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Antimicrobial use, healthcare-associated infections, and bacterial resistance in general hospitals in China: the first national pilot point prevalence survey report

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European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

The purpose of this study is to implement point prevalence survey (PPS), assess antimicrobial prescribing and resistance in general hospitals and clinical specialties in China, and compare them with similar data from other parts of the world. Twenty general hospitals in China were surveyed in October or November, 2019. A standardized surveillance protocol was used to collect data on patient demographics, diagnosis of infection, the prevalence and intensity of antimicrobial use, prescribing quality, bacterium type and resistance spectrum, and the prevalence and type of healthcare-associated infections (HAIs). Overall, 10,881 beds and 10,209 inpatients were investigated. The overall prevalence of antibiotic use was 37.00%, the use of antibiotic prophylaxis in surgical patients was high (74.97%). The intensity of antimicrobial use was 61.25 DDDs/100 patient days. Only 11.62% of antimicrobial prescriptions recorded the reason for prescribing. Intravenous or combination treatments comprised 92.02% and 38.07%, respectively, and only 30.65% of prescriptions referred to a microbiological or biomarker tests. The incidence of HAIs in all patients was 3.79%. The main associated factors for HAIs included more frequent invasive procedures (27.34%), longer hospital stay (> 1-week stay accounting for 51.47%), and low use of alcohol hand rubs (only 29.79% placed it bedside). Most of the resistant bacteria declined; only carbapenem-resistant Enterobacter is higher than previously reported. The prevalence of antibiotic use in general hospitals fell significantly, the overall bacterial resistance declined, and the incidence of HAI was low. However, the low quality of antimicrobial use requires urgent attention.

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Data availability

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

2GC:

Second-generation cephalosporins

3GC:

Third-generation cephalosporins

AMR:

Antimicrobial resistance

AMS:

Antimicrobial stewardship

CAI:

Community-acquired infections

DDDs:

Defined daily dosages

EARS-net:

The European Antimicrobial Resistance Surveillance Network

GDP:

Gross domestic product

HAI:

Healthcare-associated infection

ICU:

Intensive care unit

MNH:

Municipal non–teaching hospital

MRSA:

Methicillin-resistant Staphylococcus aureus

MTH:

Municipal teaching hospital

NAUS:

National hospital antimicrobial use surveillance network

NBRS:

National hospital bacterial resistance surveillance network

NCH:

The Chinese National Health Commission

NHAIS:

National healthcare-associated infection surveillance network

PPS:

Point prevalence survey

PVC:

Peripheral venous catheter

RTI:

Respiratory tract infection

UK:

The United Kingdom

USA:

The United States of America

USD:

US dollar

UTH:

University teaching hospitals

UTI:

Urinary tract infection

WHO:

The World Health Organization

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Acknowledgements

We gratefully acknowledge the contributions of the members of China PPS for collection of the data in this study. We are very grateful to Professor Dilip Nathwani (Ninewells Hospital and Medical School, Dundee) for his critical reading and comment to the manuscript.

Funding

YX was supported by funding from Zhejiang Province (No. 2021C03068).

Author information

Authors and Affiliations

  1. 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

    Yonghong Xiao & Yunbo Chen

  2. Research Units of Infectious Disease and Microecology, Chinese Academy of Medical Sciences, Beijing, China

    Yonghong Xiao

  3. Department of Infection Control, The Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Xing Xin

  4. National Institute of Hospital Administration, National Health Commission of China, Beijing, China

    Qing Yan

Authors
  1. Yonghong Xiao
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  4. Qing Yan
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Consortia

on behalf of the China PPS team

Contributions

YX and QY conceived of and designed the study; YX and YC collected the data and interpreted the data; YX, YC, and XX conducted statistical analysis; YX wrote the manuscript; all authors critically reviewed and contributed revisions to the final version of the paper.

Corresponding author

Correspondence to Yonghong Xiao.

Ethics declarations

Ethics approval and consent to participate

The PPS was approved by the ethics committee of the First Affiliated Hospital of Zhejiang University (approval number: 2019-093). The study does not involve the patient’s personal information and is exempt from signing the informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

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Supplementary information

ESM 1:

Table S. Hospital name and their locations

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Xiao, Y., Xin, X., Chen, Y. et al. Antimicrobial use, healthcare-associated infections, and bacterial resistance in general hospitals in China: the first national pilot point prevalence survey report. Eur J Clin Microbiol Infect Dis 42, 715–726 (2023). https://doi.org/10.1007/s10096-023-04602-z

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