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Yang Y, Xie S, He F, Xu Y, Wang Z, Ihsan A, Wang X. Recent development and fighting strategies for lincosamide antibiotic resistance. Clin Microbiol Rev 2024; 37:e0016123. [PMID: 38634634 PMCID: PMC11237733 DOI: 10.1128/cmr.00161-23] [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] [Indexed: 04/19/2024] Open
Abstract
SUMMARYLincosamides constitute an important class of antibiotics used against a wide range of pathogens, including methicillin-resistant Staphylococcus aureus. However, due to the misuse of lincosamide and co-selection pressure, the resistance to lincosamide has become a serious concern. It is urgently needed to carefully understand the phenomenon and mechanism of lincosamide resistance to effectively prevent and control lincosamide resistance. To date, six mobile lincosamide resistance classes, including lnu, cfr, erm, vga, lsa, and sal, have been identified. These lincosamide resistance genes are frequently found on mobile genetic elements (MGEs), such as plasmids, transposons, integrative and conjugative elements, genomic islands, and prophages. Additionally, MGEs harbor the genes that confer resistance not only to antimicrobial agents of other classes but also to metals and biocides. The ultimate purpose of discovering and summarizing bacterial resistance is to prevent, control, and combat resistance effectively. This review highlights four promising strategies, including chemical modification of antibiotics, the development of antimicrobial peptides, the initiation of bacterial self-destruct program, and antimicrobial stewardship, to fight against resistance and safeguard global health.
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Affiliation(s)
- Yingying Yang
- National Reference Laboratory of Veterinary Drug Residues (HZAU), Huazhong Agricultural University, Wuhan, Hubei, China
- MAO Key Laboratory for Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan, Hubei, China
| | - Shiyu Xie
- MOA Laboratory for Risk Assessment of Quality and Safety of Livestock and Poultry Products, Huazhong Agricultural University, Wuhan, Hubei, China
| | - Fangjing He
- MOA Laboratory for Risk Assessment of Quality and Safety of Livestock and Poultry Products, Huazhong Agricultural University, Wuhan, Hubei, China
| | - Yindi Xu
- Institute of Animal Husbandry Research, Henan Academy of Agricultural Sciences, Zhengzhou, Henan, China
| | - Zhifang Wang
- Institute of Animal Husbandry Research, Henan Academy of Agricultural Sciences, Zhengzhou, Henan, China
| | - Awais Ihsan
- Department of Biosciences, COMSATS University Islamabad, Sahiwal campus, Islamabad, Pakistan
| | - Xu Wang
- National Reference Laboratory of Veterinary Drug Residues (HZAU), Huazhong Agricultural University, Wuhan, Hubei, China
- MAO Key Laboratory for Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan, Hubei, China
- MOA Laboratory for Risk Assessment of Quality and Safety of Livestock and Poultry Products, Huazhong Agricultural University, Wuhan, Hubei, China
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Xu S, Kitchen C, Liu Y, Kabba JA, Hayat K, Wang X, Wang G, Zhang F, Chang J, Fang Y, Wagner AK, Ross-Degnan D. Effect of a national antibiotic stewardship intervention in China targeting carbapenem overuse: An interrupted time-series analysis. Int J Antimicrob Agents 2023; 62:106936. [PMID: 37517625 DOI: 10.1016/j.ijantimicag.2023.106936] [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: 04/03/2023] [Revised: 07/12/2023] [Accepted: 07/26/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVES To assess trends and patterns of carbapenem use and to evaluate the effects of a nationwide antibiotic stewardship policy to reduce carbapenem overuse. METHODS In this quasi-experimental study, using longitudinal data from the national drug procurement database and interrupted time-series analyses with carbapenems as the intervention group and possible carbapenem substitutes as the comparison group, we evaluated the effects of a national stewardship policy on carbapenem consumption and expenditures, by region and types of healthcare institutions. RESULTS The carbapenem procurement volume declined by -28.8% (95% CI -35.0 to -22.6) (-334.4 thousand defined daily doses [DDDs] per month), and carbapenem expenditures showed a relative reduction of -38.1% (-43.9 to -32.2). The gap between the use of carbapenems and each drug in the comparison group narrowed after the policy intervention, with an increase in tigecycline use (14.9 thousand DDDs [10.8-18.9]) and a slower decrease in use of certain third-generation cephalosporin combinations (-85.7 [-143.0 to -28.4]), penicillin combinations (-200.9 [-421.4-19.6]), and fourth-generation cephalosporins (-116.9 [-219.8 to -14.0]). Consumption was highest during the pre-policy period, and declines were largest following the intervention in the eastern region (-32.1%, -39.8 to -24.4) and among tertiary hospitals (-266.2 [-339.5 to -192.9] thousand DDDs per month). CONCLUSION This population-level drug utilization research represents the first comprehensive evaluation of the effectiveness of China's nationwide carbapenem stewardship. The national policy targeting carbapenem prescribing has led to a sustained reduction in carbapenem use with limited substitution. Effects varied geographically and were concentrated in tertiary and secondary hospitals.
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Affiliation(s)
- Sen Xu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University; Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Shaanxi, China; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Chenai Kitchen
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University; Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Shaanxi, China
| | - Yang Liu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; School of Health Policy and Management, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - John Alimamy Kabba
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University; Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Shaanxi, China
| | - Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University; Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Shaanxi, China
| | - Xinyu Wang
- Foshan Women and Children Hospital, Guangdong, China
| | - Geng Wang
- The Third People's Hospital of Datong, Shanxi, China
| | - Fang Zhang
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University; Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Shaanxi, China.
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University; Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Shaanxi, China.
| | - Anita K Wagner
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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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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Berbel D, González-Díaz A, López de Egea G, Càmara J, Ardanuy C. An Overview of Macrolide Resistance in Streptococci: Prevalence, Mobile Elements and Dynamics. Microorganisms 2022; 10:2316. [PMID: 36557569 PMCID: PMC9783990 DOI: 10.3390/microorganisms10122316] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/11/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022] Open
Abstract
Streptococcal infections are usually treated with beta-lactam antibiotics, but, in case of allergic patients or reduced antibiotic susceptibility, macrolides and fluoroquinolones are the main alternatives. This work focuses on studying macrolide resistance rates, genetic associated determinants and antibiotic consumption data in Spain, Europe and also on a global scale. Macrolide resistance (MR) determinants, such as ribosomal methylases (erm(B), erm(TR), erm(T)) or active antibiotic efflux pumps and ribosomal protectors (mef(A/E)-mrs(D)), are differently distributed worldwide and associated with different clonal lineages and mobile genetic elements. MR rates vary together depending on clonal dynamics and on antibiotic consumption applying selective pressure. Among Streptococcus, higher MR rates are found in the viridans group, Streptococcus pneumoniae and Streptococcus agalactiae, and lower MR rates are described in Streptococcus pyogenes. When considering different geographic areas, higher resistance rates are usually found in East-Asian countries and milder or lower in the US and Europe. Unfortunately, the availability of data varies also between countries; it is scarce in low- and middle- income countries from Africa and South America. Thus, surveillance studies of macrolide resistance rates and the resistance determinants involved should be promoted to complete global knowledge among macrolide resistance dynamics.
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Affiliation(s)
- Dàmaris Berbel
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, 08907 Barcelona, Spain
- Research Network for Respiratory Diseases (CIBERES), ISCIII, 28020 Madrid, Spain
| | - Aida González-Díaz
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, 08907 Barcelona, Spain
- Research Network for Respiratory Diseases (CIBERES), ISCIII, 28020 Madrid, Spain
| | - Guillem López de Egea
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, 08907 Barcelona, Spain
- Research Network for Respiratory Diseases (CIBERES), ISCIII, 28020 Madrid, Spain
| | - Jordi Càmara
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, 08907 Barcelona, Spain
- Research Network for Respiratory Diseases (CIBERES), ISCIII, 28020 Madrid, Spain
| | - Carmen Ardanuy
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, 08907 Barcelona, Spain
- Research Network for Respiratory Diseases (CIBERES), ISCIII, 28020 Madrid, Spain
- Department of Pathology and Experimental Therapeutics, School of Medicine, University of Barcelona, 08007 Barcelona, Spain
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Xie J, Liu Y, Wu Y, Li L, Fang J, Lu X. Occurrence, distribution and risk of pharmaceutical and personal care products in the Haihe River sediments, China. CHEMOSPHERE 2022; 302:134874. [PMID: 35537627 DOI: 10.1016/j.chemosphere.2022.134874] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/28/2022] [Accepted: 05/04/2022] [Indexed: 06/14/2023]
Abstract
In the aquatic environment, pharmaceuticals and personal care products (PPCPs) detected in sediments are rising health concerns to human and aquatic ecosystem. The migration of PPCPs in the sediments poses a potential risk to surface water and groundwater environment. Insight on the spatial distribution and vertical profile of PPCPs in sediments at the regional scale is valuable for comprehensive prevention of PPCP risk. The Haihe River is one of the major water systems for the rapid development of urbanization, industrialization and agriculture in Northern China. The study aimed to characterize the occurrence, distribution and ecological risks of PPCPs in the sediments of the Haihe River, especially to investigate the vertical distribution of PPCPs using core sediments. High performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) was used to analyze 24 selected PPCPs in sediment samples. In total, 11 PPCPs were detected, and the detected concentrations (0-1.26 ng g-1) were, lower than in other water bodies in literature (0-24.4 ng g-1). The sediments of the Haihe River located in the Tianjin downtown were most-severely polluted, with the highest cumulative concentration of PPCPs of 9.45 ng g-1, indicating the relatively high contribution of human consumption of PPCPs for the megacity. Spearman correlation analysis shows that both of the TOC contents and particle size distribution can influence the migration and deposition of PPCPs. The risk assessment results showed that the current level of PPCPs has no severe adverse effects on aquatic organisms in the Haihe River. However, special attention should be paid to the environmental risks caused by the migration of PPCPs with high loading and mobility (such as sulfamethoxazole).
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Affiliation(s)
- Jingyi Xie
- Tianjin Key Laboratory of Environmental Technology for Complex Trans-media Pollution and Tianjin International Joint Research Center for Environmental Biogeochemical Technology, College of Environmental Science and Engineering, Nankai University, Tianjin, 300350, China
| | - Yufei Liu
- College of Geographic and Environmental Sciences, Tianjin Normal University, Tianjin, 300387, China
| | - Yufeng Wu
- Tianjin Eco-Environmental Monitoring Center, Tianjin, 300191, China
| | - Lirong Li
- Tianjin Eco-Environmental Monitoring Center, Tianjin, 300191, China
| | - Jing Fang
- College of Geographic and Environmental Sciences, Tianjin Normal University, Tianjin, 300387, China.
| | - Xueqiang Lu
- Tianjin Key Laboratory of Environmental Technology for Complex Trans-media Pollution and Tianjin International Joint Research Center for Environmental Biogeochemical Technology, College of Environmental Science and Engineering, Nankai University, Tianjin, 300350, China.
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Wang G, Wu P, Tang R, Zhang W. Global prevalence of resistance to macrolides in Mycoplasma pneumoniae: a systematic review and meta-analysis. J Antimicrob Chemother 2022; 77:2353-2363. [PMID: 35678262 DOI: 10.1093/jac/dkac170] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 05/03/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To determine the prevalence of resistance to macrolides in Mycoplasma pneumoniae worldwide. METHODS Prior to 12 December 2020, PubMed, Web of Science, Scopus and Embase databases were searched for epidemiological studies of M. pneumoniae resistance. Two reviewers independently extracted data from included studies. The extracted data include sampling population, total sampling number, the number of resistant strains and the molecular subtype of resistant strains. The estimate of resistance prevalence was calculated using the random-effects model. RESULTS A total of 17 873 strains were obtained from five continents and reported in 98 investigations between 2000 and 2020, with 8836 strains characterized as macrolide resistant. In summary, macrolide-resistant M. pneumoniae was most common in Asia (63% [95% CI 56, 69]). In Europe, North America, South America and Oceania, the prevalence was 3% [2, 7], 8.6% [6, 11], 0% and 3.3%, respectively. Over the last 20 years, the prevalence of macrolide-resistant M. pneumoniae has remained high in China (81% [73, 87]), with a significant increasing trend in South Korea (4% [1, 9] to 78% [49, 93], P < 0.0001). Furthermore, a point mutation at 2063 from A to G was mostly related to M. pneumoniae macrolide resistance. In terms of clinical outcomes, longer cough (mean difference [MD]: 2.93 [0.26, 5.60]) and febrile days (MD: 1.52 [1.12, 1.92]), and prolonged hospital stays (MD: 0.76 [0.05, 1.46]) might be induced by macrolide-resistant M. pneumoniae pneumonia. CONCLUSIONS The incidence of macrolide-resistant M. pneumoniae varies globally, with eastern Asia having a greater degree of resistance. However, attention is also required in other areas, and antibiotic alternatives should be considered for treatment in high-prevalence countries.
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Affiliation(s)
- Guotuan Wang
- Department of pharmacy, Karamay central hospital of Xinjiang, Karamay, Xinjiang, China
| | - Peng Wu
- Department of emergency, Karamay central hospital of Xinjiang, Karamay, Xinjiang, China
| | - Rui Tang
- Department of pharmacy, West China hospital, Sichuan university, Chengdu, Sichuan, China
| | - Weidong Zhang
- Department of pharmacy, Karamay central hospital of Xinjiang, Karamay, Xinjiang, China
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Xu X, Zhang K, Ma H, Shen X, Chai J, Tang M, Du Y, Xue Q, Guan X, Li G, Wang D. Differences in service and antibiotics use following symptomatic respiratory tract infections between 2016 and 2021 in rural Anhui, China. Epidemiol Infect 2022; 150:e117. [PMID: 35610736 PMCID: PMC9254148 DOI: 10.1017/s0950268822000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In the past 10-15 years, the government of China has made various efforts in tackling excessive antibiotics use. Yet, little is known about their effects at rural primary care settings. This study aimed to determine the impact of government policies and the COVID-19 pandemic on antibiotic prescribing practices at such settings utilizing data from separate studies carried out pre- and during the pandemic, in 2016 and 2021 in Anhui province, China, using identical sampling and survey approaches. Data on antibiotics prescribed, diagnosis, socio-demographic, etc., were obtained through non-participative observation and a structured exit survey. Data analysis comprised mainly descriptive comparisons of 1153 and 762 patients with respiratory infections recruited in 2016 and 2021, respectively. The overall antibiotics prescription rate decreased from 89.6% in 2016 to 69.1% in 2021, and the proportion of prescriptions for two or more classes of antibiotics was estimated as 35.9% in 2016 and 11.0% in 2021. There was a statistically significant decrease in the number of days from symptom onset to clinic visits between the year groups. In conclusion, measures to constrain excessive prescription of antibiotics have led to some improvements at the rural primary care level, and the COVID-19 pandemic has had varying effects on antibiotic use.
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Affiliation(s)
- Xiuze Xu
- School of Health Service Management, Anhui Medical University, Meishan Road 81, Hefei, Anhui 230032, China
| | - Kexin Zhang
- School of Health Service Management, Anhui Medical University, Meishan Road 81, Hefei, Anhui 230032, China
| | - Huan Ma
- School of Health Service Management, Anhui Medical University, Meishan Road 81, Hefei, Anhui 230032, China
| | - Xingrong Shen
- School of Health Service Management, Anhui Medical University, Meishan Road 81, Hefei, Anhui 230032, China
| | - Jing Chai
- School of Health Service Management, Anhui Medical University, Meishan Road 81, Hefei, Anhui 230032, China
| | - Mengsha Tang
- School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yanan Du
- School of Health Service Management, Anhui Medical University, Meishan Road 81, Hefei, Anhui 230032, China
| | - Qun Xue
- School of Health Service Management, Anhui Medical University, Meishan Road 81, Hefei, Anhui 230032, China
| | - Xiaoqin Guan
- School of Health Service Management, Anhui Medical University, Meishan Road 81, Hefei, Anhui 230032, China
| | - Guocheng Li
- School of Health Service Management, Anhui Medical University, Meishan Road 81, Hefei, Anhui 230032, China
| | - Debin Wang
- School of Health Service Management, Anhui Medical University, Meishan Road 81, Hefei, Anhui 230032, China
- Author for correspondence: Debin Wang, E-mail:
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Has the Volume-Based Drug Purchasing Approach Achieved Equilibrium among Various Stakeholders? Evidence from China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074285. [PMID: 35409966 PMCID: PMC8999037 DOI: 10.3390/ijerph19074285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/20/2022] [Accepted: 03/30/2022] [Indexed: 12/04/2022]
Abstract
Volume-based drug purchasing by China’s health insurance system currently represents the largest group purchasing organization worldwide. After exchanging the market that accounted for nearly half of the volume of the healthcare system for the ultra-low-price supply of limited drugs, what are the effects on patient and funding burdens, drug accessibility, and clinical efficacy? We aimed to verify the effectiveness of the policy, explore the reasons behind the problem and identify regulatory priorities and collaborative measures. We used literature and reported data from 2019 to 2021 to conduct a stakeholder analysis and health impact assessment, presenting the benefit and risk share for various dimensions. The analysis method was a multidimensional scaling model, which visualized problematic associations. Seventy-nine papers (61 publications and 18 other resources) were included in the study, with 22 effects and 36 problems identified. The results indicated favorable affordability and poor accessibility of drugs, as well as high risk of reduced drug quality and drug-use rationality. The drug-use demand of patients was guaranteed; the prescription rights of doctors regarding clinical drug use were limited; unreasonable evaluation indicators limited the transformation of public hospitals to value- and service-oriented organizations; the sustainability of health insurance funds and policy promotion were at risk; and innovation by pharmaceutical companies was accelerated. The problems associated with high co-occurrence frequencies were divided into the following clusters: cost control, drug accessibility, system rationality, policy fairness, drug quality, and moral hazards. These findings suggested that China has achieved short-term success in reducing the burden on patients and reducing fund expenditure. However, there were still deficiencies in guaranteed supply, quality control, and efficacy tracking. The study offers critical lessons for China and other low- and middle-income countries.
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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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Liu X, Zhang J, Sang Y, Liu K, Zhu Y, Yang L, Wang S, Sheng J, Wang Q, Zhang D, Cao H, Tao F. Antibiotic exposure and potential risk of depression in the Chinese elderly: a biomonitoring-based population study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:26794-26806. [PMID: 33501576 DOI: 10.1007/s11356-021-12560-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 01/15/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To examine the associations between urinary antibiotics from various sources and depression in the elderly using the biomonitoring method. METHODS In the current study, we investigated 990 elderly individuals (≥ 60 years old) from a community-based elderly cohort in West Anhui, China. The participants were interviewed by the Geriatric Depression Scale and self-developed questionnaires. A total of 45 antibiotics belonging to nine categories were screened in urine samples by the developed liquid chromatography electrospray tandem mass spectrometry method. Creatinine-corrected concentrations of antibiotics in urines were used to assess their exposure. Logistic regression analysis was employed to test the relationships between exposure to antibiotics and depression. RESULTS Compared to the control group, the multinomial logistic regression analyses showed the elderly exposed to higher concentrations of azithromycin (OR = 1.81, 95% CI: 1.09-3.00) and sulfaclozine (OR = 1.54, 95% CI: 1.05-2.28) had increased risks of depression, respectively. After categorizing the detected antibiotics, tetracyclines (OR = 1.48, 95% CI: 1.02-2.16) and veterinary antibiotics (VAs) (OR = 1.53, 95% CI: 1.06-2.20) were positively correlated with increased risks of depression. After stratified by sex, the VAs (OR = 2.04, 95% CI: 1.13-3.71) at higher concentrations were associated with elevated risks of depression in males, while the associations between depression and antibiotic exposures were observed in tetracyclines (OR = 1.74, 95% CI: 1.04-2.85) and all antibiotics (OR = 2.24, 95% CI: 1.01-2.94) at higher levels in females, respectively. Notably, after the stratification by age, the significant associations were mainly present in the subjects under the age of 70. CONCLUSIONS Our findings reveal that azithromycin, sulfaclozine, tetracyclines, and the VAs were significantly associated with elevated risks of depression in the elderly. Importantly, sex- and age-specific differences were observed in the associations between antibiotic exposures and depression.
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Affiliation(s)
- Xinji Liu
- School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Health Management Center, The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Hefei, 230000, Anhui, China
| | - Jingjing Zhang
- School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Yanru Sang
- School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Kaiyong Liu
- School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
| | - Yitian Zhu
- School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Linsheng Yang
- School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Sufang Wang
- School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Jie Sheng
- School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Qunan Wang
- School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Dongmei Zhang
- School of Health Management, Anhui Medical University, Hefei, 230032, China
| | - Hongjuan Cao
- Lu'an Center of Disease Control and Prevention, Lu'an, 237000, Anhui, China
| | - Fangbiao Tao
- School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No. 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, No. 81 Meishan Road, Hefei, 230032, Anhui, China
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