Epidemiology and patterns of empiric antimicrobial therapy practice in patients with community-onset sepsis using data from a Japanese nationwide medical claims database—the Japan Sepsis Alliance (JaSA) study group

• Published in: IJID regions 2024-03, Vol.10, p.162-167
• Main Authors: Abe, Toshikazu, Iriyama, Hiroki, Imaeda, Taro, Komori, Akira, Oami, Takehiko, Aizimu, Tuerxun, Takahashi, Nozomi, Yamao, Yasuo, Nakagawa, Satoshi, Ogura, Hiroshi, Umemura, Yutaka, Matsushima, Asako, Fushimi, Kiyohide, Shime, Nobuaki, Nakada, Taka-aki
• Format: Article
• Language: English
• Subjects: Anti-infective agents; Antibacterial agents; Community-onset sepsis; Infections; Sepsis
• ISSN: 2772-7076; 2772-7076
• DOI: 10.1016/j.ijregi.2024.01.002

•Third-generation cephalosporins were the most frequently used for sepsis in wards.•Carbapenems were the most frequently used for sepsis in intensive care units in Japan.•Half of the patients with sepsis initially used an antipseudomonal microbial.•A combination therapy of antimicrobials for drug-resistant bacteria was rare. We aimed to describe empiric antimicrobial options for patients with community-onset sepsis using nationwide real-world data from Japan. This retrospective cohort study used nationwide Japanese data from a medical reimbursement system database. Patients aged ≥20 years with both presumed infections and acute organ dysfunction who were admitted to hospitals from the outpatient department or emergency department between 2010 and 2017 were enrolled. We described the initial choices of antimicrobials for patients with sepsis stratified by intensive care unit (ICU) or ward. There were 1,195,741 patients with community-onset sepsis; of these, 1,068,719 and 127,022 patients were admitted to the wards and ICU, respectively. Third-generation cephalosporins and carbapenem were most commonly used for patients with community-onset sepsis. We found that 1.7% and 6.0% of patients initially used antimicrobials for methicillin-resistant Staphylococcus aureus coverage in the wards and ICU, respectively. Although half of the patients initially used antipseudomonal agents, only a few patients used a combination of antipseudomonal agents. Moreover, few patients initially used a combination of antimicrobials to treat methicillin-resistant Staphylococcus aureus and Pseudomonas sp. Third-generation cephalosporins and carbapenem were most frequently used for patients with sepsis. A combination therapy of antimicrobials for drug-resistant bacteria coverage was rarely provided to these patients.