Abstract
Frequent use of broad-spectrum antimicrobials is known to lead to the emergence of multidrug-resistant bacteria, so methods to optimize use such as establishing a reporting and permitting system are being discussed. To allow for appropriate selection of antimicrobials, we generated antibiograms based on the drug sensitivity rates for bacteria isolated in our hospital to provide information to guide the selection of antimicrobials most likely to be efficacious against the bacteria identified by gram staining. In addition, to allow for appropriate design of the dosage regimens of the antimicrobial treatment, we developed PK/PD analysis software that can calculate the estimated blood drug concentrations over time and the time above minimum inhibitory concentration, which serves as the basis for determining the appropriate dosage regimens, and provided physicians with information on dosage regimens. As a result of these approaches, the antimicrobial use density of fourth generation cephem antimicrobials, which had been commonly used in the hospital, decreased from 2.72 to 1.12. Drug sensitivity rates (%) of Pseudomonas aeruginosa significantly (p<0.05) increased for cefpirome (58.2 in fiscal 2009 vs. 72.9 in fiscal 2010), cefepime (68.8 vs. 87.7), meropenem (91.0 vs. 95.9), and pazufloxacin (68.3 vs. 87.5). Our approaches appear to have reduced inappropriate use of broad-spectrum antimicrobials and increased the drug sensitivity rates of Pseudomonas aeruginosa.
