Effect of Antimicrobial Stewardship on Oral Quinolone Use and Resistance Patterns over 8 Years (2013–2020)

Abstract

Since 2014, several global and national guidelines have been introduced to address the problem of antimicrobial resistance. We conducted a campaign in a tertiary hospital to promote appropriate quinolone use through educational lectures in 2018. The aim of this retrospective study was to evaluate the changes in the following: prescription characteristics, trend of oral quinolone use, and antibiotic susceptibility of bacteria from 2013 to 2020. Antimicrobial use was assessed as days of therapy per 1000 patient-days. We found a significant reduction in unnecessary antibiotic prescriptions between December 2013 and December 2020. Significant negative trends were detected in the use of quinolones over 8 years (outpatients, coefficient = −0.15655, p < 0.001; inpatients, coefficient = −0.004825, p = 0.0016). In particular, the monthly mean use of quinolones among outpatients significantly decreased by 11% from 2013 to 2014 (p < 0.05) and reduced further by 31% from 2017 to 2020 (p < 0.001). A significant positive trend was observed in the susceptibility of Pseudomonas aeruginosa to levofloxacin (p < 0.001). These results demonstrate that the use of oral quinolones was further reduced following educational intervention and the bacterial susceptibility improved with optimal quinolone usage compared to that in 2013.

Search for Indexes to Evaluate Trends in Antibiotic Use in the Sub-Prefectural Regions Using the National Database of Health Insurance Claims and Specific Health Checkups of Japan

“…This might be because injectable antibiotics are primarily used in inpatients [ 10 ]. In recent years, various interventions have been implemented for the use of oral antibiotics in hospitalized patients [ 20 , 21 , 22 ]. However, no such reports were observed before 2016, when the National Action Plan on AMR was developed, suggesting that the number of patients using oral antibiotics in hospitalized patients scarcely changed.…”

Current Status of Outpatient Oral Antimicrobial Prescription and the Influence of Antimicrobial Stewardship for Inpatients: A Repeated Cross-Sectional Study at a Japanese Community Hospital

“…However, at a Japanese hospital, the prescriptions of fluoroquinolones for both prophylaxis and treatment in the outpatient setting were significantly reduced in 2019 compared to those in 2013. 13) According to antimicrobial sales volume data, fluoroquinolone sales decreased from 2.87 in 2013 to 2.35 (DDD/1000 inhabitants/d) in 2019. 14) Given these reports, a case-by-case analysis of the necessity of fluoroquinolones is necessary, despite being recommended in the JAID/JSC guide or other guides.…”