著者

内藤 結花 前田 真之 長友 安弘 宇賀神 和久 秋間 悦子 田中 道子 時松 一成 佐々木 忠徳

出版者

公益社団法人 日本薬学会

雑誌

YAKUGAKU ZASSHI (ISSN:00316903)

巻号頁・発行日

vol.142, no.5, pp.527-534, 2022-05-01 (Released:2022-05-01)

参考文献数

18

被引用文献数

2

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Antimicrobial stewardship (AS) intervention strategy is a critical process in promoting appropriate antibiotic use, thus preventing unnecessarily prolonged therapy and reducing antimicrobial resistance (AMR). Although limiting unnecessary carbapenem use by AS intervention is speculated to reduce AMR, there is a lack of specific data on the efficacy of AS team (AST) intervention regarding carbapenem-resistant Pseudomonas aeruginosa (CRPA). Consequently, this study aimed to evaluate the impact of our AS strategy on carbapenem use and CRPA. The AS intervention strategy was launched in July 2017 and consisted of daily audits and feedback on carbapenem use. We evaluated the 4-year prescription trend, including the rate of switching to other antimicrobials, and the rate of CRPA and the days of therapy required prior to and after the beginning of the AST intervention. The rate of switching to narrow-spectrum antibiotics and the discontinuation of carbapenem treatment were significantly higher in the pre-intervention period compared with the post-intervention period. (7.0% vs. 14.5%; p<0.001; 54.1% vs. 50.9%; p=0.027). However, there were no significant differences in the rate of CRPA prior to and after the beginning of the AST intervention. Furthermore, there was no correlation found between consumption and resistance rate (Pearson's r=0.123). Our results suggest that it is extremely important for AST to promote de-escalation and reduce unnecessary use, while the combination of process and outcome indicators other than antimicrobial consumption and resistance rate are required for the evaluation of the AS programs.

著者

前田 真之

出版者

公益社団法人 日本薬学会

雑誌

YAKUGAKU ZASSHI (ISSN:00316903)

巻号頁・発行日

vol.141, no.8, pp.995-1000, 2021-08-01 (Released:2021-08-01)

参考文献数

22

被引用文献数

1

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Over the past few decades, the effectiveness of antibiotics has been diminished owing to the emergence of antimicrobial resistance resulting from the overuse of antibiotics. Antimicrobial stewardship aims to improve the appropriateness of antibiotic use to reduce antimicrobial resistance and benefit patients. Antimicrobial stewardship requires structural prerequisites for implementing antimicrobial stewardship programs (ASPs), such as the presence of a multidisciplinary antimicrobial stewardship team (AST), to ensure appropriate antimicrobial use at healthcare facilities. However, manpower shortage for ASTs in most Japanese hospitals has resulted in limited implementation of ASPs. Our study provided a directive for promotion of comprehensive ASPs including various outcome measures. Our findings would provide useful benchmarks for hospitals planning to implement ASPs in Japan as well as around the world. This review provides a framework for evaluating the outcome measures and benchmarks of ASPs based on our study.

著者

具 芳明 藤友 結実子 添田 博 中浜 力 長谷川 直樹 前﨑 繁文 前田 真之 松本 哲哉 宮入 烈 大曲 貴夫

出版者

一般社団法人 日本感染症学会

雑誌

感染症学雑誌 (ISSN:03875911)

巻号頁・発行日

vol.93, no.3, pp.289-297, 2019-05-20 (Released:2019-12-15)

参考文献数

32

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背景:日本では抗菌薬の多くが診療所で処方されているが,その現状や医師の意識はあまり知られていない. 目的:診療所医師の抗菌薬適正使用の現状や意識について調査する.デザイン:診療所医師を対象としたアンケート調査.方法:日本全国の診療所から無作為抽出した1,500診療所に医師を対象とするアンケートを送付した.結果:回収数274回収率18.3%)のうち調査に同意した269通を集計の対象とした.アクションプランや抗微生物薬適正使用の手引きの認知度は低かったが,抗菌薬適正使用についての認識や意識は高かった.感冒や急性気管支炎に抗菌薬を処方している医師が一定数おり,最も処方されているのはマクロライド系抗菌薬であった.処方の背景には医師の知識だけでなく医師患者関係など複雑な要因があることが示唆された.結論:診療所医師の知識向上に加え,医師患者間のコミュニケーション改善などさまざまな手法で外来での抗菌薬適正使用を推進していく必要がある.

著者

地道 正行 前田 真之介 Masayuki Jimichi Shinnosuke Maeda

雑誌

商学論究 (ISSN:02872552)

巻号頁・発行日

vol.63, no.1, pp.39-53, 2015-07-10