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Prevalence of antimicrobial use and active healthcare-associated infections in acute care hospitals: a multicentre prevalence survey in Japan
  1. Junpei Komagamine1,
  2. Taku Yabuki1,
  3. Masaki Kobayashi2,
  4. Taro Okabe3
  1. 1 Internal Medicine, National Hospital Orginization Tochigi Medical Center, Utsunomiya, Japan
  2. 2 Geriatrics and Gerontology, National Hospital Organisation Tokyo Medical Center, Meguro-ku, Japan
  3. 3 Internal Medicine, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
  1. Correspondence to Dr Junpei Komagamine; junpei0919{at}


Objective To determine the prevalence of antimicrobial drug use and active healthcare-associated infections (HAIs) and to evaluate the appropriateness of antimicrobial therapy in acute care hospitals in Japan.

Design A prospective multicentre cross-sectional study.

Participants All hospitalised patients on a survey day.

Main outcome measures The primary outcome was the proportion of patients receiving any antimicrobial agents. The secondary outcome was the proportion of patients with active HAIs. The reasons for antimicrobial drug use and appropriateness of antibiotic therapy were also investigated.

Results Eight hundred twenty eligible patients were identified. The median patient age was 70 years (IQR 55–80); 380 (46.3%) were women, 150 (18.3%) had diabetes mellitus and 107 (13.1%) were immunosuppressive medication users. The proportion of patients receiving any antimicrobial drugs was 33.5% (95% CI 30.3% to 36.8%). The proportion of patients with active HAIs was 7.4% (95% CI 5.6% to 9.2%). A total of 327 antimicrobial drugs were used at the time of the survey. Of those, 163 (49.8%), 101 (30.9%) and 46 (14.1%) were used for infection treatment, surgical prophylaxis and medical prophylaxis, respectively. The most commonly used antimicrobial drugs for treatment were ceftriaxone (n=25, 15.3%), followed by piperacillin–tazobactam (n=22, 13.5%) and cefmetazole (n=13, 8.0%). In the 163 antimicrobial drugs used for infection treatment, 62 (38.0%) were judged to be inappropriately used.

Conclusions The prevalence of antimicrobial use and active HAIs and the appropriateness of antimicrobial therapy in Japan were similar to those of other developed countries. A strategy to improve the appropriateness of antimicrobial therapy provided to hospitalised patients is needed.

Trial registration number UMIN000033568

  • epidemiology
  • infectious diseases
  • quality in healthcare

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  • Contributors JK conceived this study. JK, TY and MK designed and wrote the protocol of this study. JK, TO, TY and MK collected data. JK analysed and guaranteed the data and wrote the draft of the manuscript. All authors contributed to the revision of the manuscript and read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval This study was approved by the Medical Ethical Committee of the National Hospital Organization Tochigi Medical Center (No. 30-3) and the Saiseikai Utsunomiya Hospital (No. 2018-07). This study was conducted in accordance with the Ethical Guidelines for Epidemiological Research in Japan and was carried out in accordance with the Declaration of Helsinki. The need for individual informed consent was formally waived by the Medical Ethical Committee of the National Hospital Organization Tochigi Medical Center because data were collected without contacting the patients. However, as per Japanese Ethical Guidelines, an opt-out statement was displayed in the waiting room and webpage of the hospitals to inform the study and provide the opportunity to refuse the use of data for the patients.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data sharing is not applicable because informed consent for data sharing was not received from the participants.

  • Patient consent for publication Not required.

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