Antimicrobial utilization and antimicrobial resistance in patients with haematological malignancies in Japan: a multi-centre cross-sectional study
Antimicrobial utilization and antimicrobial resistance in patients with haematological malignancies in Japan: a multi-centre cross-sectional study
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DOI：
10.1186/s12941-020-00348-0
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发表时间：
2020-02-17
影响因子：
5.7
通讯作者：
Akazawa, Manabu
中科院分区：
文献类型：
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作者：
Mimura, Wataru;Fukuda, Haruhisa;Akazawa, Manabu
感染是血液系统恶性肿瘤患者的主要并发症。重要的是要更好地了解抗菌药物的使用和抗生素耐药性，以适当的治疗和预防耐药性。然而，在日本，很少有多中心分析关注抗菌药物的使用和抗生素耐药性。本研究旨在描述血液系统恶性肿瘤患者抗菌药物使用和耐药性的特点。方法我们进行了一项横断面研究，使用行政索赔数据和抗菌药物敏感性数据在日本。我们纳入了2015年4月1日至2017年9月30日期间在37家医院的血液科病房住院的诊断为血液学恶性肿瘤的患者。描述性统计用于总结患者特征、抗菌药物使用、细菌感染和抗生素耐药性。结果共纳入8064例患者。非霍奇金淋巴瘤（50.0%）是最常见的恶性肿瘤。广谱抗生素使用密度（AUD）依次为头孢吡肟（156.7）、碳青霉烯类（104.8）和哌拉西林/他唑巴坦（28.4）。特别是，淋巴性白血病、髓性白血病或骨髓增生异常综合征患者的AUD高于霍奇金淋巴瘤、非霍奇金淋巴瘤或多发性骨髓瘤患者。在我们的研究队列中最常见的细菌种类是大肠埃希菌（9.4%），在血液标本中也观察到这种趋势。耐氟喹诺酮类大肠杆菌大肠埃希菌（3.6%）是最常见的耐药菌株，其他耐药菌株很少。结论广谱抗生素在日本血液系统恶性肿瘤患者中很常见;然而，包括碳青霉烯类耐药菌或多重耐药菌在内的抗生素耐药菌并不常见。我们的研究结果提供了全国范围内，横截面的抗菌药物的使用，细菌的流行和抗生素耐药性的见解，证明不同的血液疾病之间的抗菌药物利用的差异。
Background Infection is a major complication for patients with haematological malignancies. It is important to better understand the use of antimicrobial agents and antibiotic resistance for appropriate treatment and prevention of drug resistance. However, very few multi-centre analyses have focused on the use of antimicrobial agents and antibiotic resistance have been carried out in Japan. This study aimed to describe the characteristics of the use of antimicrobial agents and antibiotic resistance in patients with haematological malignancies. Methods We conducted a cross-sectional study using administrative claims data and antimicrobial susceptibility data in Japan. We included patients diagnosed with haematological malignancies, who were hospitalized in a haematology ward between 1 April 2015 and 30 September 2017 in 37 hospitals. Descriptive statistics were used to summarize patient characteristics, antimicrobial utilization, bacterial infections, and antibiotic resistance. Results In total, 8064 patients were included. Non-Hodgkin lymphoma (50.0%) was the most common malignancy. The broad-spectrum antibiotics displayed a following antimicrobial use density (AUD): cefepime (156.7), carbapenems (104.8), and piperacillin/tazobactam (28.4). In particular, patients with lymphoid leukaemia, myeloid leukaemia, or myelodysplastic syndromes presented a higher AUD than those with Hodgkin lymphoma, non-Hodgkin lymphoma, or multiple myeloma. The most frequent bacterial species in our study cohort was Escherichia coli (9.4%), and this trend was also observed in blood specimens. Fluoroquinolone-resistant E. coli (3.6%) was the most frequently observed antibiotic-resistant strain, while other antibiotic-resistant strains were rare. Conclusions Broad-spectrum antibiotics were common in patients with haematological malignancies in Japan; however, antibiotic-resistant bacteria including carbapenem-resistant or multidrug-resistant bacteria were infrequent. Our results provide nationwide, cross-sectional insight into the use of antimicrobial agents, prevalence of bacteria, and antibiotic resistance, demonstrating differences in antimicrobial utilization among different haematological diseases.