Abstract
Inappropriate use of antimicrobial agents causes unnecessary patient exposure to medication and emergence of antibiotic resistance. Our institution started to use a notification policy for various classes of antimicrobial agents (carbapenems, fourth-generation cephalosporins and quinolones, ceftazidimes, and antimethicillin-resistant Staphylococcus aureus (MRSA) agents) from November 2005. In this study, consumption of the antimicrobial agents for every half year and the trends of antimicrobial resistance were verified before and after the introduction of the notification policy, and the system was evaluated. Total antimicrobial usage density (AUD) of broad-spectrum antimicrobial agents (i.e. carbapenems, fourth-generation cephalosporins and quinolones) was decreased from 34.1 to 16.0 (p<0.01). The incidence of Pseudomonas aeruginosa isolates resistant to imipenem/cilastatin (IPM/CS) and levofloxacin (LVFX) showed decreasing trends. The detection rate of MRSA was significantly decreased (p<0.05). Multidrug-resistant Pseudomonas aeruginosa (MDRP) and extended-spectrum beta-lactamase (ESBLs) producing enterobacteria were not detected. In contrast, the AUD of anti-MRSA agents was not changed. Education about the effectiveness and appropriate use of anti-MRSA agents was given before the introduction of the notification policy. Therefore, the notification policy for agents to prevent the emergence of resistance may be ineffective. The present study indicates that our notification policy for various classes of antibiotics is effective for reducing excessive broad-spectrum antibiotic use, and control over nosocomial infections in the settings of antimicrobial agents was not used appropriately.
