薬剤耐性ワンヘルス動向調査年次報告書 2020

1 2020 Nippon AMR One Health Report (NAOR) 2020 1 .. 4 .. 5 .. 7 .. 10 .. 13 .. 14 .. 14 .. 14 .. 18 .. 23 .. 24 Mycobacterium tuberculosis .. 32 Clostridioides ( clostridium ) difficile .. 33 .. 33 .. 34 .. 36 .. 39 .. 39 .. 53 .. 55 .. 61 .. 62 .. 63 .. 67 .. 67 .. 72 .. 74 .. 75 .. 76 .. 76 .. 77 .. 77 .. 80 .. 90 .. 92 2 .. 92 .. 92 .. 93 .. 93 .. 94 .. 96 .. 97 (JANIS) .. 97 .. 97 .. 98 .. 98 (NESID).

2 98 .. 98 .. 98 .. 99 .. 100 J-SIPHE .. 100 .. 100 .. 100 .. 100 .. 101 .. 101 .. 101 .. 101 .. 101 (JVARM) .. 101 .. 101 .. 102 .. 104 JANIS .. 104 .. 106 JAMUS .. 106 .. 106 .. 106 .. 106 Campylobacter spp.. 107 .. 107 .. 107 .. 107 Non-typhoidal Salmonella spp.. 107 .. 107 .. 107 .. 108 3 Neisseria gonorrhoeae .. 108 .. 108 .. 108 .. 108 10 Salmonella Typhi, Salmonella Paratyphi A, Shigella spp.. 109 .. 109 .. 109 .. 110 .. 111 .. 112 .. 113 4 2016 4 AMR 2016 2020 AMR AMR AMR 5 AMED Japan Agency for Medical Research and Development AMU Antimicrobial Use AMR Antimicrobial Resistance ( ) AMRCRC Antimicrobial Resistance Clinical Reference Center AMR AUD Antimicrobial Use Density BP Break Point CDI Clostridioides ( clostridium )

3 difficile Infection CLSI Clinical and Laboratory Standards Institute CRE Carbapenem-resistant Enterobacteriaceae DID Defined Daily Dose per 1000 Inhabitants per Day 1000 DDD(s) Defined Daily Dose (s) DOT Days of Therapy EUCAST European Committee on Antimicrobial Susceptibility Testing FAMIC Food and Agricultural Materials Inspection Center FAO Food and Agricultural Organization of the United Nations GLASS Global Antimicrobial Resistance Surveillance System HAI Healthcare-associated Infection ICU Intensive Care Unit JAMUS Japan Antimicrobial UseSurveillance 6 JANIS Japan Nosocomial infections Surveillance J-SIPHE Japan Surveillance for Infection Prevention and Healthcare Epidemiology JVARM Japanese Veterinary Antimicrobial Resistance Monitoring System MIC Minimum Inhibitory Concentration MDRA Multidrug-resistant Acinetobacter spp.

4 MDRP Multidrug-resistant Pseudomonas aeruginosa MRSA Methicillin-resistant Staphylococcus aureus MSSA Methicillin-susceptible Staphylococcus aureus NDB National Database for Prescription and National Health Check-up NESID National Epidemiological Surveillance of Infectious Disease OIE World Organisation for Animal Health PPCPs Pharmaceuticals and Personal Products PRSP Penicillin-resistant Streptococcus pneumoniae RICSS Regional Infection Control Support System SSI Surgical Site Infection WHO World Health Organization VRE Vancomycin-resistant Enterococci VRSA Vancomycin-resistant Staphylococcus aureus DALY(s) Disability-adjusted life year(s) PPS Point Prevalence Survey 7 * benzylpenicillin penicillin G PCG ampicillin ABPC ampicillin/sulbactam ABPC/SBT piperacillin PIPC oxacillin MPIPC piperacillin/tazobactam PIPC/TAZ amoxicillin AMPC amoxicillin/clavulanic acid AMPC/CVA cefazolin CEZ cephalexin CEX cefotiam CTM cefaclor CCL cefmetazole CMZ cefoxitin CFX cefotaxime CTX ceftazidime CAZ ceftriaxone CTRX cefoperazone/sulbactam CPZ/SBT cefdinir CFDN cefcapene pivoxil CFPN-PI cefditoren pivoxil CDTR-PI cefixime CFIX cefepime CFPM cefpirome CPR cefozopran CZOP cefmetazole CMZ cefoxitin CFX flomoxef FMOX latamoxef LMOX aztreonam AZT meropenem MEPM doripenem DRPM biapenem BIPM imipenem/cilastatin IPM/CS panipenem/betamipron PAPM/BP tebipenem pivoxil TBPM-PI faropenem FRPM ST sulfamethoxazole-trimethoprim ST 8 erythromycin EM clarithromycin CAM azithromycin AZM

5 Tylosin TS telithromycin TEL clindamycin CLDM lincomycin LCM quinupristin/dalfopristin QPR/DPR virginiamycin VGM minocycline MINO tetracycline TC doxycycline DOXY oxytetracycline OTC streptomycin SM tobramycin TOB gentamicin GM amikacin AMK arbekacin ABK kanamycin KM spectinomycin SPCM dihydrostreptomycin DSM ciprofloxacin CPFX levofloxacin LVFX pazufloxacin PZFX norfloxacin NFLX prulifloxacin PUFX moxifloxacin MFLX garenoxacin GRNX sitafloxacin STFX ofloxacin OFLX enrofloxacin ERFX oxolinic acid OA nalidixic acid NA vancomycin VCM teicoplanin TEIC linezolid LZD polymyxin B PL-B colistin CL bacitracin BC Daptomycin DAP chloramphenicol CP florfenicol FF 9 fosfomycin FOM salinomycin SNM bicozamycin BCM trimethoprim TMP isoniazid INH ethambutol EB rifampicin (rifampin) RFP pyrazinamide PZA rifabutin RBT * 36(2014) 2009 antimicrobial agents, antimicrobials ( ) ( ) (antibacterial agents) (antibiotics) ( )

6 ( DDD defined daily dose AUD antimicrobial use density AUD WHO DDD DDDs/100 bed-days DDDs/1000 patient-days DID DDDs/1,000 inhabitants/ day DDD 1 inhabitants DID DOT day of therapy DOT DOTs DOTs/100 bed-days DOTs/1000 patient-days 10 AMR 2016 2020 WHO GLASS GLASS OIE AMR JANIS JVARM IQVIA NDB J-SIPHE FAMIC AMR)

7 12 % Enterococcus faecium 2018 % 2019 2014 3 MRSA 2011 11 2019 DID 2013 2019 2013 2018 2013 2014 2015 2016 2018 2014 2018 10% Lactococcus garvieae 2017 2018 2018 71 t 2018 4 % 2013 2017 2018 2017 48t 36 10t 9t 14 8t 2018

8 : 12 2019 2013 2018 AMR MRSA 3 3 2017 2020

9 2 2018 2020 5 13 % 2013 2015 2017 2018 2019 2020 ( ) , 15% , 25% 20% ( ) 10% ( ) 10% ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) *JANIS 2013 2017 AMR 1 2014 CLSI 2007 MIC g/ml 2008 CLSI JANIS 2015 AMR 1 2014 2020 (DID) 2013 2019 2013 2020 * 33% 50% 50% 50% 20% DID: Defined daily dose per 1,000 inhabitants per day 1,000 * 1 2 % 2014 * 2015 * 2016 2017 2018 2020 ( **) 33% G7 G7 * 3 JVARM ** 1 1.

10 AMR 2016-2020 2016. 2. Muraki Y, et al. Japanese antimicrobial consumption surveillance: first report on oral and parenteral antimicrobial consumption in Japan (2009 2013) J Glob Antimicrob Resist. 2016 Aug 6;7:19-23. 3. Monitoring of AMR 14 JANIS ( (IPM), (MEPM)) % (CTX) (LVFX) ESBL Enterobacter cloacae ( ) Klebsiella (Enterobacter) aerogenes ( 4) 2% ( ) ( ) % i. Escherichia coli 1 Escherichia coli % BP (-2013) BP (2014-) 2011 2012 2013 2014 2015 2016 2017 2018 2019 ABPC 32 32 (116,097) (133,330) (150,867) (170,597) (257,065) (288,052) (307,143) (325,553) (336,351) PIPC 128 128 (119,843) (136,978) (155,626) (175,763) (270,452) (305,604) (327,773) ()