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Prevalence, drivers and surveillance of antibiotic resistance and antibiotic use in rural China: Interdisciplinary study

This study aimed to characterise antibiotic prescribing and dispensing patterns in rural health facilities in China and determine the community prevalence of antibiotic resistance. We investigated patterns and drivers of antibiotic use for common respiratory and urinary tract infections (RTI/UTI) in...

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Autores principales: Lambert, H., Shen, X., Chai, J., Cheng, J., Feng, R., Chen, M., Cabral, C., Oliver, I., Shen, J., MacGowan, A., Bowker, K., Hickman, M., Kadetz, P., Zhao, L., Pan, Y., Kwiatkowska, R., Hu, X., Wang, D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10411760/
https://www.ncbi.nlm.nih.gov/pubmed/37556412
http://dx.doi.org/10.1371/journal.pgph.0001232
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author Lambert, H.
Shen, X.
Chai, J.
Cheng, J.
Feng, R.
Chen, M.
Cabral, C.
Oliver, I.
Shen, J.
MacGowan, A.
Bowker, K.
Hickman, M.
Kadetz, P.
Zhao, L.
Pan, Y.
Kwiatkowska, R.
Hu, X.
Wang, D.
author_facet Lambert, H.
Shen, X.
Chai, J.
Cheng, J.
Feng, R.
Chen, M.
Cabral, C.
Oliver, I.
Shen, J.
MacGowan, A.
Bowker, K.
Hickman, M.
Kadetz, P.
Zhao, L.
Pan, Y.
Kwiatkowska, R.
Hu, X.
Wang, D.
author_sort Lambert, H.
collection PubMed
description This study aimed to characterise antibiotic prescribing and dispensing patterns in rural health facilities in China and determine the community prevalence of antibiotic resistance. We investigated patterns and drivers of antibiotic use for common respiratory and urinary tract infections (RTI/UTI) in community settings, examined relationships between presenting symptoms, clinical diagnosis and microbiological results in rural outpatient clinics, and assessed potential for using patient records to monitor antibiotic use. This interdisciplinary mixed methods study included: (i) Observations and exit interviews in eight village clinics and township health centres and 15 retail pharmacies; (ii) Urine, throat swab and sputum samples from patients to identify potential pathogens and test susceptibility; (iii) 103 semi-structured interviews with doctors, patients, pharmacy workers and antibiotic-purchasing customers; (iv) Assessment of completeness and accuracy of electronic patient records through comparison with observational data. 87.9% of 1123 recruited clinic patients were prescribed antibiotics (of which 35.5% contained antibiotic combinations and >40% were for intravenous administration), most of whom had RTIs. Antibiotic prescribing for RTIs was not associated with presence of bacterial pathogens but was correlated with longer duration of infection (OR = 3.33) and presence of sore throat (OR = 1.64). Fever strongly predicted prescription of intravenous antibiotics (OR = 2.87). Resistance rates in bacterial pathogens isolated were low compared with national data. 25.8% of patients reported antibiotics use prior to their clinic visit, but only 56.2% of clinic patients and 53% of pharmacy customers could confirm their prescription or purchase included antibiotics. Diagnostic uncertainty, financial incentives, understanding of antibiotics as anti-inflammatory and limited doctor-patient communication were identified as key drivers of antibiotic use. Completion and accuracy of electronic patient records were highly variable. Prevalence of antibiotic resistance in this rural population is relatively low despite high levels of antibiotic prescribing and self-medication. More systematic use of e-records and in-service training could improve antibiotic surveillance and stewardship in rural facilities. Combining qualitative and observational anthropological methods and concepts with microbiological and epidemiological investigation of antibiotic resistance at both research design and analytic synthesis stages substantially increases the validity of research findings and their utility in informing future intervention development.
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spelling pubmed-104117602023-08-10 Prevalence, drivers and surveillance of antibiotic resistance and antibiotic use in rural China: Interdisciplinary study Lambert, H. Shen, X. Chai, J. Cheng, J. Feng, R. Chen, M. Cabral, C. Oliver, I. Shen, J. MacGowan, A. Bowker, K. Hickman, M. Kadetz, P. Zhao, L. Pan, Y. Kwiatkowska, R. Hu, X. Wang, D. PLOS Glob Public Health Research Article This study aimed to characterise antibiotic prescribing and dispensing patterns in rural health facilities in China and determine the community prevalence of antibiotic resistance. We investigated patterns and drivers of antibiotic use for common respiratory and urinary tract infections (RTI/UTI) in community settings, examined relationships between presenting symptoms, clinical diagnosis and microbiological results in rural outpatient clinics, and assessed potential for using patient records to monitor antibiotic use. This interdisciplinary mixed methods study included: (i) Observations and exit interviews in eight village clinics and township health centres and 15 retail pharmacies; (ii) Urine, throat swab and sputum samples from patients to identify potential pathogens and test susceptibility; (iii) 103 semi-structured interviews with doctors, patients, pharmacy workers and antibiotic-purchasing customers; (iv) Assessment of completeness and accuracy of electronic patient records through comparison with observational data. 87.9% of 1123 recruited clinic patients were prescribed antibiotics (of which 35.5% contained antibiotic combinations and >40% were for intravenous administration), most of whom had RTIs. Antibiotic prescribing for RTIs was not associated with presence of bacterial pathogens but was correlated with longer duration of infection (OR = 3.33) and presence of sore throat (OR = 1.64). Fever strongly predicted prescription of intravenous antibiotics (OR = 2.87). Resistance rates in bacterial pathogens isolated were low compared with national data. 25.8% of patients reported antibiotics use prior to their clinic visit, but only 56.2% of clinic patients and 53% of pharmacy customers could confirm their prescription or purchase included antibiotics. Diagnostic uncertainty, financial incentives, understanding of antibiotics as anti-inflammatory and limited doctor-patient communication were identified as key drivers of antibiotic use. Completion and accuracy of electronic patient records were highly variable. Prevalence of antibiotic resistance in this rural population is relatively low despite high levels of antibiotic prescribing and self-medication. More systematic use of e-records and in-service training could improve antibiotic surveillance and stewardship in rural facilities. Combining qualitative and observational anthropological methods and concepts with microbiological and epidemiological investigation of antibiotic resistance at both research design and analytic synthesis stages substantially increases the validity of research findings and their utility in informing future intervention development. Public Library of Science 2023-08-09 /pmc/articles/PMC10411760/ /pubmed/37556412 http://dx.doi.org/10.1371/journal.pgph.0001232 Text en © 2023 Lambert et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Lambert, H.
Shen, X.
Chai, J.
Cheng, J.
Feng, R.
Chen, M.
Cabral, C.
Oliver, I.
Shen, J.
MacGowan, A.
Bowker, K.
Hickman, M.
Kadetz, P.
Zhao, L.
Pan, Y.
Kwiatkowska, R.
Hu, X.
Wang, D.
Prevalence, drivers and surveillance of antibiotic resistance and antibiotic use in rural China: Interdisciplinary study
title Prevalence, drivers and surveillance of antibiotic resistance and antibiotic use in rural China: Interdisciplinary study
title_full Prevalence, drivers and surveillance of antibiotic resistance and antibiotic use in rural China: Interdisciplinary study
title_fullStr Prevalence, drivers and surveillance of antibiotic resistance and antibiotic use in rural China: Interdisciplinary study
title_full_unstemmed Prevalence, drivers and surveillance of antibiotic resistance and antibiotic use in rural China: Interdisciplinary study
title_short Prevalence, drivers and surveillance of antibiotic resistance and antibiotic use in rural China: Interdisciplinary study
title_sort prevalence, drivers and surveillance of antibiotic resistance and antibiotic use in rural china: interdisciplinary study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10411760/
https://www.ncbi.nlm.nih.gov/pubmed/37556412
http://dx.doi.org/10.1371/journal.pgph.0001232
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