At Kumamoto Kino Hospital, the antimicrobial stewardship team (AST) was established to optimize the use of antimicrobial agents in the hospital. A full-time pharmacist in AST (AS pharmacist) responded to various queries regarding issues such as doses and selection of antimicrobial agents from doctors and ward pharmacists. In this study, we examined the details of consultations, acceptance rates of suggestions, and clinical outcomes for ensuring the appropriate use of antimicrobial agents. In a total of 80 consultations (acceptance rate, 95%), 39, 20, 8, 7, and 6 were related to drug selection, dosage and administration, duration of administration, bacterial culture and sensitivity tests, and side effects/interactions, respectively. In the accepted cases, the clinical outcomes were determined to be as cured, indeterminate, and failures, in 49 (83%), 7 (12%), and 3 (5%) cases, respectively, according to the guidelines. Considering these results, we suggest that the implementation of consultations with the AS pharmacist is useful for ensuring the appropriate and optimal usage of antimicrobial agents.

Vancomycin (VCM) dosage in neonates and infants is often based on their postnatal age and body weight. However, discrepancies in measured and target trough concentrations are common. Therefore, this study aimed to determine whether gestational age affected the trough concentrations of VCM in 84 patients at the neonatal intensive care unit from January 2016 to December 2021. The patients were divided into two groups based on the postnatal age (<1 week and ≥1 week), and two groups based on the postmenstrual age (gestational age+postnatal age, ≤37 and ≥37 weeks). Comparisons of the administered doses and trough concentrations revealed no significant differences among the four groups of patients. Conversely, significantly lower doses were observed in the ≤37-week group than in the ≥37-week group; however, no significant differences in trough concentrations were observed between the groups. These findings indicate that preterm infants with wide variations in body weight and immature renal function might be able to achieve target trough concentrations at lower VCM doses. Therefore, considering the postmenstrual age while determining the dosage of VCM might prove beneficial in controlling the blood concentration in the patient.

This report examines whether a prompt initial response after COVID-19 infection of a user is confirmed in an elderly residential facility affects the infection situation. The analysis was based on the results of a survey conducted by the Tokyo Metropolitan Council of Social Welfare. The incidence of clusters in facilities where the initial response was completed in a short time (<3 h) was approximately half that in facilities where it took >3 h to complete the initial response. Moreover, the number of infected users was low, and this trend was more pronounced in the smaller facilities than in the larger facilities. Hence, the initial response must be completed in a short time to prevent the spread of infection in elderly residential facilities. Future studies should focus on investigating the support details to accelerate the initial response of the facility.

We studied the effect of nasal Staphylococcus aureus carriage in nurses at a university hospital on the effectiveness of alcohol-based hand rubs. S. aureus was isolated from the nasal cavities and hands of nurses before the beginning of their shifts as well as immediately after using an alcohol-based hand rub and 30 min and 1, 2, and 4 h later. PFGE analysis of the S. aureus isolates confirmed genetic relatedness. During the 4 h after application of the alcohol-based hand rub, nurses performed routine activities with no restrictions.

Samples were obtained from 70 nurses. Among the 70 nurses, S. aureus was detected in the nasal cavity in 31 cases (44.3%). Furthermore, S. aureus was detected in 10 cases (32.3%) of the hands before alcohol-based hand rub, and in 8 cases, DNA patterns of nasal- and hand-derived strains were identical. Of the 10 cases (32.3%) in which S. aureus was detected on the hands during work, and 5 (16.1%) strains from hands showed the same DNA pattern as that of the strains from the nasal cavity. Moreover, in 39 cases (55.7%) in which S. aureus was not detected in the nasal cavity, S. aureus was detected in 10 cases (25.6%) during work. Furthermore, only one case showed the same DNA pattern from multiple hand samples.

Considering our findings that some of the S. aureus isolates detected in the hands were identical to those detected in the nasal cavity, it was revealed that nasal S. aureus carriage affects the efficacy of alcohol-based hand-rubbing products. This suggests that appropriate hand hygiene immediately before contact with the patient is crucial to prevent direct contact infections.

In late August 2022, the supply of meropenem (MEPM) from generic drug manufacturer T Corp. was discontinued. The National Hospital Organization Kure Medical Center introduced the carbapenem license system and a full-time antimicrobial stewardship team (AST) pharmacist to not only select alternatives to carbapenems but also ensure appropriate use of these drugs. This is a single-center cohort study of process and outcome measures, comparing the preintroduction from February 2022 to August 2022 and postintroduction from September 2022 to March 2023 in patients admitted to our hospital. The number of AST suggestions and consultations per 1000 admissions significantly increased from 1.3 and 0.5 to 3.1 and 1.6 (p < 0.05), respectively. Furthermore, the number of days of therapy (DOTs/1000 patient-days) with carbapenems and total antimicrobial agents with anti-Pseudomonas aeruginosa activity decreased significantly from 46.3±3.7 and 100.9±7.3 days to 10.1±6.7 and 85.4±9.0 days (p < 0.05), respectively. Furthermore, the 30-day mortality rate of patients with bacteremia did not change from 8.1% (17/209 patients) to 6.5% (15/232 patients). The resistance rate of P. aeruginosa was significantly decreased for MEPM (from 19.5% to 6.2%) and DRPM (from 14.9% to 2.5%) (p < 0.05). Thus, these results suggest that the discontinuation of MEPM supply provided an opportunity to promote the appropriate use of carbapenems.