Prevalence And Risk Factors Of Antibiotic Resistance In Rural Residents Of Shandong Province

BackgroundSince the advent of penicillin in the1940s, the application of antibiotics has brought a revolutionary change to the treatment of bacterial infections. However, with the widespread use of antibiotics, the problem of irrational use is becoming more and more serious and some bacteria are resistant to antibiotic drugs gradually, the burden of patient’s health is growing heavier.In our country, antibiotic resistance rates are increasing year by year, while most researches of antibiotics’irrational use and resistance mechanisms are starting with a clinical point and research subjects are usually patients of medical institutions. Few studies have analyzed the relationship between the antibiotic resistance and health service providers and consumer’related cognition and behavior from the perspective of population.In rural areas, the irrational use of antibiotics are very serious, while there is almost no research about the prevalence of antibiotic resistance in rural healthy people. Therefore, this study will provide a scientific basis for establishing rural antibiotic resistance monitoring system by assessing the degree of antibiotic irrational use and bacterial resistance in rural healthy people of Shandong Province.ObjectiveThe purpose of this study is to evaluate the antibiotic resistance in rural areas by detecting the prevalence of extended-spectrum β-lactamase (ESBL) in rural health people, and explore the risk factors through analyzing the rural residents’and doctors’ antibiotic cognition and behavior. This study will promote the antibiotic rational use in rural areas and improve the health of rural residents.MethodsConsidering the geographical location and economic level, we selected Yanggu, Ningyang, and Jiaonan three sites to carry out the research in Shandong province. In each county, we selected randomly three towns and six villages to investigate. In each village,60residents are selected purposely to be conducted a questionnaire survey and collected fecal specimens. In each surveyed county, town and village, we surveyed the doctors through a questionnaire and collected the outpatient prescriptions in the medical institutions.1014rural resident questionnaires and1035fecal specimens were collected, and1000questionnaires and specimens were matched, the matched samples will be analyzed in this study.188doctor questionnaires and10676prescriptions were collected and analyzed in the study.Established a database using Epidata3.1and inputted the data. Date were managed in Excel2007, then SPSS17.0was used to conduct the descriptive analysis and statistical inference. Statistical methods included mainly chi-square test and binary logistic regression. Disease diagnoses of prescriptions were classified by ICD-10disease classification criteria and antibiotic drugs were classified by ATC drug classification method. The detections of ESBL in fecal specimens were finished by microbiology laboratory of Shandong University.Results(1)42%of rural residents were carried ESBL and in children under7years old it was45%. Among the18villages, the lowest ESBL prevalence rate was22%and the highest was64%. (2)65%of rural residents said they knew antibiotics, but42%of them can’t correctly understand the functions of antibiotics. The main way to getting antibiotic knowledge is from doctors. Rural residents’cognition on antibiotic was irrelevant to antibiotic resistance.(3)80%of rural residents were used antibiotics. Doctor’s recommendation was the main factor when residents choosing antibiotic drugs, and village clinics was the main institution for them to get antibiotics. The use of antibiotics, regular medication behavior and infusion behavior is related factors for antibiotic resistance.(4)86%of rural physicians knew the regulations of antibiotic use and most of them reported to comply with these regulations. Only1%of rural doctors reported they would prescribe antibiotics to patients with common cold, but in reality56%of common prescriptions were with antibiotics.(5) Generally the percentage of prescriptions with antibiotics was39%in all surveyed health institutions. This percentage was27%,29%and58%in the county hospital, township health center and village clinics respectively. The average rate of multi-use antibiotics was18%, and47%of antibiotics were administrated through intravenous infusion. In rural areas, the most used antibiotic types were macrolide and third-generation cephalosporin antibiotics.Conclusions and SuggestionsIrrational use of antibiotics existed in rural areas and antibiotic resistance are prevalent, especially the prevalence of children’antibiotic resistance. Risk factors affecting the prevalence of antibiotic resistance in rural areas were mainly from health providers, especially village clinic doctors. Most rural doctors had reasonable attitude on the use of antibiotics, but actual prescribing behavior are severely irrational. Based on the above conclusions, provide the following suggestions:(1) It is essential and urgent to establish antibiotic use and resistance monitoring and evaluating system in rural areas. Antibiotic resistance situation of rural residents was very serious, we should make effort to accelerate the progress of related researches and establish the rural antibiotic use and resistance monitoring system as soon as possible.(2) Carrying out health education activities about antibiotic rational use for rural residents, especially for parents. Inviting doctors to make some seminars on antibiotics will be effective, which will be helpful to change rural people’irrational medication attitudes and behavior.(3) The antibiotic prescribing behavior of village doctors should be strengthened supervision and some trains on antibiotic rational use should be provided regularly. Village doctors’antibiotic knowledge and prescribing practices is directly related to the rationality of rural residents’antibiotic use. We should pay more attention to improve the antibiotic prescribing behavior of village doctors.