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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

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
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

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.

Antibiotic Resistance Hospital, China, Epidemiology, National action plan
1-9
Wang, Shanjuan
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Hu, Yanhong Jessika
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Little, Paul
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Wang, Yifei
ae6bdfd0-d4d9-4025-8720-601a5efa7e59
Chang, Qing
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Zhou, Xudong
83b8512a-f3cf-45a8-bc09-94bd7c09c9fe
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Harwell, Joseph Irvin
c9dbf96e-0754-4f5c-a936-ce15dd3194e1
Wang, Shanjuan
92901717-b62f-4995-ad95-acc4526e993b
Hu, Yanhong Jessika
db339d28-c6e8-4daf-8983-0ef773dbb4f4
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Wang, Yifei
ae6bdfd0-d4d9-4025-8720-601a5efa7e59
Chang, Qing
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Zhou, Xudong
83b8512a-f3cf-45a8-bc09-94bd7c09c9fe
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Harwell, Joseph Irvin
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Wang, Shanjuan, Hu, Yanhong Jessika, Little, Paul, Wang, Yifei, Chang, Qing, Zhou, Xudong, Moore, Michael and Harwell, Joseph Irvin (2019) 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. Antimicrobial Resistance and Infection Control, 8 (1), 1-9, [22]. (doi:10.1186/s13756-019-0473-y).

Record type: Review

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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Accepted/In Press date: 14 January 2019
e-pub ahead of print date: 29 January 2019
Keywords: Antibiotic Resistance Hospital, China, Epidemiology, National action plan

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Local EPrints ID: 427959
URI: http://eprints.soton.ac.uk/id/eprint/427959
PURE UUID: e9ba663e-d3b6-42e1-8829-dc87c9895756
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509

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Date deposited: 06 Feb 2019 17:30
Last modified: 07 Oct 2020 01:51

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Contributors

Author: Shanjuan Wang
Author: Yanhong Jessika Hu
Author: Paul Little
Author: Yifei Wang
Author: Qing Chang
Author: Xudong Zhou
Author: Michael Moore ORCID iD
Author: Joseph Irvin Harwell

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