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

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          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<sub>trend</sub> < 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<sub>trend</sub> < 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.

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          Most cited references36

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          Interrupted time series regression for the evaluation of public health interventions: a tutorial

          Abstract Interrupted time series (ITS) analysis is a valuable study design for evaluating the effectiveness of population-level health interventions that have been implemented at a clearly defined point in time. It is increasingly being used to evaluate the effectiveness of interventions ranging from clinical therapy to national public health legislation. Whereas the design shares many properties of regression-based approaches in other epidemiological studies, there are a range of unique features of time series data that require additional methodological considerations. In this tutorial we use a worked example to demonstrate a robust approach to ITS analysis using segmented regression. We begin by describing the design and considering when ITS is an appropriate design choice. We then discuss the essential, yet often omitted, step of proposing the impact model a priori. Subsequently, we demonstrate the approach to statistical analysis including the main segmented regression model. Finally we describe the main methodological issues associated with ITS analysis: over-dispersion of time series data, autocorrelation, adjusting for seasonal trends and controlling for time-varying confounders, and we also outline some of the more complex design adaptations that can be used to strengthen the basic ITS design.
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            Segmented regression analysis of interrupted time series studies in medication use research.

            Interrupted time series design is the strongest, quasi-experimental approach for evaluating longitudinal effects of interventions. Segmented regression analysis is a powerful statistical method for estimating intervention effects in interrupted time series studies. In this paper, we show how segmented regression analysis can be used to evaluate policy and educational interventions intended to improve the quality of medication use and/or contain costs.
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              Regression based quasi-experimental approach when randomisation is not an option: interrupted time series analysis

              Interrupted time series analysis is a quasi-experimental design that can evaluate an intervention effect, using longitudinal data. The advantages, disadvantages, and underlying assumptions of various modelling approaches are discussed using published examples
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                Author and article information

                Journal
                Breast Care (Basel)
                Breast Care (Basel)
                BRC
                Breast Care
                S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.com )
                1661-3791
                1661-3805
                May 2023
                27 January 2023
                27 January 2023
                : 18
                : 2
                : 122-129
                Affiliations
                [1] aDepartment of Breast and Endocrine Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
                [2] bDepartment of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
                [3] cScience, Technology, and Innovation Governance Education and Research Program, Graduate School of Public Policy, The University of Tokyo, Tokyo, Japan
                [4] dDivision of Surgery, National Center for Child Health and Development, Tokyo, Japan
                [5] eDepartment of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
                Author notes
                Article
                brc-0018-0122
                10.1159/000529381
                10228258
                d6a981c3-78e1-451c-a791-a6c41b555b21
                Copyright © 2023 by The Author(s). Published by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Usage and distribution for commercial purposes requires written permission.

                History
                : 12 July 2022
                : 24 January 2023
                : 2023
                Page count
                Figures: 2, Tables: 3, References: 40, Pages: 8
                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.
                Categories
                Research Article

                antimicrobial stewardship,anti-bacterial agents,health policy,mastitis,national action

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