Vol.66 No.2 March 2018
The problem of bacterial antimicrobial resistance in outpatients and the appropriate use of oral antimicrobial agents
1)Nakahama Clinic, 2-15-3 Nakamiya, Asahi-ku, Osaka, Japan
2)Kyurin Medical Laboratory
Abstract
The appropriate use of antimicrobial agents is a major countermeasure against drug-resistant bacteria in outpatient practice. The isolation rates of some drug-resistant bacteria have been reduced, but no satisfactory results have been obtained. Additional countermeasures should be taken to counteract emerging new drug-resistant bacteria. According to drug-resistant bacteria surveillance over the past 10 years, penicillin-resistant Streptococcus pneumoniae (PRSP) has decreased in outpatients, and levofloxacin (LVFX)-resistant S. pneumoniae has rarely been isolated in outpatients, but the isolation rate of these bacteria has increased by 25% on average in adult and elderly inpatients, and nosocomial infections were detected in some facilities for the elderly. In the future, extensive monitoring should be implemented by promoting drug-resistant bacteria surveillance in facilities for the elderly in the community and taking countermeasures against nosocomial infections to prevent the future emergence of multidrug-resistant S. pneumoniae. The emergence of β -lactamase-negative ABPC-resistant (BLNAR) Haemophilus influenzae has been increasing. The frequencies of BLNAR, Low-BLNAR, and β -lactamase nonproducing ampicillin susceptible (BLNAS) H. influenzae are comparable among all patients in the area, suggesting that the spread of drug-resistance genes in the area is also a cause of antimicrobial resistance (AMR). Methicillin-resistant Staphylococcus aureus (MRSA) is uncommon in children, but is common (50%-70%) in adults and the elderly, with no significant change in the isolation rates over the past 10 years. Extended-spectrum β -lactamase-producing (ESBL) Escherichia coli is increasing in all patients, including children, accounting for 20%-30% in outpatients and 40% in inpatients. Of note, no significant difference was observed in either resistance rates or temporal changes in any drug-resistant bacteria between private clinics and outpatient departments. According to a survey on the appropriate use of antimicrobial agents in clinicians, their awareness regarding compliance has improved, but remains insufficient, necessitating continuous education for clinicians working in private or public practice. In addition, many patients blindly rely on antimicrobial agents even today. Therefore, education for the public is considered to be a top priority. On the other hand, many clinicians understand the importance of changing prescriptions for the appropriate use of antimicrobial agents. Thus, various AMR action plans should be implemented in the future to bring about an improvement from the early stage.
Key word
antimicrobial resistance, outpatient, appropriate use, oral antimicrobial agents, action plan
Received
October 2, 2017
Accepted
December 25, 2017
Jpn. J. Chemother. 66 (2): 185-202, 2018
