Mixed effects of restriction strategies in antimicrobial stewardship programs on antimicrobial use in 121 tertiary hospitals in China, 2013–2017

ABSTRACT

Background: The research evaluated the impact of intravenous antimicrobial restriction strategy (IARS) on different types of hospitals in China for evidence-based management, for outpatients implemented in 2016.

Methods: Based on panel data on antimicrobial use in 121 tertiary hospitals in Zhejiang, China, segmented regression analysis was used to evaluate the impact of IARS in children’s hospitals (CHs), obstetrics and gynecology hospitals (OGHs), women’s and children’s hospitals (WCHs), traditional Chinese medicine hospitals (TCMHs) and general hospitals (GHs). Antimicrobial use was measured using the percentage of total encounters with prescribing and the percentage of total drug expenditure relating to antimicrobials (APP and AEP).

Results: There was a downward baseline slope of APP in all types of hospitals and AEP in WCHs, TCMHs and GHs (P < 0.01). After IARS, a level reduction in AEP in CHs (−3.14%, 95% CI = −6.21 to 0.06), WCHs (−1.33%, 95% CI = −2.44 to 0.22) and TCMHs (−0.85%, 95%CI = −1.51 to 0.18). After IARS, the slope of AEP changed significantly in OGHs (−0.42%, 95%CI = −0.81 to 0.03) and WCHs (0.29%, 95% CI = 0.08 to 0.49), and the slope of APP changed significantly in CHs (2.35%, 95%CI = 1.20 to 3.49).

Conclusions: IARS had the mixed effects including positive effect in AEP and no significant change in APP, and an unexpected rise in APP in CHs needs further study.

KEYWORDS:

• Antimicrobial stewardship programs
• antimicrobial expenditure
• antimicrobial prescribing
• interrupted time series
• restriction strategy

Acknowledgments

We would like to acknowledge professor Hughes D for valuable suggestions and language modification, and professor Jordan SE for valuable suggestions. We also thank Yin X for providing valuable information about indicators of antimicrobial use.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Haihong Chen was involved in the conception and design, analysis and interpretation of the data, and drafting of the paper and revised it. Chenxi Liu, Junjie Liu, Yuqing Tang, and Xinping Zhang were involved in the conception and design, and revising the paper. All the authors were involved in the final approval of the version to be published, and all authors agree to be accountable for all aspects of the work.

Additional information

Funding

This work was supported by the National Social Science Fund, 'Research on the Development Strategy of Advancing Health in China Based on National Health Coverage' [Grant Number 15ZDC037, 2015].