The detailed epidemiology of invasive mycoses and superficial mycoses has not been clarified in Japan. In addition, treatment options have increased because of novel antifungals and/or guidelines for fungal infection. In the present study, we aimed to clarify the trends of antifungal use in Japan from 2006 to 2015 based on sales data to serve as an alternative indicator of fungal infection trends. We found that the total antifungal use decreased over time (r 0.057, P for trend < 0.0001). Oral and parenteral use significantly decreased by 44.1% (r 0.056, P for trend < 0.0001) and 27.1% (r 0.0012, P for trend 0.00061), respectively. The trend of antifungal use for superficial mycoses significantly decreased by 49.8% (r 0.061, P for trend < 0.0001). However, the trend of antifungal use for invasive mycoses was significantly increased by 19.9% (r 0.0032, P for trend 0.00045). In Japan, the increase in the number of immunocompromised patients might be associated with the increase in the frequency of antifungal use for invasive mycoses. This is the first study to clarify the trends of antifungal use in Japan. Further research is needed to establish a continuous surveillance system to compare fungal infections between Japan and the world. Key words antifungal use; invasive mycosis; superficial mycosis; surveillance DDD; defined daily dose. *DDD was defined as 0.15 by using the dose of 2.5 mg/kg and the standard weight of 60 kg.
Patterns of the use of anti-methicillin-resistant Staphylococcus aureus (MRSA) agents in Japan might be influenced by the launch of new anti-MRSA agents, the publication of relevant guidelines, and the increase in the number of generic medicines. However, as anti-MRSA agents are included in multiple anatomical therapeutic chemical classifications, such as glycopeptides and aminoglycosides, the trends of the use of individual anti-MRSA agents remain unclear. Here, we aimed to clarify the trends of anti-MRSA agent use in Japan from 2006 to 2015 based on sales data. Total anti-MRSA agent use was found to have significantly increased from 2006 to 2015 (P for trend 0.027, r 0.00022). Individual trends for vancomycin (VCM), daptomycin, and linezolid (LZD) use showed significant increases, while those for arbekacin (ABK) and teicoplanin (TEIC) showed decreases. In addition, oral LZD use significantly increased, while there was no significant change in intravenous LZD use. The ratio of oral LZD use to total LZD use increased from 25.5% in 2006 to 39.9% in 2015. Meanwhile, TEIC and ABK use decreased, while VCM use increased, following the launch of generic medicines. These results might reflect the status of guideline compliance, the launch of new anti-MRSA agents, and the decline in the sales promotion of the original medicines. It is extremely important to investigate trends for the use of not only different antibiotic groups but also individual antibiotics to develop and implement antimicrobial resistance countermeasures.
Titanium (Ti) is widely used for oral cavity biomedical devices. However, because it penetrates the mucosa and exists partially external to the tissue, it sometimes induces tissue inflammation, minor infection, or peri-implantitis due to oral bacteria after implantation and causes serious consequences. We have previously shown that poly(ethylene glycol) (PEG)-electrodeposited Ti inhibits bacterial adhesion and biofilm formation. However, the effect of the PEG coating in body fluid is still unclear. In this study, we investigated bacterial colony morphology and biofilm formation on PEG-electrodeposited Ti in comparison with untreated Ti in the presence of saliva. After 48 h incubation, Streptococcus mutans biofilms adhered on the untreated Ti were rigid and cohesive, while those on the PEG-electrodeposited were loose and were easily washed off. These results indicate electrodeposited-PEG layers inhibit the biofilm formation on Ti in the presence of saliva.
In Japan, there is no national surveillance study of Clostridioides (Clostridium) difficile infection (CDI), and details about the epidemiology and treatment status of CDI are unknown. Additionally, clinical practice guidelines (CPGs) for CDI are published by four different institutions. All CPGs recommend that the antimicrobials, vancomycin (VCM) and metronidazole (MNZ), should be selected according to disease severity. However, the trends for VCM and MNZ use in Japan remain unclear. Therefore, this study was aimed at clarifying the secular trends for VCM and MNZ use based on sales data from 2006 to 2015 and discussing its impact on CDI status and drug costs. This is the first study to clarify the antibiotic use trends for CDI treatment. We found that the total use increased over time (r 0.0013, P for trend < 0.0001). While VCM use significantly decreased (r 0.0003, P for trend 0.0002), MNZ use increased (r 0.0017, P for trend < 0.0001). These results show that although treatment for CDI was in line with CPGs, CDI incidence might be on an increasing trend. Additionally, despite the increased total use, the total drug costs decreased by 55% ($ 25 million) from 2006 to 2015. It was also surmised that CDI treatment in compliance with CPGs would lead to a reduction in drug costs. Hence, to understand the epidemiology of CDI, it is important to continuously investigate the use of drugs used for CDI therapy.
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