105 results on '"Kusama, Y."'
Search Results
2. Many choices but a little diversity of formulary in Japanese hospitals
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Kusama, Y., primary, Mochizuki, T., additional, Kurai, H., additional, Tanaka, C., additional, Kimura, Y., additional, Ishikane, M., additional, Gu, Y., additional, and Ohmagari, N., additional
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- 2018
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3. Application of a non-steady-state orbit-following Monte-Carlo code to neutron modeling in the MAST spherical tokamak
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Tani, K, primary, Shinohara, K, additional, Oikawa, T, additional, Tsutsui, H, additional, McClements, K G, additional, Akers, R J, additional, Liu, Y Q, additional, Suzuki, M, additional, Ide, S, additional, Kusama, Y, additional, and Tsuji-Iio, S, additional
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- 2016
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4. Experimental investigation of timing jitter of a 1.06-μm gain-switched laser diode for stimulated Raman scattering microscopy
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Tokunaga, K., primary, Fang, Y.-C., additional, Kusama, Y., additional, Yokoyama, H., additional, and Ozeki, Y., additional
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- 2015
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5. Effects of the radial electric field on the confinement of fast ions in ITER
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Tani, K., primary, Honda, M., additional, Oikawa, T., additional, Shinohara, K., additional, Kusama, Y., additional, and Sugie, T., additional
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- 2015
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6. Zeaxanthin and Echinenone Protect the Repair of Photosystem II from Inhibition by Singlet Oxygen in Synechocystis sp. PCC 6803
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Kusama, Y., primary, Inoue, S., additional, Jimbo, H., additional, Takaichi, S., additional, Sonoike, K., additional, Hihara, Y., additional, and Nishiyama, Y., additional
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- 2015
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7. Assessment of Intracranial Collaterals on CT Angiography in Anterior Circulation Acute Ischemic Stroke
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Yeo, L.L.L., primary, Paliwal, P., additional, Teoh, H.L., additional, Seet, R.C., additional, Chan, B.P., additional, Ting, E., additional, Venketasubramanian, N., additional, Leow, W.K., additional, Wakerley, B., additional, Kusama, Y., additional, Rathakrishnan, R., additional, and Sharma, V.K., additional
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- 2014
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8. First Pediatric Case of Endocarditis Caused by Moraxella nonliquefaciens : Importance of Molecular Diagnosis.
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Yoshitake S, Kusama Y, Shiomi F, Nakahashi T, Toyota N, Yoshizawa K, Ito Y, and Kamimura K
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- Humans, Male, Anti-Bacterial Agents therapeutic use, Molecular Diagnostic Techniques, Child, Female, Moraxellaceae Infections diagnosis, Moraxellaceae Infections drug therapy, Moraxellaceae Infections microbiology, Moraxella genetics, Moraxella isolation & purification, Endocarditis, Bacterial diagnosis, Endocarditis, Bacterial microbiology, Endocarditis, Bacterial drug therapy
- Abstract
Competing Interests: The authors have no funding or conflicts of interest to disclose.
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- 2024
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9. Can the "Access" percentage assess the antibiotic use appropriateness?
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Kusama Y
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- Humans, Antimicrobial Stewardship statistics & numerical data, Anti-Bacterial Agents therapeutic use, Inappropriate Prescribing statistics & numerical data
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Competing Interests: Declaration of competing interest None.
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- 2024
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10. An Infant With COVID-19 Presenting With a Bulging Fontanel: A Case Report and Literature Review.
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Kuroda H, Kusama Y, Ogura A, Matsunaga T, Atsumi Y, and Kamimura K
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A bulging fontanel is a sign of elevated intracranial pressure, which can be caused by diseases with intracranial fluid retention or swelling of the cerebral parenchyma. We experienced a case of an infant with a typical course of mild coronavirus disease 2019 (COVID-19) but with a bulging fontanel as a finding at presentation. The patient, a three-month-old boy with no underlying conditions, presented to the emergency clinic with fever, vomiting, and loss of appetite. Due to the absence of crying and the bulging fontanel, he was referred to our hospital with suspected bacterial meningitis. The diameter of the anterior fontanel was 2.5 cm, as measured by the Popich and Smith method. He showed no signs of consciousness impairment and appeared to be as active as usual. Computed tomography revealed a bulging fontanel. Cerebrospinal fluid examination showed no elevated cell counts, and cultures were negative. Accordingly, bacterial meningitis was ruled out. The fever resolved on the day after admission, and the patient was discharged on the third day after admission in good general condition. When an infant diagnosed with COVID-19 presents with a bulging fontanel, it is important to be aware of its low specificity and excessive antibiotic treatment should be reconsidered., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kuroda et al.)
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- 2024
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11. Factors Associated with Geographical Variability of Antimicrobial Use in Japan.
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Kitano T, Tsuzuki S, Koizumi R, Aoyagi K, Asai Y, Kusama Y, and Ohmagari N
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Introduction: Evidence regarding the factors affecting the geographical variation of antimicrobial use (AMU) is relatively scarce. This study aimed to evaluate factors potentially associated with geographical variability of AMU per day per 1000 habitants in the 47 prefectures of Japan., Methods: This is an observational ecological study using the Japanese national database in 2019. The outcome was the defined daily doses per 1000 inhabitants per day by prefecture. Multivariable negative binomial regression analysis was conducted using patient- and physician-level variables., Results: The study included 605,391,054 defined daily doses of AMU in 2019 from the 47 prefectures. In the multivariable negative binomial regression analyses for the outcome of total AMU, the proportion of female individuals (adjusted rate ratio [aRR] 1.04 [1.01-1.08] per 1% increase, p = 0.021), the proportion of upper secondary graduates going to further education (aRR 1.01 [1.00-1.01] per 1% increase, p = 0.005), and the annual number of diagnoses related to upper respiratory infections (URIs) per 1000 inhabitants per day (aRR 1.21 [1.10-1.34], p < 0.001) were significantly correlated with total AMU., Conclusions: In this ecological study, the variability of total AMU by Japanese prefecture was associated with the proportion of female individuals, education level, and the number of URI diagnoses per population. The results suggest the potential need for additional stewardship efforts to reduce unnecessary antimicrobial prescriptions for URI., (© 2023. The Author(s).)
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- 2023
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12. Guidelines for the Management of Respiratory Infectious Diseases in Children in Japan 2022.
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Ishiwada N, Shinjoh M, Kusama Y, Arakawa H, Ohishi T, Saitoh A, Suzuki A, Tsutsumi H, Nishi J, Hoshino T, Mitsuda T, Miyairi I, Iwamoto-Kinoshita N, Kobayashi H, Satoh K, Shimizu A, Takeshita K, Tanaka T, Tamura D, Tokunaga O, Tomita K, Nagasawa K, Funaki T, Furuichi M, Miyata I, Yaginuma M, Yamaguchi Y, Yamamoto S, Uehara S, Kurosaki T, Okada K, and Ouchi K
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- Child, Humans, Japan epidemiology, Communicable Diseases diagnosis, Communicable Diseases epidemiology, Communicable Diseases therapy, Respiratory Tract Infections diagnosis, Respiratory Tract Infections drug therapy, Respiratory Tract Infections epidemiology
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The members of the Japanese Society for Pediatric Infectious Diseases and the Japanese Society of Pediatric Pulmonology have developed Guidelines for the Management of Respiratory Infectious Diseases in Children with the objective of facilitating appropriate diagnosis, treatment and prevention of respiratory infections in children. The first edition was published in 2004 and the fifth edition was published in 2022. The Guideline 2022 consists of 2 parts, clinical questions and commentary, and includes general respiratory infections and specific infections in children with underlying diseases and severe infections. This executive summary outlines the clinical questions in the Guidelines 2022, with reference to the Japanese Medical Information Distribution Service Manual. All recommendations are supported by a systematic search for relevant evidence and are followed by the strength of the recommendation and the quality of the evidence statements., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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13. Investigation of oral macrolide prescriptions in Japan using a retrospective claims database, 2013-2018.
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Ide S, Ishikane M, Aoyagi K, Ono A, Asai Y, Tsuzuki S, Kusama Y, Gu Y, Kodama E, and Ohmagari N
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- Humans, Macrolides therapeutic use, Retrospective Studies, Japan, Anti-Bacterial Agents therapeutic use, Prescriptions, Observational Studies as Topic, Common Cold drug therapy, Anti-Infective Agents, Hypersensitivity drug therapy
- Abstract
Macrolide usage in Japan exceeds that in Europe and the United States. Investigating the actual conditions in which macrolides are used is important for identifying further interventions for appropriate antimicrobial use; however, this situation has not been evaluated in Japan. Therefore, we aimed to clarify the number of macrolide prescriptions and their changes before and after implementation of the Antimicrobial Resistance (AMR) Action Plan. In addition, we also investigated the names of diseases for which macrolides have been prescribed and the number of days of prescription. A retrospective observational study was conducted using JMDC claims data from January 2013 to December 2018. The proportion of all oral antimicrobials and macrolides used during this period and the diseases for which macrolides were used in the 3 years before and after the AMR Action Plan were determined separately for acute (< 14 prescription days) and chronic (> 14 prescription days) diseases. The number of prescriptions for macrolides constituted approximately 30% of those for all oral antimicrobials; of these, clarithromycin accounted for approximately 60%. Most prescriptions for acute diseases were for common cold, whereas allergic and dermatological diseases were included among chronic diseases. The names of these illnesses did not change before and after the AMR Action Plan. Overall, these results indicate that appropriate macrolide use involves a review of their use for common cold along with appropriate evaluation of their long-term use for skin and allergic diseases. They also indicate the need for further fact-finding studies and ongoing AMR measures., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Ide et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2023
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14. Intussusception Initially Diagnosed as a Brief Resolved Unexplained Event (BRUE).
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Atsumi Y, Kusama Y, Fukui S, and Kamimura K
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Brief resolved unexplained event (BRUE) are transient and worrying episodes observed in infants and are characterized by changes in skin color, breathing, muscle tone, and/or responsiveness. We describe the case of a female infant who was initially diagnosed with BRUE but was later determined to have intussusception. She presented to our emergency department with a transient pallor and a single episode of vomiting that resolved before her visit. Physicians did not detect any abnormalities on physical or laboratory examinations, so she was diagnosed with BRUE and discharged to be re-evaluated the next day. After returning home, she vomited several times. The patient revisited our hospital the following day and was definitively diagnosed with intussusception using ultrasonography, which was successfully treated using fluoroscopy-guided hydrostatic reduction. This case was initially diagnosed as a BRUE; however, re-evaluation helped in identifying the proper diagnosis of intussusception. Physicians should exercise caution when diagnosing patients with BRUE. When the diagnostic criteria are not completely met, follow-up should be conducted, assuming that the patient has a potentially serious condition., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Atsumi et al.)
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- 2023
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15. Two Pediatric Cases of Food Protein-Induced Enterocolitis Syndrome to Soy Eaten as an Infant Food.
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Maeda K, Kusama Y, Atsumi Y, Takahara T, and Kamimura K
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Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy that can be caused not only by infant formula but also by infant food. Herein, we report two pediatric cases of FPIES to solid soy foods, such as tofu. The patients presented with repetitive vomiting after eating the trigger food as infant food. Although both cases promptly recovered following the cessation of the trigger food, one case required rapid intravenous hydration for compensated shock. Both cases were diagnosed with FPIES to soy based on the typical presentation and parental interviews regarding food exposure. One case had a positive response to an oral food challenge for tofu, and both cases were negative for soy-specific IgE. One of our cases did not develop FPIES from fermented soy products despite having soy-triggered FPIES. The fermentation process may reduce the allergenicity of soy, but further evidence is required to confirm this hypothesis. There are various trigger foods for solid food FPIES (SFF), and these differ among countries. Solid food FPIES to soy is more common in Japan than in other countries due to the frequent use of tofu in infant food. Increased international awareness of the possibility of tofu-triggered FPIES may be warranted due to the rising global use of tofu in infant food., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Maeda et al.)
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- 2023
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16. The Incidence of Serious/Invasive Bacterial Diseases in Infants 90 Days Old or Younger at an Emergency Hospital in Japan.
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Yoshitake S, Kusama Y, Ito K, Kuroda H, Yamaji M, Ishitani K, Ito Y, Kamimura K, and Maihara T
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Background The incidence of severe bacterial infections (SBIs) in infants aged ≤90 days is thought to have decreased because of widespread vaccination programs. However, relevant epidemiological data in Japan are scarce. Materials and methods This observational, single-center study investigated the epidemiology of fever in infants aged ≤90 days. SBI was defined as the presence of meningitis, urinary tract infections (UTIs), or bacteremia. Invasive bacterial infection (IBI) was defined as the presence of meningitis, bacteremic UTI, or bacteremia. We determined the incidence of UTIs, bacteremia, meningitis, SBIs, and IBIs in the following three age groups: 0-28, 29-60, and 61-90 days. We subsequently calculated the relative incidence for the groups aged 29-60 and 61-90 days, using the group aged 0-28 days as the reference group. Results Herein, 58, 124, and 166 infants were included in the 0-28 days, 29-60 days, and 61-90 days age groups, respectively. Of the total number of patients, 15.5%, 8.9%, and 16.9% in the 0-28 days, 29-60 days, and 61-90 days age groups, respectively, were diagnosed with SBI. The relative incidences were 1 for the 0-28 days group (reference group), 0.67 for the 29-60 days group (95% confidence interval [CI], 0.39-1.15), and 1.08 for the 61-90 days group (95% CI, 0.58-2.00). Of the total number of patients, 10.3%, 3.2%, and 0.6% in the 0-28 days, 29-60 days, and 61-90 days age groups, respectively, were diagnosed with IBI. Relative incidences were 1 (reference group), 0.50 (95% CI, 0.29-0.88), and 0.28 (95% CI, 0.19-0.41) for the 0-28 days, 29-60 days, and 61-90 days age groups, respectively. All cases of IBI were caused by Group B streptococcus (GBS), except for two cases of bacteremia, which were caused by Haemophilus influenzae . Conclusion The incidence of SBI was similar in the 0-28 days and 61-90 days age groups. However, the incidence of IBI decreased with increasing age. The incidence of UTIs was highest in the 61-90 days age group, and that of meningitis and bacteremia decreased with increasing age., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Yoshitake et al.)
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- 2023
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17. Gravity-driven microfluidic device placed on a slow-tilting table enables constant unidirectional perfusion culture of human induced pluripotent stem cells.
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Limjanthong N, Tohbaru Y, Okamoto T, Okajima R, Kusama Y, Kojima H, Fujimura A, Miyazaki T, Kanamori T, Sugiura S, and Ohnuma K
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- Humans, Microfluidics, Cell Culture Techniques, Perfusion, Lab-On-A-Chip Devices, Induced Pluripotent Stem Cells
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Gravity-driven microfluidics, which utilizes gravity force to drive liquid flow, offers portability and multi-condition setting flexibility because they do not require pumps or connection tubes to drive the flow. However, because the flow rate decreases with time in gravity-driven microfluidics, it is not suitable for stem cell experiments, which require long-term (at least a day) stability. In this study, gravity-driven microfluidics and a slow-tilting table were developed to culture cells under constant unidirectional perfusion. The microfluidic device was placed on a slow-tilting table, which tilts unidirectionally at a rate of approximately 7° per day to compensate for the reduction in the flow rate. Computational simulations showed that the pulsation of the flow arising from the stepwise movement of the table was less than 0.2%, and the flow was laminar. Hydrophilization of the tanks increased the flow rate, which is consistent with the theoretical values. We showed that vitronectin is better than laminin 511 fragments as a coating material for adhering human induced pluripotent stem cells on a microchamber made of polydimethylsiloxane, and succeeded in culturing the cells for 3 days. It is believed that the system offers easy-to-use cell culture tools, such as conventional multiwell culture vessels, and enables the control of the cell microenvironment., (Copyright © 2022 The Society for Biotechnology, Japan. Published by Elsevier B.V. All rights reserved.)
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- 2023
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18. Effects of population age structure on parenteral antimicrobial use estimations.
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Koizumi R, Kusama Y, Asai Y, Tsuzuki S, Aoyagi K, Ishikane M, Muraki Y, and Ohmagari N
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- Child, Humans, Aged, Aged, 80 and over, Japan, Databases, Factual, Data Collection, Anti-Infective Agents therapeutic use, Antimicrobial Stewardship
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Antimicrobial use (AMU) is conventionally reported as unadjusted defined daily doses (DDDs) or population-adjusted DDDs per 1000 inhabitants per day (DID). DID is frequently used to monitor national AMU trends, this metric does not intrinsically take temporal changes in population age structure into account. We examined the effects of population age structure on DID estimates of parenteral AMU in Japan, and predicted future trends in DDDs based on population projections. Parenteral AMU data from 2013 to 2018 were acquired from a national claims database. We assessed temporal trends in parenteral AMU by age group (children aged < 15 years, working-age persons aged 15-64 years, and older persons aged ≥ 65 years) using both DID and DDDs. In addition, we modeled DDD predictions based on age-specific population projections from 2019 to 2030. DID values for older persons were 8.08-10.15 times and 5.43-5.63 times higher than in children and working-age persons, respectively. DID was stable, but DDDs increased in older persons. The prediction models showed that DDDs will continue to increase until 2030 if DID remains steady or decreases. DID estimates were skewed by the older population. More rigorous antimicrobial stewardship efforts targeting geriatric care are needed to counter the aging-associated increase in AMU., (© 2023. The Author(s).)
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- 2023
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19. A Case of Eating Disorder Diagnosed As Orthorexia Nervosa.
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Yoshimura A, Kusama Y, Omura Y, Shibata M, and Maihara T
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A 13-year-old girl presented to our hospital with chief complaints of rapid weight loss, fatigue, discomfort, chills in the extremities, and alopecia. We initially suspected anorexia nervosa (AN). However, she did not express fear of gaining weight or have a distorted perception of her weight or body shape; thus, her presentation was not typical of AN. We also suspected avoidant/restrictive food intake disorder (ARFID), but she did not exhibit any food-avoidance behaviors. However, she was obsessed with nutrition control, so we diagnosed her with orthorexia nervosa (ON). She was hospitalized, given education on proper nutrition, and her eating behavior subsequently improved. After discharge, we administered the ORTO-15, which assesses the propensity for ON, and her score met the diagnostic criteria for ON. The incidence of ON has increased during the COVID-19 pandemic. In this case, her obsession was brought about by information she read in magazines and on social media that promoted an unbalanced diet centered almost exclusively on vegetables. Pediatricians should raise awareness of misinformation regarding children's health to ensure healthy growth., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Yoshimura et al.)
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- 2023
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20. Necessity for a System Implementing Therapeutic Drug Monitoring in Outpatient Settings Based on the Actual Use of Voriconazole Using the National Database of Health Insurance Claims and Specific Health Checkups of Japan: A Descriptive Epidemiological Study.
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Muraki Y, Koizumi R, Kusama Y, Inose R, Ishikane M, and Ohmagari N
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- Humans, Voriconazole therapeutic use, Japan, Insurance, Health, Outpatients, Drug Monitoring
- Abstract
Voriconazole (VRCZ) is an antifungal drug that necessitates therapeutic monitoring (TDM). Typically, TDM is recommended for patients undergoing long-term outpatient treatment. However, in Japan, insurance reimbursement for TDM is only permitted for inpatients. There is a concern that VRCZ use is growing among outpatients, although information regarding this issue remains unavailable. Therefore, we aimed to clarify the use of VRCZ by utilizing data from the National Database of Health Insurance Claims and Specific Health Checkups in Japan. The use of branded and generic oral VRCZ from 2013 to 2019 was calculated using the defined daily doses/1000 inhabitants/d (DID) for each receipt type. Oral VRCZ was used more frequently in the outpatient setting than that in the inpatient setting, with use increasing over time. The use of generic drugs began in 2016 and accounted for 52.5% of the use in 2019 among outpatients. Considering outpatient prescriptions, 76.4-81.0% were dispensed at insurance pharmacies, indicating the need for community pharmacist involvement. Accordingly, the appropriate use of VRCZ in ambulatory care should be promoted in collaboration with community pharmacists, and a reimbursement system should be established to implement TDM in ambulatory care.
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- 2023
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21. Negative effects of pre-admission screening with simplified multiplex PCR.
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Suzuki Y, Kusama Y, and Ito Y
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- 2023
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22. Linezolid-induced black hairy tongue in a child following osteomyelitis.
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Tomita Y, Kusama Y, Nishiyama C, Atsumi Y, and Kamimura K
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- Humans, Child, Linezolid adverse effects, Tongue, Tongue, Hairy chemically induced, Tongue, Hairy diagnosis, Osteomyelitis diagnosis, Osteomyelitis drug therapy
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- 2023
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23. Comparing the effects of antimicrobial stewardship at primary emergency centers.
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Otake S, Kusama Y, Tsuzuki S, Myojin S, Kimura M, Kamiyoshi N, Takumi T, Ishida A, and Kasai M
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- Child, Humans, Anti-Bacterial Agents therapeutic use, Anti-Bacterial Agents pharmacology, Retrospective Studies, Hospitals, Antimicrobial Stewardship, Anti-Infective Agents
- Abstract
Background: Antimicrobial prescription rates tend to be high in outpatient settings and Primary Emergency Medical Centers (PECs) in Japan encounter difficulties in implementing antimicrobial stewardship programs (ASPs). While a nudge-based ASP publishing monthly newsletters reduces inappropriate prescription of oral third-generation cephalosporins (3GCs), which requires considerable effort. Therefore, developing more preferable ASP models in PECs is essential., Methods: We conducted a three-center, retrospective observational study. Himeji City Emergency Medical Center (Site A) introduced a facility-specific guideline for antimicrobial stewardship with reference to national guidelines. The Kobe Children's Primary Emergency Medical Center (Site B) provided the results of monitoring antibiotics prescription in a monthly newsletter. The Hanshin-Kita Children's First-Aid Center (Site C) did not perform a specific ASP. Prescription rates for 3GCs were categorized into pre- and post-intervention and compared using Poisson regression analysis. The difference-in-difference method was used to assess the effect of these interventions., Results: The numbers of patients pre- and post- intervention were 177,126 and 91,251, respectively. The 3GCs prescription rate at Site A, Site B, and Site C decreased from 6.7%, 4.2%, and 6.1% in 2016 to 2.3%, 1.0%, and 2.0% in 2019, respectively. Site B had a greater reduction than Site A and Site C (relative risk [RR] 0.71 [95% confidence interval (CI): 0.62-0.82]; p < 0.001, RR 0.71, [95% CI: 0.62-0.81]; p < 0.001). There was no significant difference between Site A and Site C (RR 1.00 [95% CI 0.88-1.13]; p = 0.963)., Conclusion: A facility-specific guideline was less effective than a nudge-based ASP for decreasing oral 3GC prescriptions in PECs., (© 2023 Japan Pediatric Society.)
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- 2023
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24. Physician practices in the diagnosis and treatment of infectious diseases in home care settings: A questionnaire study.
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Kusama Y, Miyahara M, Ishikane M, Suzuki K, Gu Y, Sasaki J, and Ohmagari N
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To elucidate the current practices of infectious disease management in home care settings in Japan, we sent a questionnaire to 36 physicians working at 13 clinics that specialize in providing care to patients in their homes or residential care facilities. The questionnaire described three hypothetical scenarios (aspiration pneumonia, pyelonephritis, and neoplastic fever) in older patients with terminal cancer, and 25 respondents answered questions on testing and treatment strategies. Most respondents chose to obtain cultures for aspiration pneumonia (sputum) and for pyelonephritis (urine), although fewer respondents chose to obtain blood cultures. For neoplastic fever, most of respondents elected to continue observation without antibiotic treatment. The most frequently selected antibiotics were cephalosporins and quinolones. The results indicated that most respondents would perform bacterial culture tests before prescribing antibiotics and observe patients when bacterial infections are not suspected. Standardized guidelines are needed to optimize infectious disease management in home care., Competing Interests: The authors have no conflicts of interest to disclose., (2022, National Center for Global Health and Medicine.)
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- 2022
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25. Influence of pharmacists and infection control teams or antimicrobial stewardship teams on the safety and efficacy of vancomycin: A Japanese administrative claims database study.
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Goto R, Muraki Y, Inose R, Kusama Y, Ono A, Koizumi R, Ishikane M, and Ohmagari N
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- Anti-Bacterial Agents adverse effects, Humans, Infection Control, Japan, Pharmacists, Retrospective Studies, Vancomycin adverse effects, Acute Kidney Injury drug therapy, Acute Kidney Injury epidemiology, Antimicrobial Stewardship, Methicillin-Resistant Staphylococcus aureus, Staphylococcal Infections drug therapy
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Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) has a high mortality and requires effective treatment with anti-MRSA agents such as vancomycin (VCM). Management of the efficacy and safety of VCM has been implemented with the assignment of pharmacists in hospital wards and the establishment of teams related to infectious diseases. However, there are no reports evaluating the association between these factors and the efficacy and safety of VCM in large populations., Methods: This study used the Japanese administrative claims database accumulated from 2010 to 2019. The population was divided into two groups, therapeutic drug monitoring (TDM) group and non-TDM group, and adjusted by propensity score matching. We performed multivariate logistic regression analysis to determine the influence of pharmacists and infection control teams or antimicrobial stewardship teams on acute kidney injury (AKI) and 30-day mortality., Results: The total number of patients was 73 478 (TDM group, n = 55 269; non-TDM group, n = 18 209). After propensity score matching, 18 196 patients were matched in each group. Multivariate logistic regression analysis showed that pharmacological management for each patient contributed to the reduction of AKI (odds ratio [OR]: 0.812, 95% confidence interval [CI]: 0.723‒0.912) and 30-day mortality (OR: 0.538, 95% CI: 0.503‒0.575). However, the establishment of infectious disease associated team in facilities and the assignment of pharmacists in the hospital wards had no effect on AKI and 30-day mortality. In addition, TDM did not affect the reduction in AKI (OR: 1.061, 95% CI: 0.948‒1.187), but reduced 30-day mortality (OR: 0.873, 95% CI: 0.821‒0.929)., Conclusion: Pharmacologic management for individual patients, rather than assignment systems at facilities, is effective to reduce AKI and 30-day mortality with VCM administration., Competing Interests: Yuichi Muraki received an honorarium for lecturing from Pfizer Japan Inc. The other authors have no conflicts of interest to declare.
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- 2022
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26. A study of trends and factors associated with therapeutic drug monitoring (TDM) implementation for arbekacin treatment using a large Japanese medical claims database.
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Ito S, Goto R, Inose R, Kusama Y, Ono A, Koizumi R, Ishikane M, Ohmagari N, and Muraki Y
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- Aminoglycosides, Anti-Bacterial Agents therapeutic use, Drug Monitoring, Humans, Japan, Dibekacin analogs & derivatives, Dibekacin therapeutic use, Methicillin-Resistant Staphylococcus aureus
- Abstract
Introduction: Reimbursements for pharmacist interventions and infectious disease teams have recently been introduced in Japan. Arbekacin (ABK) is used to treat pneumonia and sepsis caused by methicillin-resistant Staphylococcus aureus, and therapeutic drug monitoring (TDM) is recommended. This study aimed to clarify the trend in TDM implementation for ABK over time and the factors associated with TDM implementation using a claims database., Methods: Data of patients aged ≥15 years who received ABK for ≥3 consecutive days between 2010 and 2019 were extracted from a large Japanese medical claims database. The proportion of reimbursements claimed for TDM, pharmacist interventions, and the setup of infectious disease teams for each year were calculated. The factors associated with TDM implementation were identified using multivariate logistic regression analysis., Results: The proportion of TDM implementation for ABK increased by 9.1% from 2010 to 2019, but it remained less than 40% throughout this period. The proportion of TDM implementation was higher in patients who claimed reimbursements for pharmacist interventions than in patients who did not. Logistic regression analysis showed that the stationing of pharmacists in wards and long-term ABK treatment were significantly associated with TDM implementation., Conclusions: From 2010 to 2019, the proportion of TDM implementation for ABK was significantly low. Moreover, the factors associated with TDM implementation were clarified. An environment wherein pharmacists can help implement TDM for patients receiving ABK would be beneficial., (Copyright © 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)
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- 2022
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27. Measures Against Antimicrobial Resistance in Children in Japan: Current Status and Future Prospects.
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Kusama Y and Ishiwada N
- Subjects
- Anti-Bacterial Agents therapeutic use, Drug Resistance, Bacterial, Humans, Infant, Japan, Anti-Infective Agents, Antimicrobial Stewardship
- Abstract
Antimicrobial resistance (AMR) is a major problem in public health. Japan is addressing this problem with various measures based on the National Action Plan on AMR, published in 2016. In Japan, the fight against AMR is hindered by issues with the health care system, including the lack of a general practitioner registration system, an abundance of private clinics and health care for infants and toddlers being essentially free of charge. As measures against AMR in inpatient care, thorough infection prevention and the Japanese government's incentivization of collaboration in infection prevention among hospitals and regions have helped to improve infection prevention. As measures against AMR in outpatient care, the creation of official Japanese government guidelines on antimicrobial stewardship has facilitated the implementation of antimicrobial stewardship in clinics. Another unique measure taken in Japan is incentivizing the nonprescription of antimicrobials for respiratory tract infections and diarrhea. Although Asia is a hot spot for AMR bacteria, the fight against AMR is affected by various factors, including insufficient precautions against nosocomial infections and the absence of surveillance systems. To combat these problems, Japan must take a strong leadership role. AMR is a problem not only at the level of individual countries but on a global scale and should, therefore, be addressed through joint action among nations., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2022
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28. Search for Indexes to Evaluate Trends in Antibiotic Use in the Sub-Prefectural Regions Using the National Database of Health Insurance Claims and Specific Health Checkups of Japan.
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Mizuno K, Inose R, Matsui Y, Takata M, Yamasaki D, Kusama Y, Koizumi R, Ishikane M, Tanabe M, Ohge H, Ohmagari N, and Muraki Y
- Abstract
The evaluation indexes of antimicrobial use (AMU) in sub-prefectural regions have not been established because these regional units are susceptible to the effects of population inflows and outflows. We defined the difference in AMU calculated each year as a new evaluation index and compared the AMU of secondary medical areas with those already reported for Japan and each prefecture. Patients/1000 inhabitants/day (PID) for oral antibiotics in 2013 and 2016 were calculated using the National Database of Health Insurance Claims and Specific Health Checkups. ΔPID was defined as the difference between the PIDs in 2013 and 2016. Differences in AMUs for Japan and prefectures that have already been published were also calculated, and the concordance rate with ΔPID in each secondary medical area was evaluated. Antibiotics and age groups with less than 50% concordance between secondary medical area and previously reported AMU changes were observed. This revealed that even at the secondary medical area level, which is more detailed than the prefectural level, the AMU changes were not consistent. Therefore, in order to appropriately promote measures against antimicrobial resistance, we suggest the necessity of not only surveying AMU at the national or prefectural levels but also examining sub-prefectural trends in AMU.
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- 2022
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29. Rapid progressive destruction of the cochleae in an infant due to pneumococcal meningitis.
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Kusama Y, Maruyama M, Fukui S, Hatsukawa H, Ito Y, Kamimura K, and Maihara T
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- Female, Humans, Infant, Pneumococcal Vaccines, Serogroup, Serotyping, Streptococcus pneumoniae genetics, Vaccines, Conjugate therapeutic use, Vancomycin therapeutic use, Meningitis, Pneumococcal complications, Meningitis, Pneumococcal diagnosis, Meningitis, Pneumococcal drug therapy, Pneumococcal Infections prevention & control
- Abstract
The widespread adoption of pneumococcal conjugate vaccines has reduced the incidence of Streptococcus pneumoniae infections, but has also led to the emergence of infections due to non-vaccine serotypes. A 15-month-old girl was referred to our hospital with suspected meningitis. S. pneumoniae was isolated from her cerebrospinal fluid. She was initially treated with a combination of cefotaxime and vancomycin, followed by ampicillin and vancomycin. After 7 days, the patient's condition improved and she was transferred to the general ward; however, her mother noted signs of hearing difficulties. On the 16th day of admission, we performed an auditory brainstem response test, which suggested severe bilateral hearing impairment. This was confirmed using an auditory steady-state response test after consulting with otolaryngologists. Magnetic resonance imaging revealed fibrosis of both cochleae with labyrinthitis. The patient underwent emergency cochlear implantation at a different hospital. The S. pneumoniae isolate was later identified to be serotype 10A with a PBP2x mutation, which is not covered by the conjugate vaccine and has reduced cephalosporin susceptibility. This case was characterized by highly rapid cochlear destruction, and an earlier otolaryngologist consultation may have provided a more well-organized surgery plan. Pediatricians are urged to promptly consult with otolaryngologists for patients with similar indications., (Copyright © 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)
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- 2022
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30. Antimicrobial Use Fell Substantially in Japan in 2020-The COVID-19 Pandemic May Have Played a Role.
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Ono A, Koizumi R, Tsuzuki S, Asai Y, Ishikane M, Kusama Y, and Ohmagari N
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- Anti-Bacterial Agents therapeutic use, Humans, Japan epidemiology, Pandemics, Anti-Infective Agents therapeutic use, Antimicrobial Stewardship, COVID-19 epidemiology, COVID-19 Drug Treatment
- Abstract
This study investigated the impact of the COVID-19 pandemic on antimicrobial use (AU) trends in Japan in 2020 and explored its potential effects on appropriate AU. Using nationwide antimicrobial sales data, we examined the annual and monthly trends in AU from 2016-2020 according to the AWaRe classification (Access and Watch categories) and administration route (oral and injectable). To analyze the possible impact of the COVID-19 pandemic on AU, seasonal autoregressive integrated moving average (SARIMA) models were used to predict AU in 2020 (based on the trends from 2016-2019) under the assumption that the pandemic did not occur. We observed a substantial reduction in AU in 2020 compared with preceding years. In addition, the reductions in AU for total antimicrobials and Watch category antimicrobials were greater than predicted regardless of administration route. These results suggest that the COVID-19 pandemic contributed to the observed reductions in AU, but it is also possible that the changes reflect recent efforts to improve AU. Continued AU surveillance and research are needed to optimize prescribing practices through appropriate antimicrobial stewardship., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
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- 2022
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31. Complete response to combination therapy using nivolumab and ipilimumab for metastatic, sarcomatoid collecting duct carcinoma presenting with high expression of programmed death-ligand 1: a case report.
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Fuu T, Iijima K, Kusama Y, Otsuki T, and Kato H
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- Aged, B7-H1 Antigen, Humans, Immune Checkpoint Inhibitors, Ipilimumab therapeutic use, Male, Nivolumab therapeutic use, Carcinoma, Renal Cell pathology, Carcinoma, Transitional Cell, Kidney Neoplasms drug therapy, Kidney Neoplasms pathology, Neoplasms, Second Primary drug therapy, Sarcoma, Soft Tissue Neoplasms drug therapy, Urinary Bladder Neoplasms drug therapy
- Abstract
Background: Collecting duct carcinoma and sarcomatoid renal cell carcinoma are tumors with poor prognosis. Immune checkpoint inhibitors have been established as the standard treatment for advanced renal cell carcinoma. Some cases of remission of collecting duct carcinoma and sarcomatoid renal cell carcinoma have been reported using immune checkpoint inhibitor interventions. Specifically, sarcomatoid renal cell carcinoma expresses high levels of programmed death-ligand 1, an immune checkpoint protein, and immune checkpoint inhibitors have been reported to be highly effective for treating sarcomatoid renal cell carcinoma., Case Presentation: We describe the case of a 70-year-old Japanese male who underwent radical right nephrectomy for a right renal mass identified on computed tomography. The pathological examination demonstrated that the renal mass was urothelial carcinoma and collecting duct carcinoma with sarcomatoid changes, and programmed death-ligand 1 was highly expressed with a tumor proportion score of more than 10%. There was no evident submucosal connective tissue invasion in the urothelial carcinoma component, and collecting duct carcinoma was diagnosed as primary cancer. The tumor-node-metastasis classification was pT3aN0, venous invasion 1, lymphovascular invasion 0, and Fuhrman nuclear grade 4. Two months after the nephrectomy, multiple metastases were observed in both lungs, the right hilar lymph node, and the S6 segment of the right liver lobe. We initiated first-line combination therapy with nivolumab (240 mg, fixed dose) and ipilimumab (1 mg/kg). One day after administration, the patient developed drug-induced interstitial pneumonia, thus we applied steroid injections. After one administration of immunotherapy, the metastatic lesion showed complete response within 6 months, which was maintained after 3 years., Conclusion: We report the first case of complete response to a single dose of combination therapy with nivolumab and ipilimumab for metastatic collecting duct carcinoma with sarcomatoid changes and high expression of programmed death-ligand 1. This case suggests high expectations for immune checkpoint inhibitors as treatment for sarcomatoid-transformed renal carcinoma tumors that express high levels of programmed death-ligand 1., (© 2022. The Author(s).)
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- 2022
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32. The Use of Topical Antibiotics Based on the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) Open Data in 2017.
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Nakanishi T, Inose R, Kusama Y, Ishikane M, Kajihara T, Yahara K, Sugai M, Ohge H, Ohmagari N, and Muraki Y
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- Databases, Factual, Insurance, Health, Japan, Anti-Bacterial Agents therapeutic use, Anti-Infective Agents
- Abstract
The national action plan on antimicrobial resistance (AMR) in Japan emphasizes the importance of understanding antimicrobial use (AMU). Some studies have been conducted on oral and parenteral AMU in Japan. However, there are few studies on the use of topical antimicrobials, such as in dermatology and ophthalmology. Therefore, the purpose of this study was to investigate the use of topical AMU in Japan. Data on AMU in dermatology and ophthalmology were obtained from the 2017 National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data. The number of dermatological products used was 58,396,530 in 2017. The proportions of betamethasone/gentamicin and gentamicin used were 50.5% and 16.7%, respectively, whereas that of the ingredient quantity in gentamicin was 7.8%. It has been suggested that topical AMU should be evaluated based on the number of products being used. The number of ophthalmological products used was 24,655,653 in 2017, and the proportion of quinolones used was 95.9%. The high prescription rate of quinolones may cause an increase in quinolone resistance in the ophthalmologic field. Topical AMU, which is a potential "blind spot" in the measures against AMR, needs to be continuously monitored, together with systemic AMU.
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- 2022
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33. Somatostatin-derived amyloid deposition associated with duodenal neuroendocrine tumour (NET): a report of novel localised amyloidosis associated with NET.
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Ichimata S, Katoh N, Abe R, Yoshinaga T, Kametani F, Yazaki M, Kusama Y, Sano K, Uehara T, and Sekijima Y
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- Humans, Somatostatin, Amyloidosis complications, Intestinal Neoplasms complications, Neuroendocrine Tumors complications, Neuroendocrine Tumors pathology, Pancreatic Neoplasms complications
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- 2022
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34. The intended purpose and regional patterns of use of antibiotics for managing Clostridioides (Clostridium) difficile infections: An analysis of the National Database of Health Insurance Claims and Specific Health Checkups data of Japan.
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Inose R, Muraki Y, Kamimoto Y, Kusama Y, Koizumi R, Yamasaki D, Ishikane M, Tanabe M, and Ohmagari N
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- Clostridioides, Clostridium, Humans, Insurance, Health, Japan epidemiology, Retrospective Studies, Anti-Bacterial Agents therapeutic use, Clostridium Infections drug therapy, Clostridium Infections epidemiology
- Abstract
Introduction: We previously showed the trend of antimicrobial use (AMU) for Clostridioides (Clostridium) difficile infection (CDI) using sales data. However, the details of the prescribing medical institutions and regional characteristics are unknown. Therefore, the purpose of this study was to clarify the details of the medical institutions where antibiotics for CDI were prescribed, and evaluate the AMU for CDI and the regional characteristics., Methods: Antibiotics for CDI, including oral vancomycin (VCM), oral metronidazole (MNZ), and intravenous (IV) MNZ, were collected from the National Database of Health Insurance Claims and Specific Health Checkups (NDB) between 2013 and 2016. The PID (patients/1000 inhabitants/day) was used as an evaluation index for AMU. The PID was calculated using the claim types: inpatient, outpatient, dental, and pharmacy. The PID of each prefecture was calculated for inpatient claims in 2016., Results: The AMU of oral VCM and IV MNZ were observed mainly in the inpatient claims. For oral MNZ, the total AMU in the outpatient and pharmacy claims accounted for approximately 80% per year throughout the study period. For inpatient claims of each prefecture in 2016, the PID of the antibiotics used for CDIs was approximately 3.5 times the difference between the highest and lowest prefectures., Conclusions: The AMU for CDI that takes into account the purpose of use was clarified by using the information of the prescribed medical institutions that were included in the NDB. Oral MNZ was used frequently in outpatients, and attention should be paid to the acquisition of resistance., (Copyright © 2021. Published by Elsevier Ltd.)
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- 2022
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35. Myalgic encephalomyelitis/chronic fatigue syndrome post coronavirus disease 2019.
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Kusama Y, Fukui S, Maruyama M, Kamimura K, and Maihara T
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- Exercise, Humans, SARS-CoV-2, COVID-19, Fatigue Syndrome, Chronic diagnosis, Fatigue Syndrome, Chronic epidemiology, Fatigue Syndrome, Chronic etiology
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- 2022
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36. Effects of the cefazolin shortage on the sales, cost, and appropriate use of other antimicrobials.
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Koizumi R, Kusama Y, Asai Y, Yoshiaki G, Muraki Y, and Ohmagari N
- Subjects
- Anti-Bacterial Agents economics, Anti-Bacterial Agents therapeutic use, Humans, Anti-Infective Agents economics, Anti-Infective Agents therapeutic use, Cefazolin supply & distribution, Drug Utilization
- Abstract
Background: Shortages of antimicrobials lead to treatment failures, increase medical costs, and accelerate the development of antimicrobial resistance. We evaluated the effects of the serious cefazolin shortage in 2019 in Japan on the sales, costs, and appropriate use of other antimicrobials., Methods: We evaluated monthly defined daily doses/1000 inhabitants/day (DID) values of antimicrobial sales from January 2016 to December 2019 using wholesaler's sales databases. Using 2016-2018 sales data, we generated a prediction model of DID in 2019 under the assumption that the cefazolin shortage did not occur. We then compared the predicted DID and actual DID. Cefazolin, government-recommended alternatives, and government-not-recommended broad-spectrum alternatives were assessed. Antimicrobial groups according to the AWaRe classification were also assessed to evaluate the effect on appropriate antimicrobial use. In addition, we evaluated changes in costs between 9 months before and after the cefazolin shortage., Results: DID values of total antimicrobials increased sharply 1 month before the decrease in cefazolin. Actual DIDs were higher than predicted DIDs for ceftriaxone, flomoxef, clindamycin, cefotiam, piperacillin/tazobactam, and meropenem. Actual DID values were higher than the predicted DID values in the Watch group. The costs of antimicrobials between pre- and post- cefazolin shortage were unchanged., Conclusion: The cefazolin shortage brought confusion to the antimicrobial market and led to a setback in the appropriate use of antimicrobials. Early recognition and structures for prompt reactions to antimicrobial shortages are needed. Moreover, development of a system to secure the supply of essential antimicrobials is required., (© 2021. The Author(s).)
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- 2021
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37. Trends in healthcare visits and antimicrobial prescriptions for acute infectious diarrhea in individuals aged 65 years or younger in Japan from 2013 to 2018 based on administrative claims database: a retrospective observational study.
- Author
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Ono A, Aoyagi K, Muraki Y, Asai Y, Tsuzuki S, Koizumi R, Azuma T, Kusama Y, and Ohmagari N
- Subjects
- Adolescent, Adult, Aged, Child, Child, Preschool, Delivery of Health Care, Diarrhea drug therapy, Diarrhea epidemiology, Drug Prescriptions, Female, Humans, Infant, Infant, Newborn, Japan epidemiology, Male, Middle Aged, Retrospective Studies, Young Adult, Anti-Bacterial Agents therapeutic use, Anti-Infective Agents
- Abstract
Background: The inappropriate use of antimicrobials for acute infectious diarrhea is widespread and leads to the problem of antimicrobial resistance. To improve the use of antimicrobials, it is first necessary to understand the actual situation of diarrheal disease and to identify potential targets for intervention. This study aimed to investigate the recent epidemiological characteristics of and antimicrobial prescriptions for acute infectious diarrhea in Japan., Methods: This was a retrospective observational study of outpatients aged 0-65 years, separated into children (age 0-17 years) and adults (age 18-65 years), diagnosed with acute infectious diarrhea, using the administrative claims database of the Japan Medical Data Center from 2013 to 2018. We evaluated the number of eligible visits/number of database registrants (defined as the visit rate). The analysis of the antimicrobial prescription rate was restricted to otherwise healthy individuals diagnosed with acute infectious diarrhea alone by excluding patients with multiple disease diagnoses and with medical backgrounds of chronic bowel diseases or immunocompromised conditions. We further classified them by diagnosis of bacterial or nonbacterial acute infectious diarrhea., Results: The total number of eligible visits for acute infectious diarrhea was 2,600,065. The visit rate, calculated based on the number of eligible visits by database registrants, was higher in children (boys, 0.264; girls, 0.229) than in adults (men, 0.070; women, 0.079), with peaks in early summer and winter. The peaks for visits in adults lagged those of children. In total, 482,484 visits were analyzed to determine the antimicrobial prescription rate; 456,655 (94.6%) were diagnosed with nonbacterial acute infectious diarrhea. Compared with children (boys, 0.305; girls, 0.304), the antimicrobial prescription rate was higher in adults, and there were differences between sexes in adults (men, 0.465; women, 0.408). Fosfomycin and fluoroquinolone were most frequently used for nonbacterial acute infectious diarrhea in children (44.1%) and adults (50.3%), respectively., Conclusions: These results revealed overprescription of antimicrobials for acute infectious diarrhea in this administrative claims database in Japan and contribute to the development of antimicrobial stewardship strategies and the identification of targets for efficiently reducing inappropriate antimicrobial use., (© 2021. The Author(s).)
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- 2021
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38. Difficulty of morphological diagnosis in Gram staining.
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Yamaji M, Kusama Y, Kamimura K, and Maihara T
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- Anti-Bacterial Agents therapeutic use, Gram-Negative Bacteria, Humans, Staining and Labeling, Urinary Tract Infections drug therapy
- Abstract
Competing Interests: Competing interests: None declared.
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- 2021
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39. Cyst of the gallbladder.
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Yamazaki S, Takahashi Y, Seki H, Ochi Y, Horiuchi I, Kusama Y, Imai S, and Kobayashi A
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- Cholecystectomy, Laparoscopic, Cysts surgery, Gallbladder abnormalities, Gallbladder surgery, Gallbladder Diseases complications, Gallbladder Diseases surgery, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Cysts diagnosis, Cysts etiology, Gallbladder Diseases diagnosis, Gallbladder Diseases etiology
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- 2021
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40. An alternative index for evaluating AMU and anti-methicillin-resistant Staphylococcus aureus agent use: A study based on the National Database of Health Insurance Claims and Specific Health Checkups data of Japan.
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Mita Y, Inose R, Goto R, Kusama Y, Koizumi R, Yamasaki D, Ishikane M, Tanabe M, Ohmagari N, and Muraki Y
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- Anti-Bacterial Agents therapeutic use, Humans, Insurance, Health, Japan epidemiology, Microbial Sensitivity Tests, Anti-Infective Agents, Methicillin-Resistant Staphylococcus aureus, Staphylococcal Infections drug therapy, Staphylococcal Infections epidemiology
- Abstract
Introduction: Anti-methicillin-resistant Staphylococcus aureus (MRSA) agents have different doses and administration periods. Thus, it is difficult to evaluate antimicrobial use (AMU) of anti-MRSA agents using defined daily doses per 1000 inhabitants per day (DID) or days of therapy per 1000 inhabitants per day (DOTID). This study aimed to evaluate the relationship between anti-MRSA agent use and resistant bacteria using the number of patients per 1000 inhabitants per day (PID) as an alternative index of AMU., Methods: AMU data for anti-MRSA agents were collected from the National Database of Health Insurance Claims and Specific Health Checkups (NDB) in 2016. The relationship between PID and DID or DOTID was evaluated. The number of patients with MRSA isolated was obtained from Japan Nosocomial Infections Surveillance, and their correlation with PID was analyzed. The rate of anti-MRSA agent use in each prefecture was investigated., Results: PID showed a significant linear relationship with both DID and DOTID (all p < 0.0001). PID was significantly correlated with the number of patients with MRSA isolated. Additionally, the rate of anti-MRSA agent use was markedly different in each region., Conclusions: PID is not affected by doses and administration periods, and thus may be an alternative index for the selective pressure of antibiotics. Evaluating AMU using PID based on NDB data will help in the development of effective antimicrobial resistance measures., (Copyright © 2021 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)
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- 2021
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41. Effects of a nudge-based antimicrobial stewardship program in a pediatric primary emergency medical center.
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Shishido A, Otake S, Kimura M, Tsuzuki S, Fukuda A, Ishida A, Kasai M, and Kusama Y
- Subjects
- Anti-Bacterial Agents therapeutic use, Child, Emergency Service, Hospital, Humans, Japan, Anti-Infective Agents, Antimicrobial Stewardship
- Abstract
Outpatient medical facilities tend to have high antimicrobial prescription rates and are therefore major targets for antimicrobial stewardship programs (ASPs). Pediatric primary emergency medical centers in Japan have difficulties in implementing conventional ASPs due to the low continuity of stewardship. Accordingly, there is a need to develop effective ASP models for these facilities. We conducted a single-center, quasi-experimental study to evaluate the effects of a nudge-based ASP in reducing unnecessary third-generation cephalosporin (3GC) prescriptions in a pediatric primary emergency care center (PEC). The implemented ASP utilizes monthly newsletters that report current antimicrobial use patterns and prescribing targets. We compared the monthly 3GC prescription numbers and proportions of unnecessary prescriptions before and after the ASP was implemented. The trends in 3GC prescriptions were examined using an interrupted time-series analysis. The numbers of patients before and after ASP implementation were 129,156 and 28,834, respectively. The number of unnecessary 3GC prescriptions decreased by 67.2% in the year after ASP implementation. The interrupted time-series analysis showed that the ASP was significantly associated with a reduction in 3GC prescriptions (regression coefficient - 0.58, P < 0.001).Conclusion: The nudge-based ASP was effective in reducing 3GC use in a Japanese PEC. This simple and inexpensive approach may have applications in other outpatient facilities. What is Known: • Outpatient medical facilities tend to have high antimicrobial prescription rates. Despite the development of several strategies for outpatient antimicrobial stewardship programs, these approaches have not sufficiently reduced antimicrobial use. What is New • Our nudge-based antimicrobial stewardship program using newsletters was shown to be a simple, inexpensive, and feasible method for reducing unnecessary antimicrobial use in a pediatric primary emergency care center. This may represent an effective antimicrobial stewardship strategy in Japanese outpatient facilities.
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- 2021
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42. Characteristics and limitations of national antimicrobial surveillance according to sales and claims data.
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Kusama Y, Muraki Y, Tanaka C, Koizumi R, Ishikane M, Yamasaki D, Tanabe M, and Ohmagari N
- Subjects
- Commerce, Databases, Pharmaceutical, Drug Industry economics, Drugs, Generic economics, Health Facilities economics, Humans, Insurance Claim Review, Japan, Prescription Drug Monitoring Programs, Retrospective Studies, Anti-Bacterial Agents administration & dosage, Anti-Bacterial Agents economics, Drug Utilization Review
- Abstract
Purpose: Antimicrobial use (AMU) is estimated at the national level by using sales data (S-AMU) or insurance claims data (C-AMU). However, these data might be biased by generic drugs that are not sold through wholesalers (direct sales) and therefore not recorded in sales databases, or by claims that are not submitted electronically and therefore not stored in claims databases. We evaluated these effects by comparing S-AMU and C-AMU to ascertain the characteristics and limitations of each kind of data. We also evaluated the interchangeability of these data by assessing their relationship., Methods: We calculated monthly defined daily doses per 1,000 inhabitants per day (DID) using sales and claims data from 2013 to 2017. To assess the effects of non-electronic claim submissions on C-AMU, we evaluated trends in the S-AMU/C-AMU ratio (SCR). To assess the effects of direct sales of S-AMU, we divided AMU into generic and branded drugs and evaluated each SCR in terms of oral versus parenteral drugs. To assess the relationship between S-AMU and C-AMU, we created a linear regression and evaluated its coefficient., Results: Median annual SCRs from 2013 to 2017 were 1.046, 0.993, 0.980, 0.987, and 0.967, respectively. SCRs dropped from 2013 to 2015, and then stabilized. Differences in SCRs between branded and generic drugs were significant for oral drugs (0.820 vs 1.079) but not parenteral drugs (1.200 vs 1.165), suggesting that direct sales of oral generic drugs were omitted in S-AMU. Coefficients of DID between S-AMU and C-AMU were high (generic, 0.90; branded, 0.84) in oral drugs but relatively low (generic, 0.32; branded, 0.52) in parenteral drugs., Conclusions: The omission of direct sales information and non-electronically submitted claims have influenced S-AMU and C-AMU information, respectively. However, these data were well-correlated, and it is considered that both kinds of data are useful depending on the situation., Competing Interests: The authors have declared that no competing interests exist.
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- 2021
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43. Nationwide cross-sectional study of antimicrobial stewardship and antifungal stewardship programs in inpatient settings in Japan.
- Author
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Moriyama Y, Ishikane M, Kusama Y, Matsunaga N, Tajima T, Hayakawa K, and Ohmagari N
- Subjects
- Anti-Infective Agents therapeutic use, Cross Infection prevention & control, Cross-Sectional Studies, Drug Utilization standards, Hospitals, Humans, Inpatients, Internet, Japan, Program Evaluation, Surveys and Questionnaires, Antimicrobial Stewardship, Health Personnel psychology
- Abstract
Background: To prevent antimicrobial resistance, both antimicrobial stewardship (AMS) and antifungal stewardship (AFS) in inpatient settings are needed in small/middle-sized hospitals as well as large hospitals., Methods: We conducted the web-based, self-administered, nationwide cross-sectional study regarding AMS and AFS in inpatient settings in Japan, targeting hospitals that participated in a hospital epidemiology workshop conducted in July 2018. The questionnaire was composed of intervention protocols for use of broad-spectrum antimicrobials and antifungals within 7 or 28 d of beginning usage. These broad-spectrum antimicrobial and antifungal protocols were compared between large (≥501beds) and small/middle-sized (≤500 beds) hospitals., Results: Of 240 hospitals surveyed, 39 (16%; 18 large and 21 small/middle-sized) responded. The number of hospitals that intervened in the use of broad-spectrum antimicrobials within 7 and 28 d were 17 (44%) and 34 (87%), respectively; those that intervened for antifungals were 3 (8%) and 10 (26%), respectively. Interventions for use of broad-spectrum antimicrobials within 7 d were significantly more frequent in small/middle-sized hospitals compared to large hospitals [13 (61. 9%) vs. 4 (22. 2%), odds ratio = 5.7, 95% confidence interval = 1.4-23.3, p = 0.023]., Conclusions: Small/middle-sized hospitals had more frequent interventions within 7 d of broad-spectrum antimicrobial use than large hospitals. More effort to improve AFS is needed among all hospitals.
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- 2021
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44. National database study of trends in bacteraemia aetiology among children and adults in Japan: a longitudinal observational study.
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Kusama Y, Ito K, Fukuda H, Matsunaga N, and Ohmagari N
- Subjects
- Adult, Child, Child, Preschool, Escherichia coli, Haemophilus influenzae, Humans, Infant, Japan epidemiology, Staphylococcus aureus, Bacteremia epidemiology, Staphylococcal Infections
- Abstract
Objectives: Domestic epidemiological studies are needed to ascertain the disease burden of bacteraemia in individual countries. This study aimed to evaluate the domestic trends in paediatric and adult bacteraemia in Japan., Setting: Laboratory-based surveillance was used to obtain data from 592 hospitals located throughout Japan., Participants: The study was conducted using the results of 827 780 and 3 512 524 blood culture tests obtained from children and adults, respectively, between January 2010 and December 2016., Outcome Measures: We analysed the temporal trends in specific bacterial species ( Staphylococcus aureus , Streptococcus pneumoniae , Streptococcus pyogenes , Streptococcus agalactiae , Escherichia coli , Klebsiella pneumoniae , Salmonella enterica , Haemophilus influenzae , Listeria monocytogenes and Neisseria meningitidis ) detected from the blood cultures of children and adults. For children aged ≤2 years, the data were analysed for each year of age. The proportions of bacteraemia-positive results among the patients were also evaluated., Results: The number of bacteraemia-positive samples over the study period was 47,125/827,855 (5.7%) in children and 959,765/3,513,885 (27.3%) in adults. S. pneumoniae was the most frequent cause of bacteraemia in children in 2010. However, after 2011, S. aureus bacteraemia was the most frequent, followed by S. pneumoniae and E. coli. E. coli bacteraemia showed significant increases in both children and adults. In children, S. pneumoniae and H. influenzae bacteraemia decreased from 2010 to 2013. However, S. pneumoniae bacteraemia case numbers stabilised from 2013, whereas H. influenzae bacteraemia cases continued to decrease until 2016., Conclusion: The results suggest that the introduction of the 13-valent pneumococcal conjugate vaccine did not substantially affect disease occurrence. In contrast to the decreasing trends in H. influenzae and S. pneumoniae bacteraemia, S. aureus , E. coli and S. agalactiae bacteraemia showed increasing trends. These findings shed light on recent temporal trends in bacteraemia in both children and adults in Japan., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2021
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45. JCS 2018 Guideline on Diagnosis of Chronic Coronary Heart Diseases.
- Author
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Yamagishi M, Tamaki N, Akasaka T, Ikeda T, Ueshima K, Uemura S, Otsuji Y, Kihara Y, Kimura K, Kimura T, Kusama Y, Kumita S, Sakuma H, Jinzaki M, Daida H, Takeishi Y, Tada H, Chikamori T, Tsujita K, Teraoka K, Nakajima K, Nakata T, Nakatani S, Nogami A, Node K, Nohara A, Hirayama A, Funabashi N, Miura M, Mochizuki T, Yokoi H, Yoshioka K, Watanabe M, Asanuma T, Ishikawa Y, Ohara T, Kaikita K, Kasai T, Kato E, Kamiyama H, Kawashiri M, Kiso K, Kitagawa K, Kido T, Kinoshita T, Kiriyama T, Kume T, Kurata A, Kurisu S, Kosuge M, Kodani E, Sato A, Shiono Y, Shiomi H, Taki J, Takeuchi M, Tanaka A, Tanaka N, Tanaka R, Nakahashi T, Nakahara T, Nomura A, Hashimoto A, Hayashi K, Higashi M, Hiro T, Fukamachi D, Matsuo H, Matsumoto N, Miyauchi K, Miyagawa M, Yamada Y, Yoshinaga K, Wada H, Watanabe T, Ozaki Y, Kohsaka S, Shimizu W, Yasuda S, and Yoshino H
- Subjects
- Chronic Disease, Humans, Coronary Disease diagnosis
- Published
- 2021
- Full Text
- View/download PDF
46. Effect of population inflow and outflow between rural and urban areas on regional antimicrobial use surveillance.
- Author
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Koizumi R, Kusama Y, Muraki Y, Ishikane M, Yamasaki D, Tanabe M, and Ohmagari N
- Subjects
- Administrative Claims, Healthcare statistics & numerical data, Adolescent, Adult, Aged, Child, Databases, Factual statistics & numerical data, Female, Humans, Japan, Male, Middle Aged, Retrospective Studies, Rural Population statistics & numerical data, Urban Population statistics & numerical data, Young Adult, Anti-Bacterial Agents therapeutic use, Antimicrobial Stewardship statistics & numerical data, Drug Prescriptions statistics & numerical data, Population Dynamics statistics & numerical data
- Abstract
Purpose: Regional-level measures can complement national antimicrobial stewardship programs. In Japan, sub-prefectural regions called secondary medical areas (SMAs) provide general inpatient care within their borders, and regional antimicrobial stewardship measures are frequently implemented at this level. There is therefore a need to conduct antimicrobial use (AMU) surveillance at this level to ascertain antimicrobial consumption. However, AMU estimates are generally standardized to residence-based nighttime populations, which do not account for population mobility across regional borders. We examined the impact of population in/outflow on SMA-level AMU estimates by comparing the differences between standardization using daytime and nighttime populations., Methods: We obtained AMU information from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. AMU was quantified at the prefectural and SMA levels using the number of defined daily doses (DDDs) divided by (a) 1,000 nighttime population per day or (b) 1,000 daytime population per day. We identified and characterized the discrepancies between the two types of estimates at the prefectural and SMA levels., Results: The national AMU was 17.21 DDDs per 1,000 population per day. The mean (95% confidence interval) prefectural-level DDDs per 1,000 nighttime and daytime population per day were 17.27 (14.10, 20.44) and 17.41 (14.30, 20.53), respectively. The mean (95% confidence interval) SMA-level DDDs per 1,000 nighttime and daytime population per day were 16.12 (9.84, 22.41) and 16.41 (10.57, 22.26), respectively. The nighttime population-standardized estimates were generally higher than the daytime population-standardized estimates in urban areas, but lower in the adjacent suburbs. Large differences were observed in the main metropolitan hubs in eastern and western Japan., Conclusion: Regional-level AMU estimates, especially of smaller regions such as SMAs, are susceptible to the use of different populations for standardization. This finding indicates that AMU standardization based on population values is not suitable for AMU estimates in small regions., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2021
- Full Text
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47. A Matched Case-Case-Control Study of the Impact of Clinical Outcomes and Risk Factors of Patients with IMP-Type Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae in Japan.
- Author
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Saito S, Hayakawa K, Tsuzuki S, Ishikane M, Nagashima M, Mezaki K, Sugiki Y, Tajima T, Matsunaga N, Ide S, Kinoshita N, Kusama Y, Fujitomo Y, Nakamoto T, Toda Y, Kaku M, Kodama EN, and Ohmagari N
- Subjects
- Humans, Anti-Bacterial Agents therapeutic use, Bacterial Proteins genetics, beta-Lactamases genetics, Carbapenems therapeutic use, Case-Control Studies, Japan, Risk Factors, Carbapenem-Resistant Enterobacteriaceae genetics, Enterobacteriaceae Infections drug therapy
- Abstract
IMP-type carbapenemase, found in various Gram-negative bacteria, has been increasingly detected worldwide. We aimed to study the outcomes and risk factors for acquisition of IMP-type carbapenemase-producing carbapenem-resistant Enterobacteriaceae (IMP-CRE), as this has not been evaluated in detail. We conducted a matched case-case-control study of patients from whom IMP-CRE isolates were obtained. All patients who tested positive for IMP-CRE were included; they were matched with patients with carbapenem-susceptible Enterobacteriaceae (CSE) and with controls at a ratio of 1:1:2. The risk factors for acquisition for the CRE and CSE groups and mortality rates, which were calculated using multivariate logistic regression models with weighting according to the inverse probability of propensity scores, were compared. In total, 192 patients (96 patients each in the CRE and CSE groups, with 130 Enterobacter cloacae isolates and 62 Klebsiella sp. isolates) were included. The IMP-11 type was present in 43 patients, IMP-1 in 33, and IMP-60 and IMP-66 in 1 each; 31 patients with CRE (32.3%) and 34 with CSE (35.4%) developed infections. Multivariate analysis identified the following independent risk factors: gastrostomy, history of intravenous therapy or hemodialysis, and previous exposure to broad-spectrum β-lactam antibiotics, including penicillin with β-lactamase inhibitors, cephalosporins, and carbapenems. In propensity score-adjusted analysis, mortality rates for the CRE and CSE groups were similar (15.0% and 19.5%, respectively). We found that IMP-CRE may not contribute to worsened clinical outcomes, compared to CSE, and gastrostomy, previous intravenous therapy, hemodialysis, and broad-spectrum antimicrobial exposure were identified as risk factors for CRE isolation. Fluoroquinolone and aminoglycosides are potentially useful antibiotics for IMP-CRE infections., (Copyright © 2021 American Society for Microbiology.)
- Published
- 2021
- Full Text
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48. The effects of Japan's National Action Plan on Antimicrobial Resistance on antimicrobial use.
- Author
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Kusama Y, Tsuzuki S, Muraki Y, Koizumi R, Ishikane M, and Ohmagari N
- Subjects
- Anti-Bacterial Agents therapeutic use, Cephalosporins therapeutic use, Fluoroquinolones therapeutic use, Humans, Japan, Macrolides therapeutic use, Antimicrobial Stewardship, Drug Resistance, Bacterial
- Abstract
The aim of this study was to estimate the effects of Japan's National Action Plan on Antimicrobial Resistance 2016-2020 (NAP) on antimicrobial use (AMU). Monthly AMU from January 2013 to December 2019 was calculated using sales data, and time-series charts of AMU were then created for the total antimicrobials and target drug categories shown in the NAP (oral cephalosporins, oral fluoroquinolones, oral macrolides, and parenteral antimicrobials). Twelve-month predictions were generated to evaluate AMU in 2020. The publication of the NAP was associated with an AMU reduction in total antimicrobials, cephalosporins, fluoroquinolones, and macrolides. Parenteral AMU showed an upward trend, although it was not significantly associated with the intervention effect. AMU reductions of 15.0% for total antimicrobials, 26.3% for cephalosporins, 23.5% for fluoroquinolones, and 24.6% for macrolides were predicted for 2020 relative to 2013. However, there was a predicted increase of 17.4% for parenteral AMU. While Japan's NAP has contributed to the reduction in national AMU over the past 5 years, sustained action is still needed to further improve antimicrobial stewardship and promote countermeasures to antimicrobial resistance., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2021
- Full Text
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49. Narrative Review: The Process of Expanding the Manual of Antimicrobial Stewardship by the Government of Japan.
- Author
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Jindai K, Kusama Y, Gu Y, Honda H, and Ohmagari N
- Subjects
- Adolescent, Adult, Anti-Bacterial Agents therapeutic use, Child, Government, Humans, Japan epidemiology, Anti-Infective Agents therapeutic use, Antimicrobial Stewardship
- Abstract
The Ministry of Health, Labour and Welfare has published the Manual of Antimicrobial Stewardship (1st edition) in June 2017 to improve the prescribing practice of antimicrobials for immunocompetent adult and pediatric (both school-aged and older children) patients. Due to the increasing demand for further promoting outpatient antimicrobial stewardship, we conducted a literature and national guideline review to identify the area of need. The results of our review revealed a high antimicrobial prescription rate in the Japanese pediatric population. Furthermore, although the Japanese clinical guidelines/guidance covered the fields of almost all infectious diseases, no system exists to estimate the incidence and treatment patterns of important infectious diseases such as asymptomatic bacteriuria, skin and soft tissue infections, and dental practices in Japan. Therefore, addressing the issues of both establishing surveillance systems and the implementation of guidelines/guidance can be the next step to promote further outpatient antimicrobial stewardship.
- Published
- 2021
- Full Text
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50. Trends in Antipseudomonal Agent Use Based on the 2006 to 2015 Sales Data in Japan.
- Author
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Ebisui A, Inose R, Kusama Y, Koizumi R, Kawabe A, Ishii S, Goto R, Ishikane M, Yagi T, Ohmagari N, and Muraki Y
- Subjects
- Aminoglycosides therapeutic use, Carbapenems therapeutic use, Cephalosporins therapeutic use, Commerce, Drug Utilization statistics & numerical data, Fluoroquinolones therapeutic use, Humans, Japan, Penicillins therapeutic use, Anti-Bacterial Agents therapeutic use, Pseudomonas Infections drug therapy
- Abstract
Pseudomonas aeruginosa resistance is a major issue worldwide. Drug resistance is related to inappropriate antibiotic use. Because antipseudomonal agents have a wide spectrum, they must be used appropriately. The purpose of this study was to clarify the trends in antipseudomonal agent use in Japan based on sales data from 2006 to 2015. The total antipseudomonal agent use was increased significantly (r = 0.10, P
for trend = 0.00040). The proportion of fluoroquinolones use was the highest throughout the year, accounting for 88.6-91.4%. The use of piperacillin/tazobactam significantly increased. The increased use of these drugs may be due to the launch of higher doses and additional indications. On the other hand, for antipseudomonal agents, parenteral carbapenems use was 2.7-3.7%, but it has remained unchanged over the years. In Japan, permit and notification systems have been introduced to prevent the inappropriate use of parenteral carbapenems in medical institutions. It was speculated that these efforts suppressed the inappropriate use of parenteral carbapenems. This study clarified the trend of antipseudomonal agent use in Japan from 2006 to 2015. It is important to continue monitoring antipseudomonal agents use to conduct appropriate antimicrobial resistance measures.- Published
- 2021
- Full Text
- View/download PDF
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