Dote Hisashi, Funaki Daito, Ichikawa Yoshikazu, Ubukata Nanako, Miyake Hiromu, Miyakoshi Akinori, Oshima Michiko, Ohata Emi, Imaichi Yutaro, Shoji-Asahina Aya, Nakatani Eiji
Department of Emergency and Critical Care Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, JPN.
Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, JPN.
Cureus. 2025 Feb 12;17(2):e78923. doi: 10.7759/cureus.78923. eCollection 2025 Feb.
The rise of drug-resistant bacteria and associated adverse events have been linked to inappropriate antibiotic use. In Japan, inappropriate prescriptions of oral antimicrobials might be prevalent and contribute to this issue. This study explored the association between oral third-generation cephalosporins and other antimicrobials with adverse events in the Japanese population.
We conducted a population-based cohort study using a large-scale database, i.e., the Shizuoka Kokuho Database. This study included individuals with health checkup records, with the observation period for each participant ranging from insurance enrollment or April 2012 to insurance withdrawal or September 2020. The primary outcome was hospitalization with clinically important antibiotic-related adverse events (ciArAEs) based on the International Classification of Diseases, Tenth Revision (ICD-10) codes. In addition, we executed a multivariable analysis employing potential predictive factors selected from comorbidities, prescribed antimicrobials, and health checkup results.
Of the 685,161 individuals included in the analysis, 2,557 had ciArAEs. Third-generation cephalosporins (HR: 1.14, 95% CI: 1.01-1.29), tetracyclines (HR: 2.14, 95% CI: 1.47-3.13), and aminoglycosides (HR: 8.36, 95% CI: 1.18-59.2) were identified as potential predictive factors for ciArAEs among oral antimicrobial agents. Additional predictive factors included older age, males, intravenous penicillin, and various comorbidities.
By utilizing a large-scale database, we demonstrated the relationship between the use of antimicrobial agents, including oral third-generation cephalosporins, and ciArAEs. This finding underscores the need for enhanced prescription practices and further antimicrobial resistance and adverse events studies.
耐药菌的出现及相关不良事件与抗生素的不当使用有关。在日本，口服抗菌药物的不当处方可能很普遍，并导致了这一问题。本研究探讨了日本人群中口服第三代头孢菌素及其他抗菌药物与不良事件之间的关联。
我们使用一个大规模数据库，即静冈国保数据库，进行了一项基于人群的队列研究。本研究纳入了有健康检查记录的个体，每位参与者的观察期从参保或2012年4月至退保或2020年9月。主要结局是根据国际疾病分类第十版（ICD - 10）编码确定的具有临床重要性的抗生素相关不良事件（ciArAEs）导致的住院治疗。此外，我们进行了多变量分析，采用了从合并症、处方抗菌药物和健康检查结果中选择的潜在预测因素。
在纳入分析的685,161名个体中，有2,557人发生了ciArAEs。第三代头孢菌素（风险比：1.14，95%置信区间：1.01 - 1.29）、四环素（风险比：2.14，95%置信区间：1.47 - 3.13）和氨基糖苷类（风险比：8.36，95%置信区间：1.18 - 59.2）被确定为口服抗菌药物中ciArAEs的潜在预测因素。其他预测因素包括年龄较大、男性、静脉注射青霉素以及各种合并症。
通过利用大规模数据库，我们证明了包括口服第三代头孢菌素在内的抗菌药物使用与ciArAEs之间的关系。这一发现强调了加强处方规范以及进一步开展抗菌药物耐药性和不良事件研究的必要性。
