The Geriatric Nutritional Risk Index (GNRI) is used to assess nutritional risk in the elderly population based on the percent ideal body weight (IBW) and albumin (Alb) level, while severe infections are associated with hypoproteinemia and hypoalbuminemia, which can make the treatment of infections challenging. Although GNRI is an effective index to assess disease severity, its association with vancomycin (VCM) -induced renal dysfunction has not yet been clarified. In the present study, classification and regression tree (CART) analysis and receiver operating characteristic (ROC) curve were used to determine the GNRI threshold level that discriminates patients with and without renal dysfunction, with a total of 293 patients who were administered VCM being included. We examined the association between GNRI and the incidence of VCM-induced renal dysfunction to explore ways in which GNRI may be used to determine the target VCM trough levels for individual patients. Based on the threshold level, patients were further divided into high and low GNRI groups, and survival analysis was performed based on trough levels (<20, 20-25, ≥25 μg/mL). Bearing in mind that, due to safety concerns, guidelines do not recommend the trough level of >20 μg/mL, in the high GNRI group (≥68, n = 163), there was no significant difference in the rate of renal dysfunction between those with trough levels of <20 and 20-25 μg/mL (p = 0.66), while in the low GNRI group (<68, n = 130), patients with the trough level of 20-25 μg/mL were at a higher risk of developing renal dysfunction than those with trough level of <20 μg/mL (p < 0.01). While this was in agreement with our low GNRI group, our findings suggest that the trough level may be increased to 25 μg/mL in patients who are in the high GNRI group.
Antimicrobial use density (AUD) and days of therapy (DOT) are widely used to evaluate antimicrobial consumption, with surveillance of antimicrobial use being important for predicting the emergence and spread of drug-resistant bacteria. The proportion receiving antimicrobial therapy (n/1,000 admissions) and the AUD/DOT ratio as the assumed average daily dose may be useful additional indicators; however, the correlation between these measurements and antimicrobial resistance remains unclear. While we found that, in univariate analysis, the total AUD/DOT ratios of IPM/CS, panipenem/betamipron (PAPM/BP) and biapenem (BIPM) group, MEPM and doripenem (DRPM) group, and the total proportion receiving antimicrobial therapy with IPM/CS, PAPM/BP and BIPM group were significantly correlated with carbapenem resistance, the aim of this study was to evaluate carbapenem use and daily dose trends for relationships with imipenem/cilastatin (IPM/CS) or meropenem (MEPM) resistance rates of Pseudomonas aeruginosa at our hospital between January 2009 and December 2017. Based on multiple regression analysis, the total AUD/DOT ratio of MEPM and DRPM group was the only significant indicator for resistance rates of IPM/CS (β = −0.818, P = 0.007) and MEPM (β = −0.796, P = 0.010). Furthermore, according to the sigmoid dose-response model analysis, the total AUD/DOT ratio of MEPM and DRPM group equivalent to one tenth of maximum resistance rate was 0.938, suggesting that the AUD/DOT ratio of carbapenem antibiotics is not only an indicator of daily dose, but also of Pseudomonas aeruginosa resistance.
In this study, we conducted a questionnaire survey on infection control at Niigata City General Hospital and with five cooperation hospitals to assess the impact of improvement in infection control performance by cooperation between local healthcare facilities. Additionally, the amount of alcohol-based hand rub and the isolation rate of antimicrobial resistance were investigated. After cooperation between local healthcare facilities in infection control, the amount of alcohol-based hand rub was significantly increased (6.72 vs. 9.52 L/1000 patient-days, P = 0.03), and the number of hospitals that get rewards for infection control was also increased, and the system and activities of the infection control team were strengthened. In addition, isolation rate of methicillin-resistant Staphylococcus aureus and multi-drug-resistant Psudomonas aeruginosa tended to decrease in 2016 compared with in 2014. Our study suggested that cooperation between local healthcare facilities enhanced infection control activities, increased consumption of alcohol-based hand rub, and thus decreased antimicrobial resistance.
The Ministry of Health, Labor and Welfare has established an action plan for antimicrobial resistance, as the spread of antimicrobial-resistant bacteria is currently an urgent problem. One of the goals included in the plan is a 33% reduction in the use of antibacterial agents by 2020, compared with that in 2013. The inappropriate use of antibacterial agents is a likely cause of the increase in antimicrobial-resistant bacteria; thus, various initiatives are being undertaken at medical institutions to emphasize the appropriate use of antibacterial agents, with a distinctive feature of the plan being the ambitious target of a 50% reduction in the use of oral cephalosporins, fluoroquinolones, and macrolide antibiotics, which are used in large quantities in Japan. Herein, various initiatives were undertaken to reduce the use of oral third-generation cephalosporins and fluoroquinolones, and the outcomes of such initiatives have been assessed, with there being few reports on similar initiatives for reducing the use of oral antibacterial agents, although initiatives aimed at limiting the use of injectable antibacterial agents have been reported. The results showed a significant reduction in the overall use of these medications as well as in the number of patients with renal dysfunction who were administered excess oral fluoroquinolones.