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Antibiotics
Special Issues
Antibiotics Use and Stewardship in China
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Antibiotics Use and Stewardship in China

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: closed (31 October 2022) | Viewed by 8255

Special Issue Editors

Prof. Dr. Thérèse Hesketh

E-Mail Website
Guest Editor
1. Centre for Global Health, Zhejiang University School of Medicine, Hangzhou 310058, China
2. UCL Institute for Global Health, 30 Guilford Str., London WC1N1EH, UK
Interests: anti-microbial resistance; global health; health system reform; China
Dr. Paul I. Kadetz

E-Mail Website1 Website2
Guest Editor
1. Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
2. Shiley-Marcos School of Engineering, University of San Diego, San Diego, CA, USA
Interests: antimicrobial resistance; antibiotic stewardship; patient safety; health diplomacy; global health policy;digital health; one health

Special Issue Information

Dear Colleagues,

Antimicrobial resistance (AMR) is widely acknowledged as one of the greatest threats to global health this century. Mortality attributable to AMR is predicted to rise to as high as 10 million globally by 2050 unless effective control measures are introduced. Misuse of antibiotics, both in medicine and agriculture, is well-established as the major driver of AMR. China makes a major contribution to the global burden of AMR because of its size and the common practice of antibiotic misuse. The need for good practice in antimicrobial stewardship has therefore become a matter of urgency. In this Special Issue we will present an overview of AMR in China today, the epidemiology, antimicrobial stewardship, specific interventions across health and agricultural sectors, including One Health approaches, and examples of success in reducing AMR and its drivers. We welcome contributions which address any of the above topics.

Prof. Dr. Thérèse Hesketh
Dr. Paul I. Kadetz
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • anti-microbial resistance
  • antibiotics
  • antibiotic stewardship
  • One Health
  • China

Published Papers (4 papers)

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Research

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19 pages, 3021 KiB  
Article
Evaluation of Implementation and Effectiveness of China’s Antibiotic Stewardship in the First Affiliated Hospital of Sun Yat-sen University
by Nianzhen Zheng, Jian Li, Yang Liu, Kang Liao, Jie Chen, Chengcheng Zhang and Weiping Wen
Antibiotics 2023, 12(4), 770; https://doi.org/10.3390/antibiotics12040770 - 17 Apr 2023
Cited by 1 | Viewed by 1196
Abstract
Antibiotic stewardship has been prioritized by governments and health care organizations in recent years as antibiotic resistance is markedly increasing. A tertiary hospital in Guangzhou, China was chosen as a study example to undertake an implementation and effectiveness evaluation of China’s antibiotic stewardship [...] Read more.
Antibiotic stewardship has been prioritized by governments and health care organizations in recent years as antibiotic resistance is markedly increasing. A tertiary hospital in Guangzhou, China was chosen as a study example to undertake an implementation and effectiveness evaluation of China’s antibiotic stewardship to improve and promote antimicrobial stewardship nationwide. The general surgery department of the study hospital was utilized to examine surgical site infection, and samples from across the hospital were used to identify bloodstream infection. Data was analyzed using descriptive analysis, the Mann–Kendall trend test, logit model and panel data model, and t-tests. In terms of prophylactic and therapeutic antibiotic rational use, respectively, we evaluated implementation conditions, the correlation between implementation and corresponding disease progress, and the cost-effectiveness of China’s antibiotic stewardship. For perioperative prophylactic antibiotic use, antibiotic stewardship was found to have been well-implemented, cost-effective, and reduced the incidence of surgical site infection. However, concerning therapeutic use and antibiotic-resistant bacterial infection prophylaxis, the complexity of influencing factors and the contradiction between stewardship implementation and clinical demand needs to be further evaluated. Full article
(This article belongs to the Special Issue Antibiotics Use and Stewardship in China)
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9 pages, 1936 KiB  
Article
The Safety of Consuming Water Dropwort Used to Purify Livestock Wastewater Considering Accumulated Antibiotics and Antibiotic Resistance Genes
by Dongrui Yao, Yajun Chang, Wei Wang, Linhe Sun, Jixiang Liu, Huijun Zhao and Weiguo Zhang
Antibiotics 2022, 11(4), 428; https://doi.org/10.3390/antibiotics11040428 - 23 Mar 2022
Cited by 3 | Viewed by 1686
Abstract
Research is lacking on the health risks of antibiotics and antibiotic resistance genes (ARGs) in water dropwort grown in livestock wastewater. Our results showed that antibiotics from livestock wastewater were absorbed and bioaccumulated by water dropwort. The concentration of antibiotics was higher in [...] Read more.
Research is lacking on the health risks of antibiotics and antibiotic resistance genes (ARGs) in water dropwort grown in livestock wastewater. Our results showed that antibiotics from livestock wastewater were absorbed and bioaccumulated by water dropwort. The concentration of antibiotics was higher in the roots than in the stems and leaves. The health-risk coefficients of antibiotics in water dropwort were below the threshold (<0.1), indicating that in this case study, the consumption of water dropwort used to purify livestock wastewater was safe for humans considering accumulated antibiotics. ARGs were closely correlated between livestock wastewater and water dropwort, with the results showing that all 13 ARGs detected in the livestock wastewater were also found in the water dropwort. Tetracycline resistance genes were more abundant than the other ARGs in both the livestock wastewater and water dropwort. The estimated daily intake of ARGs in water dropwort for humans ranged from 2.06 × 106 to 7.75 × 1012 copies g−1, suggesting the potential risk of intaking ARGs in water dropwort cannot be ignored. Although the safety of consuming water dropwort used to purify livestock wastewater, considering accumulated antibiotics and ARGs, was assessed in this study, more studies should be conducted to ensure we fully understand the health risks. Full article
(This article belongs to the Special Issue Antibiotics Use and Stewardship in China)
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12 pages, 258 KiB  
Perspective
Antibiotic Culture: A History of Antibiotic Use in the Second Half of the 20th and Early 21st Century in the People’s Republic of China
by Xun Zhou
Antibiotics 2023, 12(3), 510; https://doi.org/10.3390/antibiotics12030510 - 03 Mar 2023
Cited by 1 | Viewed by 2104
Abstract
Antimicrobial resistance is now widely regarded as a global public health threat. A growing number of studies suggest that antibiotic resistance is higher in China than in most western countries. Despite the current official regulation prohibiting pharmacies from the unrestricted selling of antibiotics, [...] Read more.
Antimicrobial resistance is now widely regarded as a global public health threat. A growing number of studies suggest that antibiotic resistance is higher in China than in most western countries. Despite the current official regulation prohibiting pharmacies from the unrestricted selling of antibiotics, there is little sign of declining consumer demand. China now ranks as the second largest consumer of antibiotics in the world, after India. Drawing on published historical data, unpublished archival documents, and recently collected oral interviews, this paper provides a historical overview of antibiotic use and abuse in the People’s Republic of China (PRC) from the second half of the 20th century to the present. It demonstrates how the political demand for health improvement, along with the state-sponsored popularization of allopathic medicine, on the one hand, and the lack of access to adequate medical care for the majority of the population, as well as the existing culture of self-medication, on the other hand, are working in tandem to create antibiotic dependency in China. In addition, the privatization and marketization of biomedicine and health care in post-Mao China have helped to build a new and ever-thriving network of production, distribution, and marketing of antibiotics, which has often proven difficult for the authorities to monitor. At the same time, increased purchasing power and easier accessibility created by this new network of production, distribution, and marketing have further contributed to the prevalence of antibiotic overuse in the late 20th and early 21st centuries. Full article
(This article belongs to the Special Issue Antibiotics Use and Stewardship in China)
16 pages, 2658 KiB  
Systematic Review
Effectiveness of Educational Interventions for Health Workers on Antibiotic Prescribing in Outpatient Settings in China: A Systematic Review and Meta-Analysis
by Kunhua Zheng, Ying Xie, Lintao Dan, Meixian Mao, Jie Chen, Ran Li, Xuanding Wang and Therese Hesketh
Antibiotics 2022, 11(6), 791; https://doi.org/10.3390/antibiotics11060791 - 10 Jun 2022
Cited by 4 | Viewed by 2004
Abstract
Educational interventions are considered an important component of antibiotic stewardship, but their effect has not been systematically evaluated in outpatient settings in China. This research aims to evaluate the effectiveness of educational interventions for health workers on antibiotic prescribing rates in Chinese outpatient [...] Read more.
Educational interventions are considered an important component of antibiotic stewardship, but their effect has not been systematically evaluated in outpatient settings in China. This research aims to evaluate the effectiveness of educational interventions for health workers on antibiotic prescribing rates in Chinese outpatient settings. Eight databases were searched for relevant randomized clinical trials, non-randomized trials, controlled before–after studies and interrupted time-series studies from January 2001 to July 2021. A total of 16 studies were included in the systematic review and 12 in the meta-analysis. The results showed that educational interventions overall reduced the antibiotic prescription rate significantly (relative risk, RR 0.72, 95% confidence interval, CI 0.61 to 0.84). Subgroup analysis demonstrated that certain features of education interventions had a significant effect on antibiotic prescription rate reduction: (1) combined with compulsory administrative regulations (RR With: 0.65 vs. Without: 0.78); (2) combined with financial incentives (RR With: 0.51 vs. Without: 0.77). Educational interventions can also significantly reduce antibiotic injection rates (RR 0.83, 95% CI 0.74 to 0.94) and the inappropriate use of antibiotics (RR 0.61, 95% CI 0.51 to 0.73). The limited number of high-quality studies limits the validity and reliability of the results. More high-quality educational interventions targeting the reduction of antibiotic prescribing rates are needed. Full article
(This article belongs to the Special Issue Antibiotics Use and Stewardship in China)
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