Hospital-by-hospital carbapenem use in Japan: a nationwide ecological study.

BACKGROUND: The Japanese healthcare system has been based on universal health coverage since 1961. Nationwide antimicrobial use on a hospital-by-hospital basis has not previously been recorded. OBJECTIVES: To determine the nationwide distribution of carbapenem use on a hospital-by-hospital basis and to build predictive models using available hospital data from Japan. METHODS: An ecological study was conducted using open data released from the Government of Japan. The distribution of days of therapy with carbapenem (per 1000 patient-days) was analysed and predictive models built. The top 1% heavy users by crude distribution and observed-per-predicted ratio distribution were listed and compared. The analysis was conducted in three subcategories stratified by hospital characteristics (tertiary, secondary acute care, and fee-for-service) and among patients in two age groups (16-65 and >65 years). FINDINGS: The median days of therapy in the group aged 16-65 years were 7.24 for tertiary hospitals, 3.28 for secondary acute care hospitals, and 1.42 for fee-for-service hospitals. The median days of therapy of the group aged >65 years were 17.28 for tertiary hospitals, 14.43 for secondary acute care hospitals, and 8.21 for fee-for-service hospitals. For multivariable linear regression analyses, each model selected a different combination of covariates from the potential predictors based on hospital characteristics. CONCLUSION: Because a single predictive model was not appropriate for all hospitals, tailored models are needed to identify hospitals that are heavy users of carbapenem. These findings may serve as a reference to support further research on antibiotic use in healthcare and aid future policies.

Broad-spectrum antibiotic prescriptions are discontinued unevenly throughout the week.

In order to investigate prescribing patterns of in-hospital broad-spectrum antibiotics (antimeticillin-resistant Staphylococcus aureus drugs, carbapenems and piperacillin/tazobactam), data on the distribution of antibiotic initiation and discontinuation throughout the week were analysed at Osaka University Hospital, Japan. No significant differences in the number of initiations were found between weekdays. However, broad-spectrum antibiotics were disproportionately discontinued on Tuesdays or on the second day after a holiday. This study suggests that broad-spectrum antibiotics tend to be continued over weekends or holidays and discontinued thereafter; this is likely to be due to behavioural factors beyond medical indications, and needs to be addressed in future antimicrobial stewardship initiatives.

Impact of an infectious disease specialist on antifungal use: an interrupted time-series analysis in a tertiary hospital in Tokyo.

BACKGROUND: Antimicrobial stewardship programmes are considered essential for optimizing antimicrobial use in order to improve patient outcomes, reduce the number of adverse sequelae, prevent resistance, and ensure cost-effective therapy. AIM: To assess the efficacy and the limitations of antifungal antimicrobial stewardship programmes. METHODS: A bundle to manage infectious diseases was implemented in our hospital in October 2010. Data regarding antimicrobial use density (AUD) from April 2006 to May 2016 were collected. Trends in AUD were assessed using an interrupted time-series model for three separate periods: the pre-bundle, the bundle implementation, and the long-term follow-up periods. The primary and secondary outcomes were AUD (defined daily dose (DDD) per 1000 patient-days) of intravenous antifungals and expenditure on antifungals per fiscal year, respectively. FINDINGS: The AUD for all intravenous antifungals decreased from 26.1 in 2006 to 9.9 in 2015. Whereas the change in the trend during the pre-bundle period was not significant (slope: 0.062; 95% confidence interval (CI): -0.180 to 0.305), a significant decrease was observed in the bundle implementation period (slope: -0.535; 95% CI: -0.907 to -0.164). The trend slowed during the long-term follow-up period (slope: -0.040; 95% CI: -0.218 to 0.138). Total expenditure on antifungals decreased by 73%, from ¥52,354,411 in fiscal year 2006 to ¥14,073,099 in fiscal year 2015. CONCLUSION: The bundle significantly reduced the use of antifungals and decreased costs over time, but this effect was limited in that it had stabilized within three years.