, 33.1% and 13.4%, respectively. Rates of PPNG decreased significantly from 37.3% to 23.9%, TRNG from 50.0% to 31.3%, and PPNG/TRNG from 23.5% to 11.7%. However, the ratio of African-type PPNG increased significantly (18.4% to 64.1%) compared with decreasing Asian-type PPNG (81.6% to 33.3%), and the ratio of American-type TRNG increased significantly (0% to 13.7%) compared with decreasing Dutch-type TRNG (100% to 86.3%). A total of 271 sequence types (STs) were identified by NG-MAST from 380 isolates collected in 2013, 2014 and 2017, with 145 novel STs. African-type PPNG is increasing and replacing Asian-type, and novel STs have emerged. Gonococcal isolates with new genotypes might contribute to the rising gonorrhoea epidemic in this area.
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Affiliation(s)
- Xiaolin Qin
- Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong, China; Guangdong Provincial Dermatology Hospital, Guangzhou, Guangdong, China
| | - Yunhu Zhao
- Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong, China; Guangdong Provincial Dermatology Hospital, Guangzhou, Guangdong, China; Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Wei Chen
- Department of Preventive Health, Zhuhai Center for Chronic Disease Control and Prevention, Zhuhai, Guangdong, China
| | - Xingzhong Wu
- Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong, China; Guangdong Provincial Dermatology Hospital, Guangzhou, Guangdong, China
| | - Sanmei Tang
- Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong, China; Guangdong Provincial Dermatology Hospital, Guangzhou, Guangdong, China
| | - Guozhou Li
- The sixth People's Hospital of Dongguan, Dongguan, Guangdong, China
| | - Yu Yuqi
- Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong, China; Guangdong Provincial Dermatology Hospital, Guangzhou, Guangdong, China
| | - Wenling Cao
- Guangzhou Institute of Dermatology, Guangzhou, Guangdong, China
| | - Xiaofeng Liu
- Department of Preventive Health, Zhuhai Center for Chronic Disease Control and Prevention, Zhuhai, Guangdong, China
| | - Jinmei Huang
- Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong, China; Guangdong Provincial Dermatology Hospital, Guangzhou, Guangdong, China
| | - Jieyi Yang
- Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong, China; Guangdong Provincial Dermatology Hospital, Guangzhou, Guangdong, China
| | - Wentao Chen
- Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong, China; Guangdong Provincial Dermatology Hospital, Guangzhou, Guangdong, China
| | - Weiming Tang
- Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong, China; Guangdong Provincial Dermatology Hospital, Guangzhou, Guangdong, China.
| | - Heping Zheng
- Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong, China; Guangdong Provincial Dermatology Hospital, Guangzhou, Guangdong, China.
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29
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Araujo da Silva AR, Jaszkowski E, Schober T, von Both U, Meyer-Buehn M, Marques AF, Farkas B, de Abreu BS, di Biase CB, Takahashi JM, de Castro LD, Leal IA, Teixeira CH, Nussbaum CF, Hoffmann F, Hübner J. Patterns of antimicrobial consumption in neonatal and pediatric intensive care units in Germany and Brazil. Eur J Clin Microbiol Infect Dis 2019; 39:249-255. [PMID: 31673879 DOI: 10.1007/s10096-019-03714-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
Abstract
Antibiotic consumption (AC) is a key component of antimicrobial stewardship programs to recognize local patterns of antibiotic use. Our aim was to measure AC in neonatal units, including neonatal (NICU)/paediatric (PICU) intensive care units in different countries. We conducted a multicenter, retrospective, cohort study in three NICUs, one neonatal ward, and three PICUs with a total of 84 beds. Global and individual AC in days of therapy (DOT) and DOT per 1000 patient-days were assessed. During the study period, 2567 patients were admitted, corresponding to 4961 patient-days in neonatal units and 9243 patient-days in PICUs. Multidrug-resistant Gram-negative bacteria and methicillin-resistant Staphylococcus aureus were more frequent in Brazil than in Germany. Average AC was 386.5 and 1335.5 DOT/1000PD in German and Brazilian neonatal units, respectively. Aminopenicillins plus 3rd generation cephalosporins were the most commonly prescribed antibiotics in German neonatal units, while aminopenicillins plus aminoglycosides were the class most commonly used in Brazilian NICU. Average AC was 888.1 and 1440.7 DOT/1000PD in German and Brazilian PICUs, respectively. Antipseudomonal penicillins were most commonly used in the German PICU, and glycopeptides were the most frequently prescribed in Brazilian PICUs. Carbapenems represented 2.3-14% of total DOTs in German neonatal units and 4% in the Brazilian NICU and 13.0% in the German PICU and 6-12.2% in Brazilian PICUs. We concluded that different patterns of most commonly prescribed antibiotics were observed in neonatal units and PICUs in these two countries, probably related to different local patterns of antibiotic resistance, with a higher antibiotic consumption in Brazilian study units.
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Affiliation(s)
- André Ricardo Araujo da Silva
- Materno-Infantil Departament, Faculdade de Medicina, Universidade Federal Fluminense, Rua Marquês do Paraná 303, Niterói, RJ, 24033-900, Brazil.
| | - Elena Jaszkowski
- Infectiology Service, Dr. von Hauner Children's Hospital, LMU Munich, 80337, Munich, Germany
| | - Tilmann Schober
- Infectiology Service, Dr. von Hauner Children's Hospital, LMU Munich, 80337, Munich, Germany
| | - Ulrich von Both
- Infectiology Service, Dr. von Hauner Children's Hospital, LMU Munich, 80337, Munich, Germany
| | - Melanie Meyer-Buehn
- Infectiology Service, Dr. von Hauner Children's Hospital, LMU Munich, 80337, Munich, Germany
| | - Amanda Fáris Marques
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | - Beatriz Farkas
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | - Bernardo Silva de Abreu
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | - Clara Biscaia di Biase
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | - Jully Miyoshi Takahashi
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | - Luisa Dutra de Castro
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | - Izabel Alves Leal
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | - Cristiane Henriques Teixeira
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | | | - Florian Hoffmann
- Intensive Care Medicine service, Dr. von Hauner Children's Hospital, LMU Munich, 80337, Munich, Germany
| | - Johannes Hübner
- Infectiology Service, Dr. von Hauner Children's Hospital, LMU Munich, 80337, Munich, Germany
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Abbasian H, Hajimolaali M, Yektadoost A, Zartab S. Antibiotic Utilization in Iran 2000-2016: Pattern Analysis and Benchmarking with Organization for Economic Co-operation and Development Countries. J Res Pharm Pract 2019; 8:162-167. [PMID: 31728348 PMCID: PMC6830016 DOI: 10.4103/jrpp.jrpp_19_42] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/29/2019] [Indexed: 12/13/2022] Open
Abstract
Objectives: Antibiotic resistance is the main threat to health all over the world. The consumption of antibiotics is one of the factors causing the emergence of multidrug resistance. The purpose of this study was to recognize the patterns, trends, and changes of consumption in Iran and to compare them with those of Organization for Economic Co-operation and Development (OECD) countries. Methods: The data were collected from a national pharmaceutical wholesale data bank. Defined daily dose (DDD) or DDDs per 1000 inhabitants per day (DID) was calculated as a standard indicator for the consumption over 17 years. Results: Were benchmarked with the consumption of OECD countries. Drug utilization 90% (DU90%) method was used to assess the drug consumption pattern. Findings: The antibiotic consumption jumped up from 33.6 DID to 60 DID from 2000 to 2016. Compared to the average consumption of OECD countries, Iran has consumed antibiotics almost triple times. There were 9–11 chemical substances in the DU90% list during these years. Changes in DU90% list occurred within antibiotics classes during the study period. Although the total consumption growth was equal to 79% during these years, consumption of some pharmacological subgroups such as sulfonamide and aminoglycosides has decreased. Conclusion: Albeit the existence of surveillance system for health-related infectious diseases, the consumption of antibiotics has increased drastically, which illustrates the necessity of comprehensive and effective national antibiotic stewardship.
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Affiliation(s)
- Hadi Abbasian
- Department of Pharmacoeconomics and Pharmaceutical Administration, Tehran University of Medical Science, Tehran, Iran
| | - Mohammad Hajimolaali
- Department of Drug and Food Control, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Yektadoost
- Department of Pharmacoeconomics and Pharmaceutical Administration, Tehran University of Medical Science, Tehran, Iran
| | - Saman Zartab
- Department of Pharmacoeconomics and Pharmaceutical Administration, Tehran University of Medical Science, Tehran, Iran
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The Clinical and Economic Impact of Antibiotic Resistance in China: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2019; 8:antibiotics8030115. [PMID: 31405146 PMCID: PMC6784351 DOI: 10.3390/antibiotics8030115] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 11/16/2022] Open
Abstract
Antibiotic resistance (ABR) is one of the biggest threats to global health, especially in China. This study aims to analyze the published literature on the clinical and economic impact of ABR or multi-drug resistant (MDR) bacteria compared to susceptible bacteria or non-infection, in mainland China. English and Chinese databases were searched to identify relevant studies evaluating mortality, hospital stay, and hospital costs of ABR. A meta-analysis of mortality was performed using a random effects model. The costs were converted into 2015 United States (US) dollars. Of 13,693 studies identified, 44 eligible studies were included. Twenty-nine investigated the impact of ABR on hospital mortality, 37 were focused on hospital stay, and 21 on hospital costs. Patients with ABR were associated with a greater risk of overall mortality compared to those with susceptibility or those without infection (odds ratio: 2.67 and 3.29, 95% confidence interval: 2.18–3.26 and 1.71–6.33, p < 0.001 and p < 0.001, respectively). The extra mean total hospital stay and total hospital cost were reported, ranging from 3 to 46 days, and from US$238 to US$16,496, respectively. Our study indicates that ABR is associated with significantly higher mortality. Moreover, ABR is not always, but usually, associated with significantly longer hospital stay and higher hospital costs.
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Zhang H, He H, Chen S, Huang T, Lu K, Zhang Z, Wang R, Zhang X, Li H. Abundance of antibiotic resistance genes and their association with bacterial communities in activated sludge of wastewater treatment plants: Geographical distribution and network analysis. J Environ Sci (China) 2019; 82:24-38. [PMID: 31133267 DOI: 10.1016/j.jes.2019.02.023] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 05/21/2023]
Abstract
Wastewater treatment plants (WWTPs) are deemed reservoirs of antibiotic resistance genes (ARGs). Bacterial phylogeny can shape the resistome in activated sludge. However, the co-occurrence and interaction of ARGs abundance and bacterial communities in different WWTPs located at continental scales are still not comprehensively understood. Here, we applied quantitative PCR and Miseq sequence approaches to unveil the changing profiles of ARGs (sul1, sul2, tetW, tetQ, tetX), intI1 gene, and bacterial communities in 18 geographically distributed WWTPs. The results showed that the average relative abundance of sul1and sul2 genes were 2.08 × 10-1 and 1.32 × 10-1 copies/16S rRNA copies, respectively. The abundance of tetW gene was positively correlated with the Shannon diversity index (H'), while both studied sul genes had significant positive relationship with the intI1gene. The highest average relative abundances of sul1, sul2, tetX, and intI1 genes were found in south region and oxidation ditch system. Network analysis found that 16 bacterial genera co-occurred with tetW gene. Co-occurrence patterns were revealed distinct community interactions between aerobic/anoxic/aerobic and oxidation ditch systems. The redundancy analysis model plot of the bacterial community composition clearly demonstrated that the sludge samples were significant differences among those from the different geographical areas, and the shifts in bacterial community composition were correlated with ARGs. Together, these findings from the present study will highlight the potential risks of ARGs and bacterial populations carrying these ARGs, and enable the development of suitable technique to control the dissemination of ARGs from WWTPs into aquatic environments.
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Affiliation(s)
- Haihan Zhang
- Key Laboratory of Northwest Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, Xi'an 710055, China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an 710055, China.
| | - Huiyan He
- Key Laboratory of Northwest Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, Xi'an 710055, China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an 710055, China
| | - Shengnan Chen
- Key Laboratory of Northwest Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, Xi'an 710055, China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an 710055, China
| | - Tinglin Huang
- Key Laboratory of Northwest Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, Xi'an 710055, China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an 710055, China
| | - Kuanyu Lu
- Key Laboratory of Northwest Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, Xi'an 710055, China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an 710055, China
| | - Zhonghui Zhang
- Key Laboratory of Northwest Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, Xi'an 710055, China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an 710055, China
| | - Rong Wang
- Key Laboratory of Northwest Resource, Environment and Ecology, MOE, Xi'an University of Architecture and Technology, Xi'an 710055, China; Shaanxi Key Laboratory of Environmental Engineering, Xi'an University of Architecture and Technology, Xi'an 710055, China
| | - Xueyao Zhang
- Xi'an Environmental Monitoring Center, Xi'an 710119, China
| | - Hailong Li
- Research Institute of Applied Biology, Shanxi University, Taiyuan 030006, China
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Chang Y, Chusri S, Sangthong R, McNeil E, Hu J, Du W, Li D, Fan X, Zhou H, Chongsuvivatwong V, Tang L. Clinical pattern of antibiotic overuse and misuse in primary healthcare hospitals in the southwest of China. PLoS One 2019; 14:e0214779. [PMID: 31242185 PMCID: PMC6594576 DOI: 10.1371/journal.pone.0214779] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/03/2019] [Indexed: 11/19/2022] Open
Abstract
Purpose Overuse and misuse of antibiotics are the primary risk factors for antibiotics resistance. Inadequate professional competence of primary care physicians might exacerbate these problems in China. This retrospective study aims to document the clinical pattern of antibiotics use and its overuse and misuse rates in rural primary care institutions and to evaluate the association between antibiotics use and characteristics of physicians and their patients. Methods Medical records from 16 primary care hospitals in rural areas of Guizhou province, China were obtained from the Health Information System in 2018. Classification of unnecessary use, incorrect spectrum of antibiotic, escalated use of extended spectrum and combined antibiotics use was based on the Guiding Principle of Clinical Use of Antibiotics (2015, China) and guidelines from the US Centers for Disease Control and Prevention. Generalized Estimating Equations were employed to determine predictive factors for inappropriate antibiotics use. Results A total of 74,648 antibiotics prescriptions were retrieved. Uncomplicated respiratory infection was the most common disease accounting for 58.6% of all prescriptions. The main antibiotic group used was penicillins (51.5%) followed by cephalosporins and macrolides (14% each). Of 57,009 patient visits, only 8.7% of the antibiotic prescriptions were appropriate. Combined use, escalated use of extended spectrum antibiotics, incorrect spectrum and unnecessary antibiotics use was found in 7.8%, 1.9%, 4.3% and 77.3% of patient visits, respectively, of which 28.7% were given intravenously. Antibiotics misuse was significantly more likely among newly employed physicians with lower levels of professional education. Adult patients and those who had public insurance had a higher risk of being prescribed unnecessary antibiotics. Conclusion Overuse of antibiotics for uncomplicated respiratory infection and use of cephalosporins, macrolides and injection antibiotics in primary care are the major problems of clinical practice in rural areas of Guizhou.
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Affiliation(s)
- Yue Chang
- School of Medicine and Health Management, Guizhou Medical University, Guizhou, China
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Sarunyou Chusri
- Division of Infectious Disease, Department of Internal Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
- Department of Biomedical Sciences, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Rassamee Sangthong
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Edward McNeil
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Jiaqi Hu
- School of Medicine and Health Management, Guizhou Medical University, Guizhou, China
| | - Wei Du
- School of Medicine and Health Management, Guizhou Medical University, Guizhou, China
| | - Duan Li
- School of Medicine and Health Management, Guizhou Medical University, Guizhou, China
| | - Xingying Fan
- School of Medicine and Health Management, Guizhou Medical University, Guizhou, China
| | - Hanni Zhou
- School of Medicine and Health Management, Guizhou Medical University, Guizhou, China
| | - Virasakdi Chongsuvivatwong
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
- * E-mail: (VC); (TL)
| | - Lei Tang
- School of Medicine and Health Management, Guizhou Medical University, Guizhou, China
- * E-mail: (VC); (TL)
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Abstract
Despite improvements in antibiotic use in tertiary hospitals, problems remain in other parts of the health system, say Ping He and colleagues
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Affiliation(s)
- Ping He
- China Center for Health Development Studies, Peking University, Beijing 100191, China
| | - Qiang Sun
- School of Health Care Management, Shandong University, Shandong Jinan 250012, China
| | - Lizheng Shi
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Qingyue Meng
- China Center for Health Development Studies, Peking University, Beijing 100191, China
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Single-Center Analysis of the Potential Inappropriate Use of Intravenous Medications in Hospitalized Patients in China. Clin Ther 2019; 41:1631-1637.e4. [PMID: 31174860 DOI: 10.1016/j.clinthera.2019.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/20/2019] [Accepted: 05/13/2019] [Indexed: 02/08/2023]
Abstract
This study categorizes the types of inappropriate intravenous prescriptions in hospitalized patients in China. Prescription data from 2016 were retrospectively analyzed based on predefined categories of inappropriateness. Of the 123,521 patients included, 89.2% received intravenous medications, contributing to 80% of the patients' hospital medication costs. Of significant concern, antibiotics and traditional Chinese medicines were administered to 44.3% and 14.5% of hospitalized patients, respectively. Overall, 11.4% of all intravenous prescriptions were classified as inappropriate, with improper diluent and diluent volumes being the primary cause. A team-based collaborative approach is necessary to address this widespread issue in China.
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Wang S, Hu YJ, Little P, Wang Y, Chang Q, Zhou X, Moore M, Harwell JI. The impact of the national action plan on the epidemiology of antibiotic resistance among 352,238 isolates in a teaching hospital in China from 2015 to 2018. Antimicrob Resist Infect Control 2019; 8:22. [PMID: 30728954 PMCID: PMC6352357 DOI: 10.1186/s13756-019-0473-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 01/14/2019] [Indexed: 12/16/2022] Open
Abstract
Background We sought to understand the epidemiology and characteristics of antimicrobial resistance (AMR) and the impact of the National Action Plan (NAP) on AMR. This information will be critical to develop interventions and strengthen antibiotic stewardship in hospital settings in China. Methods Cross-sectional data collection from the hospital information management system from 1 January 2015 to 30 August 2018. Variables included patient age, sex, diagnosis, hospital department and antibiotic sensitivity test. T-test for two samples method was applied to compare the results before and after NAP implementation. Multivariate analysis with binary logistic regression was conducted to examine the associations of risk factors for antimicrobial resistance. Results In total there were 352,238 isolates in the final analysis after excluding contamination strains and isolates with incomplete information. More than 50% of patients were > 66 years old. 62% were male. 40% of the total samples were sputum. Among the total sample, the total resistance rate was 42% among all isolates. The rate of resistance to all antibiotics declined by 5.3% (95% CI 4.96-5.64%, p < 0.0001) and culture positivity rate declined by 9.8% (95% CI 9.22-10.34%, p < 0.0001) after NAP. Logistical regression showed that the NAP had effect with an adjusted odds ratio of 0.76 (95% CI 0.71-0.81, p = 0.002). Being male, age > 65 years, ICU department, diagnosed with certain diseases were more likely to be associated with antimicrobial resistance. Conclusions Antibiotic resistance rates were high in this teaching hospital. However, the introduction of the China NAP since 2016 followed by hospital policy emphasis was associated with a declining AMR trend. Policies will need to incorporate antimicrobial stewardship with a focus on certain departments, with infection control practices and with increases in vaccination coverage among elderly.
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Affiliation(s)
- Shanjuan Wang
- Shanghai General Practice Medical Education and Research Center, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, No 1 Chengbei Rd, Jiading, Shanghai, 201800 China
| | - Yanhong Jessika Hu
- School of Public Health, The University of Hong Kong, G/F, Patrick Manson Building (North Wing), 7 Sassoon Road, Pokfulam, Hong Kong
| | - Paul Little
- Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST UK
| | - Yifei Wang
- Shanghai General Practice Medical Education and Research Center, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, No 1 Chengbei Rd, Jiading, Shanghai, 201800 China
| | - Qing Chang
- Shanghai General Practice Medical Education and Research Center, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, No 1 Chengbei Rd, Jiading, Shanghai, 201800 China
| | - Xudong Zhou
- School of Public Health, Zhejiang University, 866 Yuhangtang Road, Hangzhou, 310058 Zhejiang China
| | - Michael Moore
- Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST UK
| | - Joseph Irvin Harwell
- Clinical Science Team, Clinton Health Access Initiative, 383 Dorchester Ave, Boston, MA 02127 USA
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Zhang D, Cui K, Lu W, Bai H, Zhai Y, Hu S, Li H, Dong H, Feng W, Dong Y. Evaluation of carbapenem use in a tertiary hospital: antimicrobial stewardship urgently needed. Antimicrob Resist Infect Control 2019; 8:5. [PMID: 30627429 PMCID: PMC6322243 DOI: 10.1186/s13756-018-0449-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 12/11/2018] [Indexed: 11/10/2022] Open
Abstract
Background China launched a 3-year rectification scheme for the clinical use of antibiotics in 2011, and a specific scheme for carbapenem use in 2017. The aim of this study was to investigate the effects of government policies on carbapenem use, and their correlation with carbapenem-resistant Pseudomonas aeruginosa (CRPA). Methods The study was divided into four stages: preintervention (2010), antimicrobial programme (2011-2013), post-antimicrobial programme (2014-2016) and carbapenem programme (2017). A point-score system was proposed for evaluating the rationality of carbapenem use, and evaluated based on the indications, microbial culture, single dose, interval, and duration. Any prescription without a global score of 10 points was judged as irrational. The trend was analyzed by regression analysis, and Spearman correlation analysis was used for testing the correlation. Findings The rate of rational use of carbapenems was 29.7% in 2010, and increased by 55.5, 45.2, and 51.5% during the subsequent three stages. The rationality declined slightly during the post-antimicrobial programme (2014-2016) while the consumption of carbapenems was markedly increased. These two parameters improved slightly in 2017. Moreover, the prevalence of CRPA was significantly negatively correlated with the rate of rational carbapenem use (Coefficient = - 0.553, P < 0.05), and not with the consumption of carbapenems (P > 0.05). Conclusions The rational application of carbapenems was related to government policies in this study, with irrational carbapenem use possibly related to the development of CRPA. The current point-score system could be a useful tool for performing assessments.
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Affiliation(s)
- Di Zhang
- Department of Pharmacy, The First Affiliated Hospital of Xi’an Jiaotong University, Yanta Western Road No. 277, Xi’an, 710061 China
| | - Kai Cui
- Department of Management of the Economy, Xi’an University of Posts and Telecommunications, Xi’an, 710061 China
| | - Wei Lu
- Department of Pharmacy, The First Affiliated Hospital of Xi’an Jiaotong University, Yanta Western Road No. 277, Xi’an, 710061 China
- Department of Pharmacy, Taihe Hospital, Hubei University of Medicine, Hubei, 442000 China
| | - Hehe Bai
- Department of Pharmacy, The First Affiliated Hospital of Xi’an Jiaotong University, Yanta Western Road No. 277, Xi’an, 710061 China
- Department of Pharmacy, Xi’an Central Hospital, Xi’an, 710003 China
| | - Yuyao Zhai
- Department of Pharmacy, The First Affiliated Hospital of Xi’an Jiaotong University, Yanta Western Road No. 277, Xi’an, 710061 China
- Department of Pharmacy, Xi’an No.4 Hospital, Xi’an, 710004 China
| | - Sasa Hu
- Department of Pharmacy, The First Affiliated Hospital of Xi’an Jiaotong University, Yanta Western Road No. 277, Xi’an, 710061 China
| | - Hao Li
- Central Intensive Care Unit, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061 China
| | - Haiyan Dong
- Department of Pharmacy, The First Affiliated Hospital of Xi’an Jiaotong University, Yanta Western Road No. 277, Xi’an, 710061 China
| | - Weiyi Feng
- Department of Pharmacy, The First Affiliated Hospital of Xi’an Jiaotong University, Yanta Western Road No. 277, Xi’an, 710061 China
| | - Yalin Dong
- Department of Pharmacy, The First Affiliated Hospital of Xi’an Jiaotong University, Yanta Western Road No. 277, Xi’an, 710061 China
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Trends in and correlations between antibiotic consumption and resistance of Staphylococcus aureus at a tertiary hospital in China before and after introduction of an antimicrobial stewardship programme. Epidemiol Infect 2018; 147:e48. [PMID: 30442220 PMCID: PMC6518834 DOI: 10.1017/s0950268818003059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The overuse of antibiotics and the rapid emergence of antibiotic resistance prompted the launch of an antimicrobial stewardship programme in 2011. This study aimed to investigate the trends and correlations between antibiotic consumption and resistance of Staphylococcus aureus in a tertiary hospital of northwest China from 2010 to 2016. Trends were analysed by linear regression, and correlations were assessed by an autoregressive integrated moving average model. The total consumption of antibiotics halved during the 7-year study period, while the rates of resistance of S. aureus decreased significantly or remained stable; methicillin-resistant S. aureus (MRSA) declined markedly, from 73.3% at the beginning of the study to 41.4% by the end. This latter decrease was significantly correlated with the consumption of several classes of antibiotics. In conclusion, reduction in antibiotic use impacted significantly on resistance rates and contributed to a decline in MRSA prevalence.
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Zhang D, Hu S, Sun J, Zhang L, Dong H, Feng W, Lei J, Dong Y. Antibiotic consumption versus the prevalence of carbapenem-resistant Gram-negative bacteria at a tertiary hospital in China from 2011 to 2017. J Infect Public Health 2018; 12:195-199. [PMID: 30385238 DOI: 10.1016/j.jiph.2018.10.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/18/2018] [Accepted: 10/08/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE China launched a 3-year rectification scheme on the clinical use of antibiotics in 2011, and a specific scheme on carbapenem use in February 2017. This study investigated the trends in and correlations between antibiotic consumption and the prevalence of carbapenem-resistant Gram-negative bacteria (CRGN) at a tertiary hospital during these years, particularly in carbapenem consumption. METHODS The data were collected calculated per quarter from 2011 to 2017. The trends in antibiotic consumption and resistance were analyzed by regression analysis, while Spearman correlation analysis was used to assess the correlations. RESULT The total consumption of antibiotics halved during the 7-year study period, from 770.15 DDDs/1000 PDs in quarter 1 of 2011 to 395.07 DDDs/1000 PDs in quarter 4 of 2017. Meantime, carbapenem consumption showed the significant increase, from 28.71 DDDs/1000 PDs to 49.2 DDDs/1000 PDs. The detection rates of CRGN (carbapenem-resistant Klebsiella pneumonia, Acinetobacter baumannii, and Pseudomonas aeruginosa) remained stable (P>0.05). The positive correlation was only discovered between the resistance rate of carbapenem-resistant K. pneumonia and the usage of carbapenems, which included meropenem and imipenem, with coefficients of 0.543, 0.537, and 0.497 (P<0.05), respectively. There was no more significant correlation in this study. CONCLUSION The total consumption of antibiotics reduced significantly in the analysed hospital, which could be related to the antimicrobial stewardship programme. However, the carbapenem consumption was increased. The specific index should be established to limit the application of carbapenems. This study identified the positive correlation between the detection rate of carbapenem-resistant K. pneumonia and carbapenem consumption. More research is needed to confirm the impact of restricting and appropriated use of carbapenems on the prevalence of CRGN.
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Affiliation(s)
- Di Zhang
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Sasa Hu
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jinyao Sun
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lu Zhang
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Haiyan Dong
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Weiyi Feng
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jin'e Lei
- Department of Clinical Laboratory, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yalin Dong
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
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