China’s new national action plan to combat antimicrobial resistance (2022–25)
Li Ding, Fupin Hu
Abstract
Antimicrobial resistance (AMR) is a major challenge for global public health, and the wide spread of MDR organisms brings a heavy economic burden to infected patients, especially those in developing countries or low-resource countries or regions; this is a global problem of wide concern to governments and society.1 The WHO has been calling on countries to pay attention to the threat of AMR for many years, and important international meetings such as the General Assembly of the United Nations, the World Health Assembly, and the G20 Summit have repeatedly studied and discussed AMR.2,3 In 2016, in response to the global action plan on AMR issued by the WHO, 14 ministries and commissions of the Chinese government jointly issued a national action plan for combating AMR (2016–20), which adopted comprehensive management measures at the national level and strengthened regulation in all aspects of drug research and development, production, distribution, application and environmental protection.4 To further strengthen efforts to combat AMR and actively respond to international and domestic concerns, the Chinese government recently announced a new national action plan, the ‘National Action Plan for Combating Antimicrobial Resistance (2022–2025)’ in October 2022.5 The action plan, led by the National Health Commission in conjunction with 12 ministries and commissions, focuses on the need to effectively control major pathogens of human and animal origin and gives new annual targets and more detailed indicators for combating AMR. The prevalence of clinical MDR bacteria in China is still high.6 According to the results in 2021 from the China Antimicrobial Surveillance Network (www.chinets.com; 71 hospitals from 29 provinces or cities), the resistance rates of meropenem-resistant Klebsiella pneumoniae, meropenem-resistant Pseudomonas aeruginosa and meropenem-resistant Acinetobacter baumannii were 24.4%, 18.9% and 72.3%, respectively. The rates of MRSA, ceftriaxone-resistant Escherichia coli and ceftriaxone-resistant K. pneumoniae were 30%, 52.4% and 41.5%, respectively. Carbapenem-resistant Gram-negative bacilli are the priority organisms that WHO and CDC jointly believe the world should take urgent measures to address, including infection prevention and control and the development of new antimicrobial agents.1,7 In China, few antimicrobial agents are available for treating infections caused by a carbapenem-resistant organism, including ceftazidime/avibactam, polymyxins and tigecycline, while other new β-lactam/β-lactamase inhibitor combinations including meropenem/vaborbactam, imipenem/relebactam, and cefiderocol are not yet available.8 Therefore, with the current limited resources, there is a need for multisectoral and multidisciplinary cooperation, communication and education to improve the rational use of antimicrobial agents to combat AMR in China. Based on this, China has carried out various targeted efforts. For example, since 2015, the National Institute of Hospital Administration has organized the ‘Peiyuan project’,9 the ‘Peiying project’,10 the ‘Peiwei project’11 and the ‘SHIP project’ for clinicians, clinical pharmacists, clinical microbiology technicians and infection control professionals, respectively. In 2017, the Shanghai Municipal Health and Family Planning Commission established the ‘Three Networks’ programme, which integrates the networks on AMR surveillance, antimicrobial clinical application surveillance and infection control surveillance.12 In 2020, the National Health Commission conducted the first national epidemiological study on carbapenem-resistant Enterobacterales (covering 151 hospitals in 31 provinces and cities), and in 2021, the Chinese government announced its first plan to establish its own performance standards for antimicrobial susceptibility testing.13 In 2022, 14 reference laboratories for antimicrobial susceptibility testing were firstly established in China by CHINET and the Shanghai Antimicrobial Surveillance Network in order to establish standards for antimicrobial susceptibility testing and to promote the standardization of susceptibility testing methodology.14 China’s national action plan to combat AMR is a response to the needs of the international community and five clear key goals are presented (Table 1). The five clear key goals to combat AMR in China’s new national action plan (2022–25) To address the challenge, countries have announced national action plans to combat AMR.15 China’s action plan is designed to focus on the global demand for ‘One Health’. Combating AMR is a huge systemic project, and countries worldwide are taking various measures to control resistance, but with little success, one of the reasons being that it takes a long time to integrate multisectoral and multidisciplinary collaboration. Nonetheless, we believe that with the implementation of this national action plan, China will provide ‘Chinese solutions’ and ‘Chinese experience’ for national prevention and control of AMR. This work was supported by the National Key Research and Development Program of China (2021YFC2701800, 2021YFC2701803), the National Natural Science Foundation of China (82172311 and 32141002) and China Antimicrobial Surveillance Network (2020QD049). None to declare.