Background As a result of the constant increase in carbapenem resistance amongst gram‐negative bacteria in several countries, the inappropriate use of carbapenems must be reduced. Antimicrobial stewardship programmes (ASPs) aim to improve carbapenem usage by implementing interventions, including the promotion of the de‐escalation (DE) strategy. Thus, this study aimed to evaluate the impact of this strategy on carbapenem use based on a clear definition of DE. Methods The post‐prescription review and feedback (PPRF) strategy, which is used to optimise carbapenem use, was implemented by the antimicrobial stewardship team (AST). We compared the DE rate during the pre‐AST intervention period (from April 2017 to March 2018) and post‐AST intervention period (from April 2018 to March 2019). Result A total of 1500 patients (n = 771 in the pre‐AST intervention period and n = 729 in the intervention post‐AST period) were admitted to the hospital. The average duration of antibiotic therapy decreased from 9.9 to 7.7 days. The DE rate significantly increased in the post‐AST intervention period compared with the pre‐AST intervention period (51.4% vs 40.3%; P < .001). Conclusion The PPRF strategy implemented by the AST could improve the carbapenem usage by increasing the DE rate of carbapenem.

As antibiotic resistance has become a global problem, the intervention of an antimicrobial stewardship team (AST) is warranted. In hematological disorders, infectious complications are crucial owing to abnormal neutrophil function and decreased cell-mediated immunity. Despite the widespread implementation of AST intervention, the effectiveness of stewardship practices for immunocompromised patients remains uncertain. We determined the effect of AST interventions on carbapenem therapy in the department of hematology. Patients admitted to the department and undergoing carbapenem therapy were enrolled. We compared carbapenem use between the pre-AST (April 2016–March 2018) and post-AST (April 2018–March 2021) periods. Factors associated with long-term carbapenem therapy were investigated. Overall, 515 episodes of carbapenem therapy in 264 patients in the department were evaluated. According to the interrupted time series analysis, the number of days of therapy decreased with AST intervention (β = −0.263, p = 0.011). In multivariate analysis, predictive factors associated with long-term carbapenem therapy (>8 days) were outpatient onset, chronic obstructive pulmonary disease, acute myeloid leukemia, multiple myeloma, and infection with resistant bacteria (such as extended spectrum β-lactamases and AmpC) (95% confidence interval, 1.030–2.818, 1.067–66.667, 1.057–2.782, 0.168–0.742, and 1.382–5.750, respectively). The AST intervention reduced carbapenem use in patients with hematological disorders.

Background: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), immediately became a pandemic. Therefore, nosocomial infection control is necessary to screen for patients with possible COVID-19. Objective: This study aimed to investigate commonly measured clinical variables to predict COVID-19. Methods: This cross-sectional study enrolled 1087 patients in the isolation ward of a university hospital. Conferences were organized to differentiate COVID-19 from non-COVID-19 cases, and multiple nucleic acid tests were mandatory when COVID-19 could not be excluded. Multivariate logistic regression models were employed to determine the clinical factors associated with COVID-19 at the time of hospitalization. Results: Overall, 352 (32.4%) patients were diagnosed with COVID-19. The majority of the non-COVID-19 cases were predominantly caused by bacterial infections. Multivariate analysis indicated that COVID-19 was significantly associated with age, sex, body mass index, lactate dehydrogenase, C-reactive protein, and malignancy. Conclusion: Some clinical factors are useful to predict patients with COVID-19 among those with symptoms similar to COVID-19. This study suggests that at least two real-time reverse-transcription polymerase chain reactions of SARS-CoV-2 are recommended to exclude COVID-19.

バンコマイシン塩酸塩（VCM）は薬物血中濃度モニタリング（TDM）が必要な抗菌薬である．今回，抗菌薬適正使用プログラム推進のため，体重とクレアチニンクリアランス（Ccr）からVCMの初期投与設計を行い，有用性を検討した．2013年6月～2015年7月に昭和大学藤が丘病院にて初期投与設計を行った実施群と非実施群に分けて後方視的に検討した．さらに2016年にガイドライン改訂版が発刊されたため，推定腎糸球体濾過率（eGFR）を算出しトラフ値を比較した． 211例の対象患者のうち初期投与設計実施群は120例（56.9％）であった．両群のトラフ到達度に差が認められ（p＜0.001），10～15 μg/mLに到達したのは実施群42.5％，非実施群14.2％であった．用量変更を要した患者はそれぞれ30.8％，56.0％で実施群で有意に少なかった（p＜0.001）．ガイドライン改訂版に該当した43例のうちトラフ値が10～15 μg/mLに到達した患者は27.9％であった．eGFR 80 mL/分/1.73 m²以上の患者における負荷投与群と非負荷投与群の到達度に差が認められ（p＝0.005），非負荷投与群における10 μg/mL未満の患者は63.5％であった． 体重とCcrによる初期投与設計は簡便であり，有用性が確認できた．また腎機能が良好な場合に特に初回負荷投与の重要性が示唆された．