Appropriateness of surgical antimicrobial prophylaxis in Japanese university hospitals.

BACKGROUND: Surgical antimicrobial prophylaxis (SAP) is one of the major purposes of antimicrobial use. AIM: To determine the adherence to the Japanese SAP guidelines in Japanese university hospitals. METHODS: This was a retrospective cohort study including 15 general hospitals and one dental university hospital. Up to three cases of 18 designated surgeries were evaluated regarding adherence to Japanese SAP guidelines: selection of antibiotics, timing of administration, re-dosing intervals, and duration of SAP. When all items were appropriate, surgery was defined as 'appropriate'. FINDINGS: In total, 688 cases (22-45 cases per surgery) were included. The overall appropriateness was 46.8% (322/688), and the appropriateness of each surgery ranged from 8.0% (2/25, cardiac implantable electronic device implantation) to 92.1% (35/38, distal gastrectomy). The appropriateness of each item was as follows: pre/intraoperative selections, 78.5% (540/688); timing of administrations, 96.0% (630/656); re-dosing intervals, 91.6% (601/656); postoperative selection, 78.9% (543/688); and duration of SAP, 61.4% (423/688). The overall appropriateness of hospitals ranged from 17.6% (9/51) to 73.3% (33/45). The common reasons for inappropriateness were the longer duration (38.5%, 265/688) and choice of antibiotics with a non-optimal antimicrobial spectrum before/during, and after surgery (19.0%, 131/688 and 16.9%, 116/688, respectively), compared to the guideline. CONCLUSIONS: Adherence to the guidelines differed greatly between the surgeries and hospitals. Large-scale multi-centre surveillance of SAP in Japanese hospitals is necessary to identify inappropriate surgeries, factors related to the appropriateness, and incidences of surgical site infections.

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.

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.