Otake Shogo, Yamagishi Takuya, Shiomoto Takayuki, Nakashita Manami, Kurosu Hitomi, Ikenoue Chiaki, Kato Hirofumi, Fukusumi Munehisa, Shimada Tomoe, Takahashi Takuri, Suzuki Motoi, Kirikae Teruo, Arakawa Yoshichika, Nozu Kandai, Sunagawa Tomimasa, Sugai Motoyuki
Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan.
Field Epidemiology Training Program, National Institute of Infectious Diseases, Tokyo, Japan.
PLoS One. 2025 Aug 4;20(8):e0329635. doi: 10.1371/journal.pone.0329635. eCollection 2025.
Antimicrobial resistance in Pseudomonas aeruginosa is one of the global health concerns. Like many countries, Japan monitors multidrug-resistant P. aeruginosa (MDRP) infections through a national sentinel surveillance system, which has shown a recent decline in MDRP reports. We evaluated this surveillance system to verify the validity of this trend and explore future directions.
We conducted a cross-sectional mixed-method study based mainly on the guidelines published by the United States Centers for Disease Control and Prevention in 2001. As a quantitative method, we analyzed characteristics of reports on MDRP infections from designated sentinel sites (DSSs) between 2013-2022. A questionnaire was sent to identifiable DSSs (target DSSs) requesting data on accurate numbers of MDRP infections between 2018-2022 to assess attributes such as geographical representativeness. Additionally, we conducted as a qualitative method face-to-face, semi-structured key informant interviews with surveillance system stakeholders to assess its usefulness and challenges.
From 2013 to 2022, 1,666 cases of MDRP infections were reported by 463 target DSSs, which were scattered across the county. We obtained valid responses to the questionnaire survey from 231 target DSSs (49.9%). From 2018 to 2022, these sites reported 277 cases as MDRP infections, while 184 cases were accurate cases of MDRP infection, with both numbers declining over time. False reporting and underreporting of MDRP infections were common, resulting in a positive predictive value of 0.45 and a sensitivity of 0.65 for the reports of MDRP infections to the surveillance system. The interviews highlighted the difficulties in timely detection, accurate reporting, and international data comparison.
Our evaluation indicated that the current sentinel surveillance system for MDRP infections partially captured the true decreasing trend in Japan. However, as the epidemiology of drug-resistant P. aeruginosa is changing, national policy and surveillance strategies would need to address changing public health needs.
铜绿假单胞菌的抗菌药物耐药性是全球卫生关注的问题之一。与许多国家一样，日本通过国家哨点监测系统监测多重耐药铜绿假单胞菌（MDRP）感染情况，该系统显示近期MDRP报告数量有所下降。我们对该监测系统进行了评估，以验证这一趋势的有效性并探索未来方向。
我们主要根据美国疾病控制与预防中心2001年发布的指南开展了一项横断面混合方法研究。作为定量方法，我们分析了2013年至2022年指定哨点（DSS）的MDRP感染报告特征。向可识别的DSS（目标DSS）发送了一份问卷，要求提供2018年至2022年MDRP感染的准确病例数，以评估地理代表性等属性。此外，我们作为定性方法，对监测系统利益相关者进行了面对面的半结构化关键信息访谈，以评估其有用性和挑战。
2013年至2022年，463个目标DSS报告了1666例MDRP感染病例，这些病例分布在全国各地。我们从231个目标DSS（49.9%）获得了对问卷调查的有效回复。2018年至2022年，这些地点报告了277例MDRP感染病例，而准确的MDRP感染病例为184例，两者数量均随时间下降。MDRP感染的虚假报告和漏报情况很常见，导致监测系统MDRP感染报告的阳性预测值为0.45，敏感性为0.65。访谈突出了及时检测、准确报告和国际数据比较方面的困难。
我们的评估表明，当前用于MDRP感染的哨点监测系统部分捕捉到了日本真实的下降趋势。然而，由于耐药铜绿假单胞菌的流行病学正在发生变化，国家政策和监测策略需要应对不断变化的公共卫生需求。
