Impact of antimicrobial stewardship interventions in paediatric populations on antimicrobial resistance: analysis of national claim and antimicrobial resistance surveillance data in Japan

BACKGROUND: Excessive antibiotic use contributes to the emergence of antimicrobial resistance (AMR). The Japanese government implemented an antimicrobial stewardship incentive program for the paediatric population in 2018. However, its effect on prescription patterns and the AMR rates remains unclear. OBJECTIVES: The aim of this study was to investigate the impact of the implementation of the antimicrobial stewardship incentive program on AMR rates through changes in antimicrobial prescribing patterns. METHODS: We retrospectively analysed prescription patterns using data from a nationwide claims database and extracted paediatric patient data from healthcare facilities with ≥20 beds from January 2014 to July 2021. The antibiotic prescription amounts were calculated per 1000 patient-days. The AMR rates of urinary Escherichia coli were analysed using data from the comprehensive national AMR surveillance database. Changes were evaluated using an interrupted time-series analysis. RESULTS: After the intervention, antibiotic prescription patterns in 8292 healthcare facilities of both broad- and narrow-spectrum antimicrobials, but not of first-generation cephalosporins, showed a decreasing trend. Prescriptions of fluoroquinolones and broad-spectrum penicillins changed from increasing to decreasing trends, whereas those of third-generation cephalosporins continued to decline. The AMR patterns of urinary E. coli to both broad- and narrow-spectrum antibiotics showed decreasing trends in over 800 healthcare facilities. CONCLUSIONS: After the introduction of the antimicrobial stewardship incentive program, prescriptions for broad-spectrum antibiotics and a part of narrow-spectrum antibiotics declined and the AMR rates of urinary E. coli to both broad- and narrow-spectrum antibiotics decreased. These findings suggest the effectiveness of policy-driven interventions for containing AMR in the paediatric population.