Mizuno Kanako, Inose Ryo, Goto Ryota, Muraki Yuichi
Laboratory of Clinical Pharmacoepidemiology, Kyoto Pharmaceutical University, 5 Misasagi Nakauchi-Cho, Yamashina-Ku, Kyoto, 607-8414, Japan.
J Pharm Health Care Sci. 2025 Jun 6;11(1):47. doi: 10.1186/s40780-025-00455-0.
Pseudomonas aeruginosa, a causative microorganism of febrile neutropenia (FN), accounts for approximately 15% of bloodstream infections and is associated with a high mortality rate. Therefore, antibiotics with anti-P. aeruginosa activity should be administered appropriately during the initial treatment of FN. While other countries have examined guideline adherence and its associated factors in FN initial treatment, limited data are available on these aspects in Japan. This study aimed to evaluate adherence to FN treatment guidelines regarding antibiotics used in patients with cancer and identify factors associated with adherence using a Japanese health insurance claims database.
This study used the JMDC hospital-based administrative claims database between April 2014 and August 2022 obtained from JMDC Inc. Hospitalized patients with cancer with a definitive diagnosis of FN were included in the study. FN cases were defined as patients who underwent bacteriological culture and identification test for blood in the same month as their first definitive FN diagnosis. The date of the first bacteriological culture and identification test for blood was considered the date of the first FN definitive diagnosis.
Among 31,947 patients diagnosed with FN, 12,008 underwent bacteriological culture and identification test for blood in the same month as their FN diagnosis. After applying exclusion criteria, 11,292 patients were included in the analysis. The overall adherence rate to FN treatment guidelines for initial antibiotic selection in Japan was 78.8% and remained stable over time, consistently above 75%. Factors significantly associated with guidelines adherence included patients with hematologic malignancies (OR: 1.117, 95% CI: 1.007-1.239). The study also identified trends in antibiotic use in initial treatment. The use of penicillin with beta-lactamase inhibitor significantly increased over time (r = 0.01621, p < 0.001), while carbapenem use significantly decreased (r = -0.00813, p < 0.001).
The study revealed an FN guideline adherence rate of 78.8% in Japan, along with changes in antibiotic prescribing patterns, including a trend toward carbapenem-sparing strategies between 2014 and 2022. Continuous surveillance is necessary, as adherence rates and antibiotic selection may be influenced by future guideline revisions and antimicrobial stewardship initiatives.
铜绿假单胞菌是发热性中性粒细胞减少症（FN）的致病微生物，约占血流感染的15%，且与高死亡率相关。因此，在FN的初始治疗期间应适当使用具有抗铜绿假单胞菌活性的抗生素。虽然其他国家已研究了FN初始治疗中指南的遵循情况及其相关因素，但日本在这些方面的数据有限。本研究旨在利用日本医疗保险理赔数据库评估癌症患者FN治疗指南中抗生素使用的遵循情况，并确定与遵循情况相关的因素。
本研究使用了2014年4月至2022年8月期间从JMDC公司获得的基于医院的JMDC行政理赔数据库。确诊为FN且住院的癌症患者纳入研究。FN病例定义为在首次确诊FN的同月接受血液细菌培养和鉴定试验的患者。首次血液细菌培养和鉴定试验的日期被视为首次FN确诊的日期。
在31947例诊断为FN的患者中，12008例在FN诊断的同月接受了血液细菌培养和鉴定试验。应用排除标准后，11292例患者纳入分析。日本在初始抗生素选择方面对FN治疗指南的总体遵循率为78.8%，且随时间保持稳定，始终高于75%。与指南遵循显著相关的因素包括血液系统恶性肿瘤患者（OR：1.117，95%CI：1.007 - 1.239）。该研究还确定了初始治疗中抗生素使用趋势。随着时间的推移，青霉素与β-内酰胺酶抑制剂的使用显著增加（r = 0.01621，p < 0.001），而碳青霉烯类药物的使用显著减少（r = - 0.00813，p < 0.001）。
该研究显示日本FN指南遵循率为78.8%，同时抗生素处方模式有所变化，包括2014年至2022年期间有碳青霉烯类药物节省策略的趋势。由于遵循率和抗生素选择可能会受到未来指南修订和抗菌药物管理举措的影响，持续监测是必要的。
