Factors affecting the antimicrobial changes during treatment for acute otitis media in Japan: A retrospective cohort study using classification and regression trees (CART) analysis

Masamitsu Kono; Daichi Murakami; Hideki Sakatani; Katsuya Okuda; Tetsuya Kinoshita; Masayoshi Hijiya; Takuro Iyo; Tatsuya Shiga; Yohei Morita; Koju Itahashi; Yuji Sasagawa; Yasuhiro Iwama; Tomohisa Yamaguchi; Muneki Hotomi

doi:10.1016/j.jiac.2024.02.022

Factors affecting the antimicrobial changes during treatment for acute otitis media in Japan: A retrospective cohort study using classification and regression trees (CART) analysis

J Infect Chemother. 2024 Feb 27:S1341-321X(24)00057-6. doi: 10.1016/j.jiac.2024.02.022. Online ahead of print.

Affiliations

¹ Department of Otorhinolaryngology Head and Neck Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, Wakayama, 641-8510, Japan.
² Department of Otorhinolaryngology, Head and Neck Surgery, Kinan Hospital, 46-70 Shinjyo-Cho, Tanabe-shi, Wakayama, 646-8588, Japan.
³ Medical Affairs Department, Meiji Seika Pharma Co., Ltd., 2-4-16 Kyobashi, Chuo-ku, Tokyo, 104-8002, Japan.
⁴ Clinical Development Department, Meiji Seika Pharma Co., Ltd., 2-4-16 Kyobashi, Chuo-ku, Tokyo, 104-8002, Japan.
⁵ Department of Otorhinolaryngology Head and Neck Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, Wakayama, 641-8510, Japan. Electronic address: mhotomi@wakayama-med.ac.jp.

PMID: 38417479
DOI: 10.1016/j.jiac.2024.02.022

Abstract

Objectives: Factors that affect the change of first-line antimicrobial agents were investigated to further promote their appropriate use.

Methods: This descriptive study used an electronic medical records database. Total 16,353 of the 199,896 patients enrolled between 1996 and 2019 met the inclusion criteria and formed the overall pediatric acute otitis media (AOM) cohort. The factors leading to the change in first-line antimicrobial agents within 14 days were analyzed using classification and regression trees (CART) analysis.

Results: This antimicrobial treatment cohort, involved 4860 cases of AOM alone and 9567 cases of AOM with other diseases. The size of the medical facility based on number of beds and historical duration of patient registration impacted on antimicrobial changes.

Conclusions: The current results show that hospital-wide or nation-wide antimicrobial stewardship promotion could be the most influencing factor for antimicrobial changes. Particularly in cases of AOM where other diseases coexist, a more accurate diagnosis and definition of treatment failure of first-line drug are suggested to be important while establishing future treatment strategies. The current study is important to promote appropriate antimicrobial use for AOM treatment.

Keywords: Antimicrobial stewardship; Guidelines for diagnosis and management; Pediatric acute otitis media; Pneumococcal conjugate vaccine; Real-world data.

Copyright © 2024 Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases, and Japanese Society for Infection Prevention and Control. Published by Elsevier Ltd. All rights reserved.