title: Nationwide surveillance of antimicrobial consumption and resistance to Pseudomonas aeruginosa isolates at 203 Japanese hospitals in 2010.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Fifth Subcommittee, Committee on Academic, Japanese Society of Hospital Pharmacists, Tokyo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Muraki
authors.forename: M
authors.initials: M
authors.lastname: Kitamura
authors.forename: Y
authors.initials: Y
authors.lastname: Maeda
authors.forename: T
authors.initials: T
authors.lastname: Kitahara
authors.forename: T
authors.initials: T
authors.lastname: Mori
authors.forename: H
authors.initials: H
authors.lastname: Ikeue
authors.forename: M
authors.initials: M
authors.lastname: Tsugita
authors.forename: K
authors.initials: K
authors.lastname: Tadano
authors.forename: K
authors.initials: K
authors.lastname: Takada
authors.forename: T
authors.initials: T
authors.lastname: Akamatsu
authors.forename: T
authors.initials: T
authors.lastname: Yamada
authors.forename: T
authors.initials: T
authors.lastname: Yamada
authors.forename: T
authors.initials: T
authors.lastname: Shiraishi
authors.forename: M
authors.initials: M
authors.lastname: Okuda
mesh_terms: D000583:Amikacin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial; D004363:Drug Utilization / Q000706:statistics & numerical data*; D017723:Drug Utilization Review / Q000379:methods; D006761:Hospitals / Q000592:standards; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D000077731:Meropenem; D008826:Microbial Sensitivity Tests; D009313:National Health Programs; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000453:epidemiology; D011550:Pseudomonas aeruginosa / Q000187:drug effects* / Q000302:isolation & purification; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013845:Thienamycins / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D013845:Thienamycins; D002939:Ciprofloxacin; D015378:Imipenem; D000583:Amikacin; D000077731:Meropenem