Clinical diagnosis and treatment of common respiratory tract infections in relation to microbiological profiles in rural health facilities in China: implications for antibiotic stewardship

BMC Family Practice

Helen Lambert¹  Yaping Pan²  Jilu Shen³  Isabel Oliver⁴  Alasdair MacGowan⁵  Karen Bowker⁵  Jing Cheng⁶  Jing Chai⁶  Debing Wang⁷  Xingrong Shen⁷ 

[1] Bristol Medical School, University of Bristol, Bristol, UK;Department of Clinical Laboratory, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China;Department of Clinical Laboratory, the Fourth Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China;Field Service, National Infection Service, Public Health England, 3rd floor, 2 Rivergate, BS1 6EH, Bristol, UK;Infection Sciences, Severn Pathology, North Bristol NHS Trust, Pathology Building, Southmead Hospital, Westbury-On-Trym, BS10 5NB, Bristol, UK;School of Health Service Management, Anhui Medical University, Hefei, Anhui, China;School, of Public Health, Anhui Medical University, Hefei, Anhui, China;School of Health Service Management, Anhui Medical University, Hefei, Anhui, China;

关键词: Antibiotic;    Respiratory tract infection;    Primary care;    Diagnosis;    Microbiological;    China;   

DOI  :  10.1186/s12875-021-01448-2

来源: Springer

【 摘 要 】

BackgroundThis paper tries to describe prevalence and patterns of antibiotics prescription and bacteria detection and sensitivity to antibiotics in rural China and implications for future antibiotic stewardship.MethodsThe study was implemented in one village clinic and one township health center in each of four rural residential areas in Anhui Province, China. It used mixed-methods comprising non-participative observations, exit-survey and microbiological study. Observations were conducted to record clinical diagnosis and antibiotic prescription. Semi-structured questionnaire survey was used to collect patient’s sociodemographic information and symptoms. Sputum and throat swabs were collected for bacterial culture and susceptibility testing.ResultsA total of 1068 (51.0% male vs 49.0% female) patients completed the study with diagnosis of respiratory tract infection (326,30.5%), bronchitis/tracheitis (249,23.3%), pharyngitis (119,11.1%) and others (374, 35.0%). They provided 683 sputum and 385 throat swab specimens. Antibiotics were prescribed for 88% of the RTI patients. Of all the specimens tested, 329 (31%) were isolated with bacteria. The most frequently detected bacteria were K. pneumonia (24% in all specimens), H. influenza (16%), H. parainfluenzae (15%), P. aeruginosa (6%), S.aureus (5%), M. catarrhalis (3%) and S. pneumoniae (2%).ConclusionsThe study establishes the feasibility of conducting microbiological testing outside Tier 2 and 3 hospitals in rural China. It reveals that prescription of antibiotics, especially broad-spectrum and combined antibiotics, is still very common and there is a clear need for stewardship programs aimed at both reducing the number of prescriptions and promoting single and narrow-spectrum antibiotics.

【 授权许可】

CC BY