Regional antimicrobial stewardship program in a provincial medical zone in Japan: A multifaceted approach

抄録

Antimicrobial resistance (AMR) is a threat to patient health. However, there is a lack of data for optimizing antimicrobial use. Furthermore, reducing antibiotic use raises concerns regarding patient safety; there is controversy regarding its effectiveness in reducing AMR prevalence. Researchers at the Japanese Red Cross Ishinomaki Hospital (JRCIH), the only tertiary care hospital in the medical zone, along with local medical and pharmacy associations and public health centers, has been leading the AMR control program since 2018. The program involves lectures aimed at optimizing antimicrobial use, regular publication of surveillance data of drug-resistant strains at the JRCIH, and presentation of first-line treatments for community-acquired infections. Delivery of oral antimicrobials across the region in 2020 was 28.7% lower than that in 2013, with delivery of cephalosporins, quinolones, and macrolides dropping by 34.8%, 46.8%, and 56.0%, respectively. Despite these reductions, there has been no associated increase in the number of patients with severe infectious diseases admitted to the JRCIH. The rates of representative drug-resistant strains bacteremia, such as extended-spectrum beta-lactamase-producing Escherichia coli and methicillin-resistant Staphylococcus aureus, reduced by half. Herein, we demonstrated the potential of collaborative efforts to optimize antimicrobial agent use and reduce AMR prevalence without compromising patient safety.