Provincial clustering and related factors analysis of clinic antimicrobial resistance in China

ABSTRACT: Objective: Antimicrobial resistance (AMR) is among the biggest and most pressing risks facing healthcare in China and globally. We aimed to describe the current status regarding the distribution of clinic AMR in China through provincial clustering and analyse the related factors. Methods: Based on the detection rates of 13 major drug-resistant bacteria in 31 provinces across the country, as reported by the National Bacterial Resistance Surveillance Network in 2019, we carried out a provincial clustering by dividing the conditions of provincial clinical AMR into different groups, and we then examined the potentially related factors, such as the use of antibiotics, economic development status, health service utilization, and health resource allocation. Results: According to the different levels of bacterial resistance, the provinces were clustered into three categories: low, medium, and high detection rates of AMR. The three categories had notable geographic clustering and associations. Economic development status, health service utilization, such as the number of the types of antibacterial drugs (P = 0.025), health resource allocations, such as low licensed pharmacist per 1000 patient visits (P = 0.004) were related to AMR in China. Conclusions: The levels of AMR in public hospitals within the coastal areas of North China and East China were higher than those in other areas. The regions with higher levels of clinical bacterial resistance also had higher levels of health costs, health services volume and utilization, insufficient health resources per time, and higher probability of overuse of antimicrobials. Targeted measures should be taken in these areas to curb the resistance trends