Correlation between antibiotic use and antibiotic resistance: A multicenter study using the Japan Surveillance for Infection Prevention and Healthcare Epidemiology (J-SIPHE) system in Hokkaido, Japan.

BACKGROUND: The Japan Surveillance for Infection Prevention and Healthcare Epidemiology (J-SIPHE) system aggregates information related to antimicrobial resistance (AMR) measures in participating medical institutions nationwide and is intended to be used for promotion of AMR measures in participating facilities and their communities. This multicenter study aimed to determine the usefulness of the J-SIPHE system for evaluating the correlation between antibiotic use and antibiotic resistance in Hokkaido, Japan. METHODS: Data on antibiotic use and detection rate of major resistant Gram-negative bacteria at 19 hospitals in 2020 were collected from the J-SIPHE system, and data correlations were analyzed using JMP Pro. RESULTS: The detection rate of carbapenem-resistant Pseudomonas aeruginosa was significantly positively correlated with carbapenem use (Spearman's ρ = 0.551; P = .015). There were significant positive correlations between the detection rate of fluoroquinolone-resistant Escherichia coli and the use of piperacillin/tazobactam, carbapenems, and quinolones [ρ = 0.518 (P = .023), ρ = 0.76 (P < .001), and ρ = 0.502 (P = .029), respectively]. CONCLUSIONS: This is the first multicenter study to investigate the correlation between antibiotic use and antibiotic resistance using the J-SIPHE system. The results suggest that using this system may be beneficial for promoting AMR measures.

[Factors related to frequent emergency hospital refusal of ambulance transport calls].

Purpose　Among the factors that adversely affect the time needed for ambulance transport, one factor for which intervention is possible is the time it takes to choose a medical receiving facility. This research clarified the characteristics of the time, location, and severity of medical emergencies in which the choice of hospital was difficult.Methods　The research covered a 1-year period from January 1 through December 31, 2014, investigating all incidents of ambulance transport for patients in Wakayama Prefecture, except for those involving pediatric patients, amounting to a total of 41,574 incidents. Of those, the number of referrals was missing in 129 cases and the remaining 41,445 incidents were analyzed. Cases with 4 or more referrals were adopted as an indicator of difficulty in choosing a hospital. Using binary logistic regression analysis, odds ratios (ORs) with 95% confidence intervals (CIs) were computed for the times and locations of emergency calls, and the degree of injury or illness. A comprehensive analysis was performed, and stratified analysis by Major Diagnostic Category (MDC) was performed, examining external injuries, burns, and poisoning; nervous system disorders; digestive system, liver, biliary tract, and pancreatic disorders; respiratory disorders; and circulatory system disorders.Results　The distribution of numbers of referrals ranged from 1 to 12, and 79.6% of cases involved 1 referral, while cases with 4 or more referrals made up 3.5% of the total. In the overall analysis, for cases with 4 or more referrals, call times were examined using weekday working hours as a reference; all other times had high ORs (at 95%CI). The highest OR (95%CI) of 4.0 (3.2-5.0) was for late nights during weekends and holidays. Regarding the degree of injury or illness, using moderate and mild injuries as a reference, the number of referrals (3 times or fewer) was significantly lower for severe injuries and incidents of death (0.8;0.7-0.9). However, in the results of the stratified analysis by MDC, external injuries, burns, and poisoning; severe injury; and death each had an OR (95%CI) of 1.4 (1.0-1.8).Conclusion　The relationship between the time, location, and severity of medical emergencies was examined using the number of referrals as an indicator of difficulty with hospital choice in ambulance transport. This research clarified that cases late at night during weekends and holidays, and moderate and mild injuries caused the most difficulty, and that the problems depended on the secondary medical district.