Antimicrobial Stewardship in China: Systems, Actions and Future Strategies.

Antimicrobial resistance (AMR) has become a serious global public health crisis, and AMR control has consequently become a priority in all countries. Specifically, the incidence of various common multidrug-resistant bacteria is high, and there are multiple problems concerning the irrational use of antimicrobial drugs. In the past decade, China has established a relatively comprehensive management system and technical support framework for antimicrobial stewardship, including regulations, guidelines, networks for the surveillance of AMR and antimicrobial consumption, and professional personnel training. In addition, the Ministry of Health has carried out a special campaign to promote the proper clinical use of antibiotics in medical institutions, which significantly improved outcomes. The use of antibacterial drugs without indication and the consumption of antibiotics have been significantly reduced. In consideration of the factors that contribute to AMR, the structure of the healthcare system in China, and the need for long-term sustaining efforts to control AMR, the strategy of "two steps and two hands" must be implemented to contain AMR. The first step is to generally promote the rational use of antimicrobial agents in order to promptly curb the rising momentum of resistance with high pressure from the government. The second step requires sustainable professional work with the implementation of precise AMR control. The "first hand" refers to the government-oriented active establishment and optimization of the system and infrastructure of rational antibiotic use and AMR control. The "second hand" refers to the cultivation of professional teams to ensure the establishment and development of sustainable processes in AMR control.