Development of a Framework for Evaluating Appropriateness of Antimicrobial Agent Use

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  • YAMANAKA Naoko
    Infection Control Office, Kitakyushu General Hospital Graduate School of Medical Sciences, Department of Health Care Administration and Management, Kyusyu University
  • IMAMURA Youko
    Department of Pharmacy, Kitakyushu General Hospital
  • FUKUDA Haruhisa
    Graduate School of Medical Sciences, Department of Health Care Administration and Management, Kyusyu University

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Other Title
  • 抗菌薬適正使用評価のための分析フレームワークの構築
  • コウキンヤク テキセイ シヨウ ヒョウカ ノ タメ ノ ブンセキ フレームワーク ノ コウチク

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Abstract

 The inappropriate use of antimicrobial agents can prolong infection treatment durations and encourage the development of drug-resistant bacteria, which may result in the proliferation of infections that are difficult to treat and induce higher healthcare expenditures. This study estimated the proportion of hospitals that appropriately utilize antimicrobial agents, and investigated the potential effects of appropriate utilization on reducing drug expenditure. The analysis used 2 different datasets. The antimicrobial agent susceptibility data from the Clinical Laboratory Division of the Japanese Nosocomial Infection Surveillance (JANIS) program under the Ministry of Health, Labour and Welfare was designated “JANIS data”. The data from a government survey on the post-implementation effects of the diagnosis procedure combination (DPC) reimbursement system was designated “DPC data”. These data were collected from hospitals that are reimbursed under the DPC system. Using the DPC data, we identified patients who had been hospitalized between January 2008 and December 2013 with a major diagnosis of pyelonephritis for inclusion in analysis. A total of 45 study subjects were identified with 50 hospitalization records after taking into account multiple hospitalizations. Based on clinical practice guidelines for the use of antimicrobial agents, we found that antimicrobial agents were appropriately used in 31.1% of the patients. The most frequently used initial antimicrobial agents were tazobactam/piperacillin, followed by meropenem. If the patients who had received inappropriate utilization of antimicrobial agents had undergone appropriate antimicrobial therapy, the reduction in pharmaceutical expenditure would be approximately 8,909 yen per patient. This study verifies that existing JANIS data and DPC data can be used to assess the appropriateness of antimicrobial agent utilization and to estimate the associated reductions in pharmaceutical expenditure. This method could be applied to examine the appropriateness of antimicrobial agent utilization and its economic effects in a large-scale multi-institutional study as a countermeasure against the development and spread of drug-resistant bacteria.<br>

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