Abstract
ObjectivesThe supply of cefazolin has been reduced dramatically since March 2019 in Japan. However, no studies have evaluated the effects of cefazolin shortage on the appropriateness of antimicrobial use. Therefore, we compared the appropriateness of inpatient antimicrobial drug use between the two surveys conducted in August 2018 and August 2019 in a Japanese hospital with no supply of cefazolin since the cefazolin shortage.ResultsIn the 2019 survey, a total of 275 patients were included, and 256 patients were included in the 2018 survey. The prevalence of antimicrobial drug use did not change from 2018 to 2019 (28.5% versus 28.7%; p = 0.96). The proportion of cefazolin in all antimicrobial drugs used on the survey date significantly decreased from 2018 to 2019 (24.1% versus 0.0%; p < 0.001). The proportion of appropriate antimicrobial use in all antimicrobial therapies tended to be lower in 2019 than in 2018 (41.2% versus 60.6%; p = 0.06), and the proportion of unnecessary use of a broader spectrum of antimicrobial drugs significantly increased from 2018 to 2019 (4.7% versus 37.3%; p = 0.002). The shortage of cefazolin might lead to inappropriate use of other antimicrobial drugs.
Highlights
Antimicrobial resistance is a major threat to public health
We conducted a point prevalence survey to investigate the appropriateness of antimicrobial therapy in a Japanese hospital with no supply of cefazolin since March 2019 and compared this outcome with those of the survey conducted in August 2018 [14]
The proportion of patients who received any antimicrobial drugs did not change from the previous survey to the present survey (28.5% versus 28.7%; odds ratio (OR) 0.99, 95% confidence interval (CI) 0.68 to 1.44)
Summary
Antimicrobial resistance is a major threat to public health. Infection caused by antimicrobial-resistant bacteria is associated with a poor prognosis and a higher cost burden [1, 2]. One strategy to reduce antimicrobialresistant bacteria is to improve the appropriateness of antimicrobial drug use [3]. The prevalence of antimicrobial drug use is 30–50% [4–14]. The supply of cefazolin to Japanese hospitals has been reduced dramatically because Nichi-Iko Pharmaceutical Co., which covered approximately 60% of the domestic market share of cefazolin in Japan, stopped production of cefazolin due to contaminated ingredients since March 2019 [23–25]. Given that cefazolin is one of most frequently used parenteral antimicrobial drugs in Japan [26], no supply of cefazolin can dramatically change inpatient antimicrobial use. We conducted a point prevalence survey to investigate the appropriateness of antimicrobial therapy in a Japanese hospital with no supply of cefazolin since March 2019 and compared this outcome with those of the survey conducted in August 2018 [14]
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