DataSheet1_Antibiotic Use in China’s Public Healthcare Institutions During the COVID-19 Pandemic: An Analysis of Nationwide Procurement Data, 2018–2020.docx

Background: The overuse of antibiotics is a serious public health problem and a major challenge in China, and China lacks up-to-date evidence on the nationwide antibiotic use in different healthcare settings. The changes of China’s antibiotic use under the COVID-19 pandemic are still unknown.
Objective: This study aimed to investigate the use of antibiotics in China’s public medical institutions based on a three-year nationwide surveillance and to examine the impact of the COVID-19 pandemic on China’s antibiotic consumption.
Methods: This study used nationwide drug procurement data from the China Drug Supply Information Platform (CDSIP). We retrospectively analyzed antibiotic procurement data of 9,176 hospitals and 39,029 primary healthcare centers (PHCs) from 31 provinces in mainland China from January 2018 to December 2020. Antibiotic utilization was measured by defined daily doses (DDDs) and DDD per 1,000 inhabitants per day (DID). Generalized linear regression models were established to quantify the impact of the COVID-19 pandemic on antibiotic use.
Results: The total antibiotic consumption among all healthcare settings increased from 12.94 DID in 2018 to 14.45 DID in 2019, and then dropped to 10.51 DID in 2020. More than half of antibiotics were consumed in PHCs, especially in central regions (59%–68%). The use of penicillins (J01C) and cephalosporins (J01D) accounted for 32.02% and 28.86% of total antibiotic consumption in 2020. During 2018–2020, parenteral antibiotics accounted for 31%–36% of total antibiotic consumption; the proportion is more prominent in central and western regions and the setting of hospitals. Access category antibiotics comprised 40%–42% of the total utilization. Affected by COVID-19, the antibiotic consumption was significantly dropped both in hospitals (β = −.11, p < .001) and PHCs (β = −.17, p < .001), as well as in total (β = −.14, p < .001). Significant increments were observed in the proportion of total antibiotics (β = .02, p = .024) consumed in hospitals (against the consumption in all healthcare settings), as well as parenteral antibiotics (β = 1.73, p = .001).
Conclusion: The consistent preferred use of penicillin and cephalosporin, as well as injections, among China’s public healthcare institutions should draw concern. China’s antibiotic consumption significantly declined during the COVID-19 pandemic, which brings opportunities for antibiotic use management in China.

研究背景：抗生素过度使用是中国当前面临的一项严峻公共卫生问题与重大挑战，且我国目前缺乏不同医疗场景下全国范围内抗生素使用情况的最新循证数据。新冠疫情期间我国抗生素使用的变化趋势仍不明确。
研究目的：本研究基于为期三年的全国监测数据，旨在调查我国公立医疗机构的抗生素使用情况，并探讨新冠疫情对我国抗生素消费量的影响。
研究方法：本研究使用中国药品供应信息平台（China Drug Supply Information Platform, CDSIP）的全国药品采购数据，对2018年1月至2020年12月中国大陆31个省份的9176家医院与39029家基层医疗卫生机构（primary healthcare centers, PHCs）的抗生素采购数据进行回顾性分析。本研究以限定日剂量（defined daily doses, DDDs）及每千人口每日限定日剂量（DDD per 1,000 inhabitants per day, DID）作为抗生素使用量的衡量指标，并构建广义线性回归模型以量化新冠疫情对抗生素使用的影响。
研究结果：所有医疗场景下的抗生素总消费量从2018年的12.94 DID升至2019年的14.45 DID，随后在2020年降至10.51 DID。超过半数的抗生素消费集中于基层医疗卫生机构，尤以中部地区为甚（占比59%~68%）。2020年，青霉素类（J01C）与头孢菌素类（J01D）的使用量分别占抗生素总消费量的32.02%与28.86%。2018-2020年期间，注射用抗生素占抗生素总消费量的31%~36%，该比例在中西部地区及医院场景中更为突出。非限制级抗生素（Access category antibiotics）占总使用量的40%~42%。受新冠疫情影响，医院（β=-0.11，p<0.001）、基层医疗卫生机构（β=-0.17，p<0.001）的抗生素消费量均出现显著下降，整体总消费量亦呈显著下降趋势（β=-0.14，p<0.001）。与此同时，医院抗生素消费量占所有医疗场景总消费量的比例（β=0.02，p=0.024）以及注射用抗生素的占比（β=1.73，p=0.001）均出现显著提升。
研究结论：我国公立医疗机构持续优先使用青霉素类、头孢菌素类及注射用抗生素的现状值得关注。新冠疫情期间我国抗生素消费量出现显著下降，这为我国抗生素使用管理带来了新的机遇。