【短 報】 Antimicrobialusedensity 算出時に用いる …

1 430 S E P T. 2 0 0 9.. Antimicrobial use density defined daily dose .. 1 .. 2 .. 3 .. 21 2 10 21 7 3 . Antimicrobial use density AUD . AUD 1 defined daily dose DDD . DDD . 5 7 AUD . DDD ! DDD 1. 1 prescribed daily dose PDD . DDD PDD ! DDD . DDD PDD AUD . AUD DDD .. Key words: antimicrobial use density defined daily dose daily dose antimicrobial use density AUD . World Health Organization WHO 1 prescribed daily dose PDD DDD .. DDD 1 . DDD .. AUD DDD .. AUD 1,000 AUD . AUD 4 MRSA.. 2003 8 2008 7 5 . AUD 1 imipenem! cilastatin IPM! CS . defined daily dose DDD meropenem MEPM cefpirome CPR . !DDD . AUD g . cefepime CFPM vancomycin VCM .. 1,000 teicoplanin TEIC linezolid LZD . WHO DDD 70 kg 1 . 1 10 7 . 70 ! DDD. AUD ATC! ! DDD index http:! ! atcddd! . DDD IPM! CS 2 g MEPM 2 g CPR 4 g . CFPM 2 g VCM 2 g TEIC g LZD g .. 4 18 1.

2 VOL. 57 NO. 5 AUD DDD 431. (g). defined daily dose Prescribed daily dose Imipenem/ Meropenem Cefpirome Cefepime Vancomycin Teicoplanin Linezolid cilastatin Fi Defi neddai lydosev ersusaver agepr escr ibe dda i lydosefor7anti microbi als . Def ineddai lydosewascit edfr om homepageoftheWorl dHe al thOrganiz a t ion(. htt p://. www. whocc. no/. at cddd/).. Pr escr ibeddai lydosewassur veyedov erape r iodof5yea rsatKita kyushuCityYahat aHos pi talandthe av eragewascal cula ted.. PDD 1 piperacillin PIPC . 1 2 4 g DDD . PDD 14 g PIPC . IPM! CS . g MEPM . DDD . g CPR . g CFPM . g AUD . VCM . g TEIC . g LZD 1 .. g PDD DDD IPM! CS 1 g 2 g . MEPM 1. IPM! CS MEPM CPR VCM PDD DDD g 2 g . CPR 1 2 g 4 g . CFPM 1 2. CFPM TEIC g 4 g . VCM 2 g TEIC g LZD LZD PDD DDD Fig. 1 . g DDD IPM! 1 CS MEPM CPR . DDD . 1 CFPM VCM TEIC LZD . IPM!

3 CS MEPM DDD 7 . CPR VCM CFPM TEIC PIPC . LZD Fig. 2 .. 1 PDD PDD . DDD DDD VCM . DDD . DDD AUD . AUD PDD DDD. DDD AUD . AUD . 1 DDD . AUD . AUD .. CPR CFPM PDD infection control team ICT . g DDD 4 g 2 g DDD . DDD AUD . AUD 2 CPR . 432 S E P T. 2 0 0 9. P P 200 500. 180 450. 160 400. 140 350. 120. 300. 100. 250 221. 80. 60 200. 40 150 118. 20 100. 0 50. A B A B. Imipenem/cilastatin Meropenem P P 40 70. 35 60. 30 50. 25. 40. 20 30 15. 10 20. 5 10. 0 0. A B A B. Cefpirome Cefepime P P 120 50. 100 40. 80. 30. 60. 20. 40 20 10. 0 0. A B A B. Vancomycin Teicoplanin P = 30. 25. 20. 15. Total antimicrobial use in 1 month A: 10 defined daily dose 5 B: Total treatment days in 1 month 0. A B. Linezolid Fi Totala nt i microbi alusedividedbyde f ineddai lydosever susactua ltota ltr eat mentdaysi n1. month. ThenumberofAde note st ot alanti mi cr obi alusedivi dedbydef ineddai lydosei n1month.

4 ThenumberofBde note sa ct ualtotaltr eat me ntda ysin1mont h. Thenumber sofAa ndBs howedme di anvalueint heboxpl ots. St ati sti calanaly sisusedMa nn-Whitney'. sUt es t. DDD DDD .. AUD . DDD 1 Merlo J, Wessling A, Melander A : Comparison of VOL. 57 NO. 5 AUD DDD 433. dose standard units for drug utilisation studies. Eur 3 . J Clin Pharmacol 1996; 50: 27-30 AUD . 2 MRSA 2008; 56: 570-6. carbapenem 7 Capella D: Descriptive tools and analysis. WHO Reg 2006; 54: 511-9 Publ Eur Ser 1993; 45: 55-78. 3 Koizumi Y, Nakanishi T, Nomura M, Tanaka H, 8 . Mugitani A, Hatanaka S, et al: Effectiveness of re- 2007; 127: 1789-95. porting system for carbapenem antibiotics in re- 9 Muller A, Monnet D L, Talon D, Henon T, Bertrand stricting their use. Jpn J Pharm Health Care Sci X : Discrepancies between prescribed daily doses 2007; 33: 877-82 and WHO defined daily doses of antibacterials at a 4 university hospital.

5 Br J Clin Pharmacol 2006 ; 61 : ICT 2007; 22: 585-91. 33-6 10 de With K, Maier L, Steib-Bauert M, Kern P, Kern W. 5 V: Trends in antibiotic use at a university hospital: defined or prescribed daily doses? Patient days or 2007; 22: 286-93 admissions as denominator? Infection 2006; 34: 91-4. 6 . Issues in defined daily dose for calculating antimicrobial use density in Japan Tetsuya Ueki , Yukikazu Awaya and Shigehiko Ito . 1 . Department of Pharmacy, Kitakyushu City Yahata Hospital, 4 18 1 Nishihonmachi, Yahatahigashi-ku, Kitakyushu, Fukuoka, Japan 2 . Department of Internal Medicine, Kitakyushu City Yahata Hospital 3 . Department of Surgery, Kitakyushu City Yahata Hospital Antimicrobial use density(AUD) is a widely used indicator for measuring antimicrobial use in the hospital setting. defined daily doses(DDD) set by the World Health Organization(WHO) are used for calculating AUD.

6 Discrepancies among countries in antimicrobial dosage, however, bring into question DDD appropri- ateness. We compared total antimicrobial use divided by DDD (total amount!DDD, incorporated into the equation for calculating AUD) to actual total treatment days in 1 month and surveyed average prescribed daily doses(PDD) for 7 antimicrobials over a period of 5 years at Kitakyushu City Yahata Hospital. We found a marked, statistically significant difference in antimicrobial DDD and average PDD and in the total amount!DDD and total treatment days. Our findings indicate that the degree of difference between DDD. and PDD affects the number of AUD, making it necessary for DDD to be determined based on antimicrobial use in Japan before AUD can be evaluated appropriately.