An alternative index for evaluating AMU and anti-methicillin-resistant Staphylococcus aureus agent use: A study based on the National Database of Health Insurance Claims and Specific Health Checkups data of Japan

Yosuke Mita,Ryo Inose,Ryota Goto,Yoshiki Kusama,Ryuji Koizumi,Daisuke Yamasaki,Masahiro Ishikane,Masaki Tanabe,Norio Ohmagari,Yuichi Muraki

doi:10.1016/j.jiac.2021.02.009

Abstract

IntroductionAnti-methicillin-resistant Staphylococcus aureus (MRSA) agents have different doses and administration periods. Thus, it is difficult to evaluate antimicrobial use (AMU) of anti-MRSA agents using defined daily doses per 1000 inhabitants per day (DID) or days of therapy per 1000 inhabitants per day (DOTID). This study aimed to evaluate the relationship between anti-MRSA agent use and resistant bacteria using the number of patients per 1000 inhabitants per day (PID) as an alternative index of AMU. MethodsAMU data for anti-MRSA agents were collected from the National Database of Health Insurance Claims and Specific Health Checkups (NDB) in 2016. The relationship between PID and DID or DOTID was evaluated. The number of patients with MRSA isolated was obtained from Japan Nosocomial Infections Surveillance, and their correlation with PID was analyzed. The rate of anti-MRSA agent use in each prefecture was investigated. ResultsPID showed a significant linear relationship with both DID and DOTID (all p < 0.0001). PID was significantly correlated with the number of patients with MRSA isolated. Additionally, the rate of anti-MRSA agent use was markedly different in each region. ConclusionsPID is not affected by doses and administration periods, and thus may be an alternative index for the selective pressure of antibiotics. Evaluating AMU using PID based on NDB data will help in the development of effective antimicrobial resistance measures.

Highlights

Anti-methicillin-resistant Staphylococcus aureus (MRSA) agents have different doses and administration periods
Antimicrobial-resistant bacteria are the major threat in the world [1e3], and methicillin-resistant Staphylococcus aureus (MRSA) is one of the typical resistant bacteria
It is assumed that PID is less affected by various confounding factors than doses per inhabitants per day (DID) or DOTID when selective pressure is evaluated in each region

Summary

Introduction

Anti-methicillin-resistant Staphylococcus aureus (MRSA) agents have different doses and administration periods. It is difficult to evaluate antimicrobial use (AMU) of anti-MRSA agents using defined daily doses per 1000 inhabitants per day (DID) or days of therapy per 1000 inhabitants per day (DOTID). This study aimed to evaluate the relationship between anti-MRSA agent use and resistant bacteria using the number of patients per 1000 inhabitants per day (PID) as an alternative index of AMU. Evaluating AMU using PID based on NDB data will help in the development of effective antimicrobial resistance measures. In Japan, the national action plan on AMR was formulated, and set six goals in 2016 In one of these goals, the importance of monitoring antimicrobial use (AMU) as well as the trend of resistant bacteria has been described [5]. The aim is to reduce MRSA to 20% or less by 2020 [5]

Objectives

Methods

Results

Discussion

Conclusion