Using J-SIPHE System Could Promote Antibiotic Resistance Measures in Japan

Antibiotic use is key for healing patients in modern medicine, but it can also lead to antibiotic resistance, making the antibiotics useless. Many studies have tackled how to make antibiotics effective again amid the challenges of overuse and abuse of prescribing antibiotics. Even the Center for Disease Control has fought against antibiotic overprescribing throughout the world.

A recent study published in the American Journal of Infection Control (AJIC), “Correlation between antibiotic use and antibiotic resistance: A multicenter study using the Japan Surveillance for Infection Prevention and Healthcare Epidemiology (J-SIPHE) system in Hokkaido, Japan,” discusses this topic and how the J-SIPHE can be used to investigate the levels of antibiotic use and resistance in facilities in Japan in order to eventually mitigate those numbers and promote antimicrobial resistance (AMR) measures. Leading author, Keisuke Kagami, PhD, Department of Pharmacy, Hokkaido University Hospital, Hokkaido, Japan, answered questions for Infection Control Today® (ICT®) about the study.

Infection Control Today^® (ICT^®): A brief summary of the key findings and why they are important.

Keisuke Kagami, PhD: The evidence for the correlation between antibiotic use and antibiotic resistance is controversial. Furthermore, many studies investigating this correlation involve a single facility. Therefore, a multicenter study was required to clarify this correlation.

The Japan Surveillance for Infection Prevention and Healthcare Epidemiology (J-SIPHE) system is a national surveillance system for AMR measures, which was developed by the National Center for Global Health and Medicine, the AMR Clinical Reference Center.

The J-SIPHE system aggregates information related to AMR measures and is intended to be used for promotion of AMR measures in participating facilities and their communities. The aggregated information includes the status of antibiotic use, the emergence of major bacteria and antimicrobial-resistant bacteria, hand rub usage, and the incidence of health care-associated (HAI) and bloodstream infections. Data are uploaded by medical institutions on the website of the J-SIPHE system and aggregated in the J-SIPHE server. The registered information can be visualized as a graph on the website and downloaded at any time. These data can be used by each institution and also by regional or freely created institutional groups.

In the current study, using this system [in 2020], we investigated the correlation between antibiotic use and antibiotic resistance in 19 hospitals in our region and showed the possibility that an increase in carbapenem and quinolone use was associated with an increase in carbapenem-resistant Pseudomonas aeruginosa and fluoroquinolone-resistant Escherichia coli, respectively. The important point is that this is the first multicenter study to investigate the correlation between antibiotic use and antibiotic resistance using the J-SIPHE system and showed that using the J-SIPHE system can easily be used to monitor and evaluate the relationship between antibiotic use and antibiotic resistance in local communities.

ICT^®: What is the practical application for the key findings for infection preventionists from this study?

KK: Although the correlations between antibiotic use and antibiotic resistance were controversial in previous studies, we showed several correlations between antibiotic use and antibiotic resistance. Therefore, we consider recognizing this correlation as a useful tool for developing antimicrobial stewardship policies.

In the current study, we showed that the J-SIPHE system enabled to easily monitor and evaluate this correlation in local communities. Therefore, we believe that the current study could contribute to promoting the use of the J-SIPHE system for other local communities and encourage AMR measures such as antimicrobial stewardship implementation in their facilities in the future.

ICT^®: What results surprised you, if any?

KK: The surprising point is that the J-SIPHE system enabled to easily evaluate the correlation between antibiotic use and antibiotic resistance in multiple centers in local communities. In addition, we are also surprised by the results that an increase in carbapenem and quinolone use was associated with an increase in carbapenem-resistant P. aeruginosa and fluoroquinolone-resistant E. coli, respectively. Thus, it is considered necessary to take AMR measures such as antimicrobial stewardship implementation in each hospital.

ICT^®: What, if any, future research will there be related to this one?

KK: In the future, we would like to increase the number of hospitals to be analyzed for the correlation between antibiotic use and antibiotic resistance and perform several sub-analyses such as by hospital size.

ICT^®: Is there anything else that you would like to add?

KK: Various factors are involved in the development of AMR; therefore, the correlations between antibiotic use and antibiotic resistance were controversial. However, we showed several correlations between antibiotic use and antibiotic resistance in the multicenter study. Based on our results, we consider that the correlation between antibiotic use and antibiotic resistance is important for AMR measures.

We demonstrated the J-SIPHE system is a powerful tool for evaluating this correlation in local communities. We hope our study could contribute to promote AMR measures in several other communities.