Japan Antimicrobial Consumption Surveillance (JACS) is aimed at establishing a network for identifying the volume of use of antimicrobials and infection status in Japan over time, and at further upgrading the quality of infection control in order to benefit the general public, by providing collected information as materials for enhancing regional collaboration in infection control.
i. Identification of the status of use of parenteral antimicrobials at medical institutions and their demographics
A web-based system was established (service rendered by: DOMO Inc.) and published in April 2015. In November 2015, a pilot survey request was issued concerning the volume of use in 2014. At the end of FY2016, a survey request was issued concerning the volume of use from 2010 to 2015. Aggregated results are to be provided in FY2017.
ii. Identification of the status of use of parenteral and oral antimicrobials based on sales data
The volumes of use of antimicrobials in 2009, 2011 and 2013 were obtained from IMS Japan, and DID recommended by WHO were calculated. Each antimicrobial was aggregated in Level 3 and Level 4 based on the ATC classification system, and was compared with data from other countries.
To evaluate two elements ((1) the frequency of isolation of antimicrobial-resistant bacteria does not increase, that is, infection control and treatment are properly undertaken; (2) resistance does not proceed, that is, selection pressure is adequately controlled), the JACS system consists of (1) online data collection by pharmacists concerning infection control, aimed at the identification of actual administration to patients with antimicrobial-resistant bacteria infection at medical institutions; and (2) data collection that includes clinics and ambulatory care, based on sales and other data from wholesalers. As for the online data collection by pharmacists, the titers or days of use of parenteral antimicrobials at medical institutions are entered into an integrated online form. The entered data are automatically calculated in AUD (Antimicrobial Used Density) and DOT (Day of Therapy), as indicators recommended by WHO and CDC, and provided as aggregated data. As for ambulatory use, the data of volume of sales are purchased from IMS Japan, and the volume of use of antimicrobials over time is aggregated. Subsequently, data are calculated in DDD (Defined Daily Dose), as defined by WHO, and in DID (DDD per 1,000 inhabitants per day), after correction by the population of Japan.
- Antimicrobial use density (AUD)
AUD is calculated by dividing the total titer of antimicrobials in a specified period by DDD (defined daily dose) as defined by the World Health Organization (WHO), and correcting the DDDs with the total patient days. Units used for AUD are DDDs per 100 bed-days, DDDs per 1000 patient-days, etc. Outpatient prescription may also be calculated by dividing the volume of use (titer) by DDD, and correcting the denominator with regional inhabitants per day (DID; DDDs per 1,000 inhabitants per day). While the term AUD is common in Japan, DDDs are interchangeably used in overseas journals. Although AUD used in Europe is relatively easy to handle and can be utilized for cost calculation via computing titers, AUD cannot be adapted to pediatric population. Furthermore, AUD may cause underestimation or overestimation in comparison among facilities, when the defined DDDs differ from the local dosage or recommended amount.
- Day of therapy (DOT)
DOT is calculated by correcting the total days of therapy (DOTs) using antimicrobials in a specified period with the total patient-days. Units used for DOT are DOTs per 100 bed-days, DOTs per 1,000 patient-days, etc. DOT is used as a standard indicator in the U.S., and can also be used for pediatric population. On the other hand, the treatment period cannot be estimated, since DOT does not incorporate a concept of dosage and DOT can be inaccurate if a patient is on more than one antimicrobial. There are also cases where the number of inpatients is used as the denominator, instead of the total patient-days. In such cases, some reports indicate that correlation with proportion of resistance is improved, compared to when the total patient-days is used as the denominator.
Currently a program is under development for automatically calculating the status of antimicrobial use at medical institutions mentioned above, based on medical prescription request files (EF files). Preparations are in progress to archive automatically calculated files in servers for the Japan Surveillance for Infection Prevention and Healthcare Epidemiology (J-SIPHE), which is installed in the AMR Clinical Reference Center (AMRCRC) established in April 2017 at the National Center for Global Health and Medicine (NCGM). J-SIPHE allows a facility to compare the status of the antimicrobial use among the given groups. By utilizing NDB, identification of antimicrobial use based on various demographic information stratified by age, prefecture and medical area are under progress; and the identification of status of use in pediatric population are underway.