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

Author

Listed:
  • H Lambert
  • X Shen
  • J Chai
  • J Cheng
  • R Feng
  • M Chen
  • C Cabral
  • I Oliver
  • J Shen
  • A MacGowan
  • K Bowker
  • M Hickman
  • P Kadetz
  • L Zhao
  • Y Pan
  • R Kwiatkowska
  • X Hu
  • D Wang

Abstract

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.

Suggested Citation

  • H Lambert & X Shen & J Chai & J Cheng & R Feng & M Chen & C Cabral & I Oliver & J Shen & A MacGowan & K Bowker & M Hickman & P Kadetz & L Zhao & Y Pan & R Kwiatkowska & X Hu & D Wang, 2023. "Prevalence, drivers and surveillance of antibiotic resistance and antibiotic use in rural China: Interdisciplinary study," PLOS Global Public Health, Public Library of Science, vol. 3(8), pages 1-19, August.
  • Handle: RePEc:plo:pgph00:0001232
    DOI: 10.1371/journal.pgph.0001232
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    References listed on IDEAS

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    1. Andrea Bernardi & Anna Greenwood, 2014. "Old and new Rural Co-operative Medical Scheme in China: the usefulness of a historical comparative perspective," Asia Pacific Business Review, Taylor & Francis Journals, vol. 20(3), pages 356-378, July.
    2. Helen Lambert & Meixuan Chen & Christie Cabral, 2019. "Antimicrobial resistance, inflammatory responses: a comparative analysis of pathogenicities, knowledge hybrids and the semantics of antibiotic use," Palgrave Communications, Palgrave Macmillan, vol. 5(1), pages 1-13, December.
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