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

Xingrong Shen, Alasdair MacGowan, Isabel Oliver, Helen Lambert, Debing Wang, et al.

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Abstract

Background
This 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.

Methods
The 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.

Results
A 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%).

Conclusions
The 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.
Original languageEnglish
Article number87
Number of pages9
JournalBMC Family Practice
Volume22
Issue number1
DOIs
Publication statusPublished - 6 May 2021

Bibliographical note

Funding Information:
This study was supported by the Newton Fund (UK Research and Innovation (UKRI) and the National Natural Science Foundation of China (NSFC, grant number 81661138001 and 81861138049) under the UK-China Antimicrobial resistance Partnership Initiative, grant number MR/P00756/1. The funding source has not plaid any role in the study design, analysis or in the decision to submit the manuscript for publication.

Publisher Copyright:
© 2021, The Author(s).

Keywords

  • antibiotic
  • respiratory tract infection
  • primary care
  • diagnosis
  • microbiological
  • China

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