Nationwide surveillance of antimicrobial consumption and resistance to Pseudomonas aeruginosa isolates at 203 Japanese hospitals in 2010
Nationwide surveillance of antimicrobial consumption and resistance to Pseudomonas aeruginosa isolates at 203 Japanese hospitals in 2010
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DOI：
10.1007/s15010-013-0440-0
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发表时间：
2013-04-01
期刊：
影响因子：
7.5
通讯作者：
Okuda, M.
中科院分区：
文献类型：
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作者：
Muraki, Y.;Kitamura, M.;Okuda, M.
在日本，从未进行过全国性的抗菌药物消费监测研究。本研究的目的是描述抗菌药物的消费和耐药铜绿假单胞菌在203日本医院，以确定质量improvement.Methods的目标，我们进行了一项生态研究，使用回顾性数据（2010年）。以世界卫生组织（WHO）解剖学治疗化学/限定日剂量（ATC/DDD）格式收集抗菌药物消耗量。亚胺培南（IPM）、美罗培南（MEPM）、环丙沙星（CPFX）或阿米卡星（AMK）的耐药率表示为非敏感分离株的发生率。此外，医院被要求提供有关医院特点和感染控制政策的数据。根据日本《医疗服务法》的功能类别对医院进行分类。结果数据收集自203家日本医院（共91，147张床位）。抗菌药物的总消耗量为15.49 DDDs/100床日（中位数），青霉素类、碳青霉烯类、喹诺酮类和糖肽类的消耗量分别为4.27、1.60、0.41和0.49。IPM、MEPM、CPFX和AMK耐药的中位发生率分别为0.15、0.10、0.13和0.03分离株/1，000患者-天。183家医院（90.1%）存在抗菌通知和/或批准系统。在多变量分析中，哌拉西林/他唑巴坦、喹诺酮类药物和/或总消耗量以及高级治疗医院与铜绿假单胞菌对IPM、MEPM、CPFX和AMK耐药的发生率显著相关[校正R-2（aR（2））值分别为0.23、0.30、0.22和0.35，结论这是日本首次对抗菌药物消费进行全国性监测研究。为了评价耐药性、抗生素限制和消费之间的关系，有必要在日本进行持续监测。
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.