Antimicrobial use in Japanese hospitals: results from a point-prevalence survey in Aichi, 2020

Comprehensive antimicrobial use (AMU) data are essential to promote effective antimicrobial stewardship. However, qualitative information on AMUs in Japanese hospitals is limited.

To provide an overview of AMU for inpatients in Japanese hospitals.

A multi-centre point-prevalence survey was conducted across Aichi Prefecture in 2020, collecting patient demographics, underlying conditions, indications of AMU (for treatment of community-acquired infections (CAIs)/healthcare-associated infections (HAIs), surgical prophylaxis (SP), medical prophylaxis (MP) and others), treated infections, and antimicrobial stewardship team (AST) intervention.

Among the 10,199 patients from 27 hospitals included in this study, a total of 3738 antimicrobials were prescribed to 3024 patients (29.6%; 95% confidence interval: 28.8-30.5). Of these, 1510 (40.4%) antimicrobials were prescribed for CAI treatment, 815 (21.8%) for HAI treatment, 745 (19.9%) for SP, and 639 (17.1%) for MP. SP administration over 2 days was observed in 31.2% of the cases. The top three prescribed antimicrobials were cefazolin (12.0%, 450), ceftriaxone (9.2%, 343), and oral trimethoprim-sulfamethoxazole (8.7%, 327). AMU per 1000 patients was highest in extra-large hospitals (472) and lowest in small hospitals (264). Ceftriaxone was most commonly prescribed for CAIs, while meropenem was typical for HAIs. AST intervention rates were 15.0% and 22.5% in CAIs and HAIs, respectively.

This study provides comprehensive AMU information from a region in Japan, highlighting variations linked to hospital size, frequent prescriptions of broad-spectrum antimicrobials for HAIs, high prescription rate of trimethoprim-sulfamethoxazole as MP, and prolonged SAP.