The changes of different restriction level adjustments on antibiotic use in China.
The changes of different restriction level adjustments on antibiotic use in China.
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我国抗生素使用不同限制级别调整的变化
DOI：
10.1016/j.ijantimicag.2023.107073
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发表时间：
2024
影响因子：
10.8
通讯作者：
Du K
中科院分区：
文献类型：
--
作者：
Du K
本拟实验研究旨在通过中断时间序列分析，调查2013 - 2019年中国省级抗生素限制清单调整后的抗生素使用变化。抗生素使用以每1000名患者每天的定义日剂量（DDD）进行评估。采用分段回归分析趋势和水平变化。该研究确定了4个省份调整限制水平的19种抗生素配方（干预组）和110种未调整限制水平的省份（对照组）。抗生素限制水平在两个类别之间变化：(1)在“高度限制”和“限制”之间，(2)在“限制”和“非限制”之间。分析显示，与对照组相比，抗生素在“高度限制”和“限制”之间（β= 0.0211，P= 0.003）和“限制”到“高度限制”之间（β= - 0.0039，P= 0.128）有明显的变化趋势。经过2年的适应期，当从“限制”转为“高度限制”时，绝对抗生素使用率显著下降（P< 0.001），与对照组相比，相对下降100.8% （P< 0.001）。此外，个体抗生素用量越高，对调整的反应性越强。这些发现强调了抗生素限制水平调整的变化，强调了抗生素限制清单政策是抗菌药物管理的重要工具。
This quasi-experimental study aimed to investigate the changes in antibiotic use tailored by adjusting provincial antibiotic restriction lists in China using interrupted time-series analysis from 2013 to 2019. Antibiotic use was assessed as defined daily dose (DDD) per 1000 patients per day. Trends and level changes were analysed with segmented regression. The study identified 19 antibiotic formulations in four provinces with adjusted restriction levels (intervention group) and 110 formulations in the rest provinces without adjustments (comparison group). Antibiotics restriction level changed between two categories: (1) between ‘highly-restricted’ and ‘restricted’ and (2) between ‘restricted’ and ‘non-restricted’. Analysis revealed distinct trend changes for antibiotics moving between ‘highly-restricted’ and ‘restricted’ (β= 0.0211,P= 0.003) and ‘restricted’ to ‘highly-restricted’ (β= −0.0039,P= 0.128) compared to the comparison group. After a 2-y adjustment period, when moving from ‘restricted’ to ‘highly-restricted’, absolute antibiotic utilisation significantly decreased (P< 0.001), with a relative decrease of 100.8% (P< 0.001) compared to the comparison group. Besides, individual antibiotics with higher consumption displayed greater responsiveness to adjustment. These findings underscore the changes in restriction level adjustments on antibiotics, highlighting antibiotic restriction list policies as crucial tools for antimicrobial stewardship.