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Nationwide surveillance of antimicrobial consumption and resistance to Pseudomonas aeruginosa isolates at 203 Japanese hospitals in 2010
Authors:Y. Muraki  M. Kitamura  Y. Maeda  T. Kitahara  T. Mori  H. Ikeue  M. Tsugita  K. Tadano  K. Takada  T. Akamatsu  T. Yamada  T. Yamada  T. Shiraishi  M. Okuda
Affiliation:1. The Fifth Subcommittee, Committee on Academic, Japanese Society of Hospital Pharmacists, Tokyo, Japan
2. Department of Pharmacy, Faculty of Medicine, Mie University Hospital, Mie University, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
3. Department of Pharmacy, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
4. Department of Pharmacy, Osaka Rosai Hospital, Sakai, Osaka, Japan
5. Department of Hospital Pharmacy, Nagasaki University Hospital, Nagasaki, Japan
6. Faculty of Pharmacy, Meijo University, Nagoya, Aichi, Japan
7. Department of Pharmacy, Kagawa Rosai Hospital, Marugame, Kagawa, Japan
8. Department of Pharmacy, Niitsu Medical Center Hospital, Niigata, Niigata, Japan
9. Faculty of Pharmaceutical Sciences, Health Sciences University of Hokkaido, Ishikari-gun, Hokkaido, Japan
10. Department of Pharmacy, Narita Hospital, Japanese Red Cross Society, Narita, Chiba, Japan
11. Department of Pharmacy, Kyushu Kosei Nenkin Hospital, Kitakyushu, Fukuoka, Japan
12. Department of Translational Medical Science, Mie University Graduate School of Medicine, Tsu, Mie, Japan
13. Department of Pharmacy, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
14. Department of Pharmacy, Yamagata University Hospital, Yamagata, Yamagata, Japan
Abstract:

Purpose

In Japan, a national surveillance study of antimicrobial consumption has never been undertaken. This study aimed to describe antimicrobial consumption and resistance to Pseudomonas aeruginosa in 203 Japanese hospitals, to identify targets for quality improvement.

Methods

We conducted an ecological study using retrospective data (2010). Antimicrobial consumption was collected in the World Health Organization (WHO) anatomical therapeutic chemical/defined daily dose (ATC/DDD) format. Rates of imipenem (IPM), meropenem (MEPM), ciprofloxacin (CPFX), or amikacin (AMK) resistance were expressed as the incidence of non-susceptible isolates. Additionally, hospitals were asked to provide data concerning hospital characteristics and infection control policies. Hospitals were classified according to functional categories of the Medical Services Act in Japan.

Results

Data were collected from 203 Japanese hospitals (a total of 91,147 beds). The total antimicrobial consumption was 15.49 DDDs/100 bed-days (median), with consumptions for penicillins, carbapenems, quinolones, and glycopeptides being 4.27, 1.60, 0.41, and 0.49, respectively. The median incidences of IPM, MEPM, CPFX, and AMK resistance were 0.15, 0.10, 0.13, and 0.03 isolates per 1,000 patient-days, respectively. Antimicrobial notification and/or approval systems were present in 183 hospitals (90.1 %). In the multivariate analysis, the piperacillin/tazobactam, quinolones, and/or total consumptions and the advanced treatment hospitals showed a significant association with the incidence of P. aeruginosa resistant to IPM, MEPM, CPFX, and AMK [adjusted R 2 (aR 2) values of 0.23, 0.30, 0.22, and 0.35, respectively).

Conclusion

This is the first national surveillance study of antimicrobial consumption in Japan. A continuous surveillance program in Japan is necessary in order to evaluate the association among resistance, antimicrobial restriction, and consumption.
Keywords:
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