Relationships Between Diagnosis, Bacterial Isolation, and Antibiotic Prescription in Out Patients With Respiratory Tract Infection Symptoms in Rural Anhui, China

Xingrong Shen, Rui Feng, Jing Chai, Jing Cheng, Isabel Oliver, Helen S Lambert, Debin Wang*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

3 Citations (Scopus)
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Abstract

Objectives: This paper aims to explore the direct associations of antibiotics prescription with clinical diagnosis and bacterial detection. It also analyses the relations of clinical diagnosis with symptoms and bacterial detection, with a hope of revealing indirect links to antibiotic prescription.

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. Observations were conducted to record clinical diagnosis and antibiotic prescription. A semi-structured questionnaire survey was used to collected patients' sociodemographic information and reported symptoms. Sputum and throat swabs were collected for bacterial culture.

Results: Among 1,068 patients presenting in the study settings who received a diagnosis of respiratory tract infection (RTI), 87.8% of prescriptions included an antibiotic and 35.8% included two or more antibiotics. Symptomatic RTI patients to the site clinics were diagnosed mainly as having upper respiratory tract infection (32.0%), bronchitis/tracheitis (23.4%), others (16.6%), pharyngitis (11.1%), common cold (8.0%), pneumonia/bronchopneumonia (4.6%) and tonsillitis (4.3%). These clinical diagnosis were associated with symptoms to a varied degree especially for upper respiratory tract infection and bronchitis/tracheitis. Prescription of any antibiotics was positively associated with diagnosis of bronchitis/tracheitis (OR: 5.00, 95% CI: 2.63–9.51), tonsillitis (OR: 4.63, 95% CI: 1.48–14.46), pneumonia/bronchopneumonia (OR: 4.28, 95% CI: 1.40–13.04), pharyngitis (OR: 3.22, 95% CI: 1.57–6.59) and upper respiratory tract infection (OR: 3.04, 95% CI: 1.75–5.27). Prescription of two or more antibiotics was statistically significant related to diagnosis of bronchitis/ tracheitis (OR: 2.20, 95% CI: 1.44–3.35) or tonsillitis (OR: 2.97, 95% CI: 1.47–6.00). About 30% of the patients were identified with some type of bacteria. Bacteria detection was linked with pharyngitis (OR: 0.50, 95% CI: 0.28–0.88) but not prescription of antibiotics.

Conclusions: Antibiotics prescription were found with a strong relation to diagnosis of RTIs given by the clinician but was not associated with the presence of bacteria in patient samples. Part of the diagnosis may have been given by the clinician to justify their antibiotics prescription. There is clear need to use additional measures (e.g., symptoms) in conjunction with diagnosis to supervise or audit excessive antibiotics use.
Original languageEnglish
Article number 810348
Number of pages9
JournalFrontiers in Public Health
Volume10
DOIs
Publication statusPublished - 9 Feb 2022

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.

Funding Information:
Funded jointly by the National Natural Science Foundation of China (NSFC) and UK Research and Innovation (UKRI) through the Newton Fund, we carried out a 3-year project titled “Pathways to optimizing antibiotic use in rural Anhui province, China” that aimed to investigate the magnitude and drivers of antibiotic use and antibiotic resistance in rural areas in China. The project adopted a mixed methodology making innovative use of non-participant observation, qualitative interviews, structured questionnaire surveys, microbiological testing and record review. The overall study protocol and results from other study components are published elsewhere (19, 20). This part of the study explores the direct associations of antibiotics prescription with clinical diagnosis and bacterial detection. It also analyses the relations of clinical diagnosis with symptoms and bacterial detection, with a hope of revealing indirect links to antibiotic prescription.

Publisher Copyright:
Copyright © 2022 Xingrong, Rui, Jing, Jing, Oliver, Lambert and Wang.

Keywords

  • antibiotic
  • respiratory tract infection
  • primary care
  • diagnosis
  • bacterial isolation

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