BACKGROUND Infection is a major complication for patients with haematological malignancies. It is important to better understand the use of antimicrobial agents and antibiotic resistance for appropriate treatment and prevention of drug resistance. However, very few multi-centre analyses have focused on the use of antimicrobial agents and antibiotic resistance have been carried out in Japan. This study aimed to describe the characteristics of the use of antimicrobial agents and antibiotic resistance in patients with haematological malignancies. METHODS We conducted a cross-sectional study using administrative claims data and antimicrobial susceptibility data in Japan. We included patients diagnosed with haematological malignancies, who were hospitalized in a haematology ward between 1 April 2015 and 30 September 2017 in 37 hospitals. Descriptive statistics were used to summarize patient characteristics, antimicrobial utilization, bacterial infections, and antibiotic resistance. RESULTS In total, 8064 patients were included. Non-Hodgkin lymphoma (50.0%) was the most common malignancy. The broad-spectrum antibiotics displayed a following antimicrobial use density (AUD): cefepime (156.7), carbapenems (104.8), and piperacillin/tazobactam (28.4). In particular, patients with lymphoid leukaemia, myeloid leukaemia, or myelodysplastic syndromes presented a higher AUD than those with Hodgkin lymphoma, non-Hodgkin lymphoma, or multiple myeloma. The most frequent bacterial species in our study cohort was Escherichia coli (9.4%), and this trend was also observed in blood specimens. Fluoroquinolone-resistant E. coli (3.6%) was the most frequently observed antibiotic-resistant strain, while other antibiotic-resistant strains were rare. CONCLUSIONS Broad-spectrum antibiotics were common in patients with haematological malignancies in Japan; however, antibiotic-resistant bacteria including carbapenem-resistant or multidrug-resistant bacteria were infrequent. Our results provide nationwide, cross-sectional insight into the use of antimicrobial agents, prevalence of bacteria, and antibiotic resistance, demonstrating differences in antimicrobial utilization among different haematological diseases.

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日本血液学恶性肿瘤患者的抗菌利用和抗菌素耐药性：一项多中心的横断面研究。

背景技术感染是血液系统恶性肿瘤患者的主要并发症。重要的是更好地了解抗菌剂和抗生素耐药性的使用，以进行适当的治疗和预防耐药性。但是，很少有针对抗生素使用的多中心分析，并且在日本已经进行了抗生素耐药性分析。这项研究旨在描述血液系统恶性肿瘤患者使用抗菌药物和抗生素耐药性的特点。方法我们使用日本的行政声明数据和抗菌药物敏感性数据进行了横断面研究。我们纳入了诊断为血液系统恶性肿瘤的患者，这些患者于2015年4月1日至2017年9月30日期间在血液病房住院，共37所医院。描述性统计数据用于总结患者特征，抗菌药物利用，细菌感染和抗生素耐药性。结果总共包括8064例患者。非霍奇金淋巴瘤（50.0％）是最常见的恶性肿瘤。广谱抗生素显示以下抗菌药物使用密度（AUD）：头孢吡肟（156.7），碳青霉烯（104.8）和哌拉西林/他唑巴坦（28.4）。特别是，淋巴样白血病，髓样白血病或骨髓增生异常综合症的患者比霍奇金淋巴瘤，非霍奇金淋巴瘤或多发性骨髓瘤患者的AUD更高。在我们研究的队列中，最常见的细菌种类是大肠杆菌（9.4％），并且在血液样本中也观察到了这种趋势。对氟喹诺酮类耐药的大肠杆菌（3.6％）是最常见的对抗生素耐药的菌株，而其他耐药菌则很少见。结论在日本的血液系统恶性肿瘤患者中，广谱抗生素很常见。然而，包括碳青霉烯或多药耐药菌在内的耐药菌很少见。我们的结果为全国范围内对抗菌剂的使用，细菌的流行以及对抗生素的耐药性提供了洞察力，从而证明了不同血液学疾病之间抗菌利用的差异。