The Public Health Agency of Sweden
Updated 10 July 2018

Sino-Swedish bilateral cooperation on management of antibiotic resistance

The importance of a long term commitment for collaboration between China and Sweden on containment of antibiotic resistance was manifested at the China-Sweden conference on antibiotic resistance in Beijing, April 2009. The objectives of the project Sino-Swedish Bilateral Cooperation on Management of Antibiotic Resistance sprung from the thematic areas specified in the Plan of Action on Health Cooperation signed one year later (2010) by the Chinese and Swedish health ministers. These objectives were subsequently realised as five subprojects, demonstrating the importance of collaboration and joint action between political commitment and research interest. The project lasted over the period 2011–2013.


Anette Hulth
Phone: +4610-205 23 95

Antibiotic prescription, utilization and prevalence of ESBL in healthy subjects in Shandong province

This study showed a substantial gap between doctors' attitudes and their practice in prescribing antibiotics, where self-reported attitudes were in line with recommendations whereas practice showed a high inappropriate prescription of antibiotics for e.g. common colds.

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Sun Q, Dyar OJ, Zhao L, Tomson G, Nilsson LE, Grape M, et al. Overuse of antibiotics for the common cold - attitudes and behaviors among doctors in rural areas of Shandong Province, China. BMC Pharmacol Toxicol 2015; 16:6.

A high faecal carriage of ESBL-producing Enterobacteriaceae was found in healthy subjects in three rural counties. Analyses of risk factors indicated that previous antibiotic consumption and hospital stay are risk factors for carriage of ESBL-producing Enterobacteriaceae. The carriage was highest in the county with the highest income.

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Sun Q, Tärnberg M, Zhao L, Stålsby Lundborg C, Song Y, Grape M, et al. Varying high levels of faecal carriage of extended-spectrum beta-lactamase producing Enterobacteriaceae in rural villages in Shandong, China: implications for global health. PLoS One 2014; 9(11):e113121.

Comparative study on antibiotic prescribing in Sweden and China

This subproject showed that the proportion of hospitalised patients receiving antibiotics are higher in China than in Sweden, but the level of consumption measured in DDD/1000 patient days are higher in Sweden. These results could be explained by the different health service delivery systems (primary care as a gatekeeper of hospital specialist care does not exist in the Chinese settings), different prescribed doses, and different mean length of stay for hospitalised patients. The consumption of broad spectrum antibiotics still dominates in China, compared to Sweden were the most used antibiotics are penicillins.

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Sun J, Shen X, Li M, He L, Guo S, Skoog G, Grape M, Cars O, Dong S. Changes in patterns of antibiotic use in Chinese public hospitals (2005–2012) and a benchmark comparison with Sweden in 2012. J Glob Antimicrob Resist 2015; 3(2):95–102.

Prevalence of ESBL producing Escherichia coli and Klebsiella pneumoniae in primary health care patients with urinary tract infections

The prevalence of multiresistant ESBL producing E. coli and K. pneumoniae in primary care urinary tract infections (UTI) patients in China were in this subproject found to be similar to the high levels found in hospital treated patients in China. This would indicate that the most commonly prescribed antibiotics are not optimal for treatment of patients with UTI in Chinese primary care.

The study also showed that there is a rising proportion of a certain ESBL resistance gene in both humans and animals. There may be two possible explanations for this. One is transmission between humans and animals, the other is transmission of ESBL genes through the food chain.

Investigation among medical facilities in China and Sweden on the current situation on bacterial drug-resistance and the rational use of antibiotics

This subproject aimed to investigate bacterial drug resistance and rational use of antibiotics in tertiary hospitals in China and Sweden. The research may have contributed to the establishment and implementation of the mandatory administrative strategies for rational use of antimicrobials in hospital settings which was introduced by the Chinese MoH in March 2011. The improved strategies resulted in changes in consumption that significantly decreased resistance rate for antibiotics in several clinical pathogens isolated in tertiary hospitals during the observation period of two years.

Antibiotics in education for sustainable development

Teaching material including handbooks, posters and an online game were jointly developed, translated and shared by Chinese and Swedish partners. Antibiotics in education for sustainable development was implemented in three counties in China. In total, 45 green schools and preschools and 15 green communities were involved. In Sweden, the national networks for Education for Sustainable Development and Health Promoting Schools were involved, and a pilot with 40 schools and preschools was conducted. The surveys performed pre and post education revealed a self-reported increased knowledge among those responding to the survey, including an understanding that antibiotics are useless for curing common colds, as well as a behavioural change with a reduced inclination of buying antibiotics over the counter but rather obtaining antibiotics at hospitals.



Dr Xiao Yonghong, Zhejiang University, China
Dr Sun Qiang, Shandong University, China
Dr Jing Sun, Ministry of Health, China
Ms Jin Yuting, Ministry of Environmental Protection, China
Dr Yu Yong, First Affiliated Hospital of PLA General Hospital, China
Dr Lennart Nilsson, Linköping University, Sweden
Ms Elisabeth Mühlhäuser, formerly Swedish Institute for Communicable Disease Control and Lund University, Sweden
Dr Staffan Sylvan, Uppsala County Council and Uppsala University, Sweden
Dr Malin Grape, Public Health Agency of Sweden
Ms Gunilla Skoog, Public Health Agency of Sweden

Senior Advisors

Dr Göran Tomson, Karolinska Institutet, Sweden and Shandong University, China
Dr Otto Cars, Public Health Agency of Sweden and Uppsala University, Sweden