Impact of the National Action Plan for Antimicrobial Resistance on Antibiotic Use for Mastitis Using a Japanese Nationwide Database

Takaaki Konishi; Michimasa Fujiogi; Misuzu Sato; Nobuaki Michihata; Hiroki Matsui; Kotoe Nishioka; Masahiko Tanabe; Yasuyuki Seto; Hideo Yasunaga

doi:10.1159/000529381

Impact of the National Action Plan for Antimicrobial Resistance on Antibiotic Use for Mastitis Using a Japanese Nationwide Database

Breast Care (Basel). 2023 May;18(2):122-129. doi: 10.1159/000529381. Epub 2023 Jan 27.

Authors

Takaaki Konishi^{1

2

3}, Michimasa Fujiogi^{2

4}, Misuzu Sato², Nobuaki Michihata⁵, Hiroki Matsui², Kotoe Nishioka¹, Masahiko Tanabe¹, Yasuyuki Seto¹, Hideo Yasunaga²

Affiliations

¹ Department of Breast and Endocrine Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
² Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
³ Science, Technology, and Innovation Governance Education and Research Program, Graduate School of Public Policy, The University of Tokyo, Tokyo, Japan.
⁴ Division of Surgery, National Center for Child Health and Development, Tokyo, Japan.
⁵ Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Abstract

Introduction: Mastitis is the inflammation of the mammary gland that mainly occurs during the lactation period and requires antibiotic treatment with little evidence for its efficacy. We investigated the effect of the National Action Plan for antimicrobial resistance aiming for appropriate antimicrobial stewardship on broad-spectrum antibiotics administration for mastitis despite the lack of a disease-specific antimicrobial agents manual.

Methods: Using a large nationwide database, an interrupted time-series analysis was performed using data from 34,340 female patients who received antibiotics for mastitis between April 2012 and March 2020. This study compared the trend of outcomes before and after the publication date of the National Action Plan (April 2016). The outcomes were the proportion of broad-spectrum and first-choice narrow-spectrum antibiotic administration and surgical drainage within 30 days after the administration.

Results: Broad-spectrum antibiotics were administered in 70% of the cases before and 67% of the cases after the National Action Plan publication date. The trend of broad-spectrum antibiotics administration significantly changed at the publication (-2.6% [95% confidence interval, -3.9% to -1.3%], p < 0.001) and the administration decreased after the publication (1.9% annual decrease, P_trend < 0.001). The trend of first-choice antibiotics administration also changed at the publication (1.3% [0.1-2.4%], p = 0.028) and the administration increased after the publication (1.3% annual increase, P_trend < 0.001). The occurrence of surgical drainage was stable during the study period.

Conclusion: Despite the lack of a disease-specific antimicrobial manual, the publication of the National Action Plan improved antimicrobial stewardship for mastitis without any impact on a surgical treatment course.

Keywords: Anti-bacterial agents; Antimicrobial stewardship; Health policy; Mastitis; National action.

Grants and funding

This work was supported by grants from the Ministry of Health, Labour and Welfare, Japan (21AA2007); the Ministry of Education, Culture, Sports, Science and Technology, Japan (20H03907); and Kanzawa Medical Research Foundation, Japan.