ObjectiveTo determine the prevalence of potentially inappropriate medication (PIM) use at admission and discharge among hospitalised elderly patients and evaluate the association between PIMs at discharge and unplanned readmission in Japan.DesignA prospective observational study conducted by using electronic medical records.ParticipantsAll consecutive patients aged 65 years or older who were admitted to the internal medicine ward were included. Patients who were electively admitted for diagnostic procedures were excluded.Main outcome measuresThe primary outcome was 30-day unplanned readmissions. The secondary outcome was the prevalence of any PIM use at admission and discharge. PIMs were defined based on the Beers Criteria. The association between any PIM use at discharge and the primary outcome was evaluated by using logistic regression.ResultsSeven hundred thirty-nine eligible patients were included in this study. The median patient age was 82 years (IQR 74–88); 389 (52.6%) were women, and the median Charlson Comorbidity Index was 2 (IQR 0–3). The proportions of patients taking any PIMs at admission and discharge were 47.2% and 32.2%, respectively. Of all the patients, 39 (5.3%) were readmitted within 30 days after discharge for the index hospitalisation. The use of PIMs at discharge was not associated with an increased risk of 30-day readmission (OR 0.93; 95% CI 0.46 to 1.87). This result did not change after adjusting for patient age, sex, number of medications, duration of hospital stay and comorbidities (OR 0.78; 95% CI 0.36 to 1.66).ConclusionThe prevalence of any PIM use at discharge was high among hospitalised elderly patients in a Japanese hospital. Although the use of PIMs at discharge was not associated with an increased risk of unplanned readmission, given a lack of power of this study due to a low event rate, further studies investigating this association are needed.Trial registration numberUMIN000027189.

ObjectiveTo 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.DesignA prospective multicentre cross-sectional study.ParticipantsAll hospitalised patients on a survey day.Main outcome measuresThe 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.ResultsEight 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.ConclusionsThe 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 numberUMIN000033568

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