Changes in antimicrobial use prevalence in China: results from five point prevalence studies.

OBJECTIVE: The abuse of antimicrobials is a serious concern in China. Several measures have been taken to improve the rational use of antimicrobials, including the establishment of a national surveillance network for antimicrobial use. This study describes the dynamic changes in antimicrobial use in China between 2001 and 2010, with the scope of identifying targets to improve the prescription of antimicrobials. METHODS: Five point prevalence surveys were performed in hospitals across mainland China in 2001, 2003, 2005, 2008, and 2010. All inpatients who were admitted for at least 24 hours were included in the study. Details regarding antimicrobial use by these patients and the collection of samples for bacterial culture from inpatients administered therapeutic antimicrobials were recorded. RESULTS: The surveys encompassed tertiary hospitals from all 31 provinces of mainland China. Antimicrobial use prevalence decreased from 54.79% in 2001 to 46.63% in 2010. While this decline was observed in most hospital departments, antimicrobial use remained stable or increased in others. Antimicrobial use prevalence was relatively high in the Pediatrics departments and general intensive care units, whereas it was lower in the Obstetrics (Neonatal group) departments in each survey. The proportion of patients administered a single antimicrobial increased from 60.78% in 2001 to 70.16% in 2010, while the proportion of administration of two or more antimicrobials declined. The bacterial culture rate increased from 25.22% in 2003 to 34.71% in 2010. Antimicrobial use prevalence (47.96% vs 46.16%), bacterial culture rate (36.40% vs 34.19%), and the proportion of administration of a single antimicrobial (71.41% vs 67.33%) were higher in teaching hospitals than in nonteaching hospitals in 2010. CONCLUSION: Although measures for enhancing the rational use of antimicrobials have been effective, further improvements are required. The findings from this study can promote such improvements.

[DNA detection and sequence analysis of spotted fever group Rickettsiae in rodents from Heilongjiang forest region].

OBJECTIVE: To investigate the infection in spotted fever group Rickettsiae (SFGR) in wild rodents from Heilongjiang, China. METHODS: Polymerase chain reaction (PCR) was used to detect the OmpA gene of SFGR in rodents collected in Heilongjiang. The PCR products amplified from rodent specimens were sequenced and compared with the corresponding part of the sequences deposited in the GenBank. Phylogenetic trees were constructed with Mega 5.0 software. RESULTS: A total of 514 rodents were collected from Heilongjiang during 2009-2011 and 11 species were included. The infection rate of SFGR in the rodents was 9.3% (95% CI: 7.1%-12.2%). Statistical analysis showed a significant difference in different areas of Heilongjiang (P=0.023). The highest prevalence was observed in Mudanjing area (12.42%). There were significant differences in different species of rodents (P=0.002). The infection rate of SFGR determined in Clethrionomys rufocanus was the highest (22.1%). Sequence analysis revealed SFGR belonged to R.heilongjiangensis and a new unknown rickettsia genotype. CONCLUSION: R.heilongjiangensis has been presented in rodents in Heilongjiang, and a new SFGR genotype different from other rickettsiae genotypes may exist in this area.

Human infection with Candidatus Neoehrlichia mikurensis, China.

To identify Candidatus Neoehrlichia mikurensis infection in northeastern China, we tested blood samples from 622 febrile patients. We identified in 7 infected patients and natural foci for this bacterium. Field surveys showed that 1.6% of ticks and 3.8% of rodents collected from residences of patients were also infected.

[Dynamic investigation on the co-infection status of two pathogens in ticks from tourist point in Heilongjiang province].

OBJECTIVE: To monitor the co-infection status of Borrelia burgdorferi sensu lato (B.b.s.l) and spotted fever group Rickettsia (SFGR) in tourist areas of Heilongjiang province. METHODS: Polymerase chain reaction (PCR) was used to detect the 5S-23S rRNA intergenic spacer of B.b.s.l and ompA of SFGR in ticks, dynamically collected from tourist areas of Heilongjiang province in 2010. Amplification products from positive ticks were sequenced, and phylogenetic analysis was conducted by Mega 5.0 software package. RESULTS: 849 ticks were collected from two tourist points, with the dominant ticks in Tiger Mountain and Jingpo Lake were Ixodes persulcatus and Haemaphysalis concinna. Regarding the Ixodes persulcatus from Tiger Mountain, the infection rates of B.b.s.l and SFGR were 26.15% and 10.05%. The infection rate of SFGR was 13.33% in Haemaphysalis concinna and the B.b.s.l was undiscovered in the same ticks from Jingpo Lake. However, the co-infection could only be detected in Ixodes persulcatus of both tourist areas. Surveillance data showed that the major ticks were more likely to be appeared in July at Tiger Mountain and in June at Jingpo Lake. Data from the sequence analysis on B.b.s.l showed that the B.b.s.l in tourist areas could be classified into three different genotypes, other than B. garinii and B. afzelii. We first detected B. valaisiana-like group genotype in northeast of China. Results from the sequence analysis of SFGR positive products showed that the two DNA sequences of newly detected agents were completely the same as Rickettsia sp. HL-93 which was detected in Hulin and Rickettsia sp. H820 found in northeast, China. CONCLUSION: The co-infection of B.b.s.l and SFGR was detected in ticks from the tourist areas of Heilongjiang province, and data from the sequencing of specific fragment showed that various kinds of genotypes existed in this area. However; the rates of co-infections-different according to environment, time and population that contributed to the kinds of and the index of ticks existed in the surveys points, also the infection rate of the ticks was studied.

[Meta-analysis of intervention effects on obesity in Chinese pupils].

OBJECTIVE: To comprehensively evaluate the effect of interventions on obesity in Chinese pupils. METHODS: A literature research was carried out in China National Knowledge Infrastructure, Wanfang Data, VIP Database for Chinese Technical Periodicals, PubMed and the Excerpts Medica Database (EMBASE) databases to collect articles published between 1979 and 2010 concerning the effect of interventions for preventing obesity in Chinese pupils. Rate difference (RD) of the rate of obesity as the evaluation indicator was selected to Meta-analyze the effect of interventions on obesity. There are total 215 articles, in which 211 articles were written in Chinese and other articles were written in English. RESULTS: 17 literatures were used for Meta-analysis by the uniform inclusion and exclusion criteria. The results showed that the RD of obesity rate for the students in the intervention group was 3% (95%CI: 1% - 5%) after the intervention. However, the RD of obesity rate for the students in the control group was -2% (95%CI: -4% - -1%) after the intervention. Results of stratified analysis for the RD of obesity rate showed that the obesity rate for the students in the intervention group were decreased significantly after the intervention of combined programs with health education, physical exercise and nutrition interventions with moderate intervention time (1 to 2 years), the RD (95%CI) of obesity rate were 5% (2% - 8%), 3% (1% - 4%), respectively. For the studies whose baseline obesity rates was insignificant difference between the intervention group and the control group, the obesity rate for the students in the intervention group was 4% (95%CI: -7% - -1%) lower than the obesity rate for the students in the control group after the intervention. CONCLUSION: Health-education-based comprehensive intervention is effective on obesity prevention in Chinese pupils; combined intervention programs with moderate intervention time (1 to 2 years) were effective in improving efficiency of obesity prevention in pupils.

[Meta-analysis on the relationship between leptin receptor Gln223Arg and Pro1019Pro gene polymorphism and obesity in the Chinese population].

OBJECTIVE: To evaluate the associations between polymorphisms of LEPR Gln223Arg, LEPR Pro1019Pro and the risk on obesity. METHODS: A computerized search on literature was carried out in Wanfang, CNKI, VIP databases and CBM, PubMed, EMBASE databases to collect articles published between 1979 and 2010 concerning the associations between polymorphisms of LEPR Gln223Arg and/or LEPR Pro1019Pro and risk of obesity in the Chinese population. Odds ratios (ORs) were used to assess the strength of the association, and 95% confidence intervals (CIs) to present the precision of the estimates. Meta-analysis was performed using the STATA statistical software. RESULTS: Fifteen literature were collected for Meta-analysis by the uniform inclusion and exclusion criteria. There were 1096 obese patients and 949 controls for polymorphisms of LEPR Gln223Arg in 9 papers, together with 961 obese patients and 818 controls for polymorphisms of LEPR Pro1019Pro in 8 papers. Overall, there were significant associations between decreased risk of obesity and LEPR Gln223Arg polymorphisms (-668 A→G) (G versus A, OR = 0.66, 95%CI: 0.49 - 0.89; AG and GG versus AA, OR = 0.50, 95%CI: 0.32 - 0.77; respectively). There were significant associations between increased risk of obesity and LEPR Pro1019Pro polymorphisms (-3057 G→A) (A versus G, OR = 1.61, 95%CI: 1.15 - 2.26; AG and AA versus GG, OR = 1.50, 95%CI: 1.08 - 2.08; respectively). CONCLUSION: Variant alleles at both LEPR-668 and LEPR-3057 were associated with obesity in the Chinese Han-dominated population.