Nippon AMR One Health Report (NAOR) 2019 November 27, 2019 The AMR One Health Surveillance Committee TABLE OF CONTENTS Preface .................................................................................................................................................................... 1 Abbreviations ......................................................................................................................................................... 2 Types and Abbreviations of Antimicrobials ........................................................................................................... 3 Executive Summary ................................................................................................................................................ 6 Outcome Indices for the Action Plan...................................................................................................................... 9 Current Status of Antimicrobial-resistant Bacteria in Japan ................................................................................. 10 (1) Humans ......................................................................................................................................................................... 11 1) Gram-negative bacteria ................................................................................................................................................. 11 2) Gram-positive bacteria .................................................................................................................................................. 14 3) Antimicrobial-resistant bacteria infection ..................................................................................................................... 17 4) Other antimicrobial-resistant bacteria ........................................................................................................................... 18 5) Mycobacterium tuberculosis ......................................................................................................................................... 25 6) Clostridioides (Clostridium) difficile infection ............................................................................................................. 25 7) Status of health care associated infection ...................................................................................................................... 26 8) Survey of infections and antimicrobial use at long-term care facilities for the elderly ................................................. 27 (2) Animals ......................................................................................................................................................................... 28 1) Bacteria derived from food-producing animal .............................................................................................................. 28 2) Aquatic animal farming................................................................................................................................................. 43 3) Companion animals ....................................................................................................................................................... 44 (3) Food .............................................................................................................................................................................. 48 (4) Environment .................................................................................................................................................................. 49 Current Volume of Use of Antimicrobials in Japan ............................................................................................. 53 (1) Antimicrobials for humans (based on volume of sales) ................................................................................................ 53 (2) Veterinary drugs ............................................................................................................................................................ 55 1) Food-producing animals................................................................................................................................................ 56 2) Aquatic animals ............................................................................................................................................................ 57 3) Companion animals ....................................................................................................................................................... 58 (3) Antimicrobial feed additives ......................................................................................................................................... 58 (4) Agrochemicals............................................................................................................................................................... 59 (5) Current status of antimicrobial use in Japan.................................................................................................................. 59 (6) Research into antimicrobial stewardship ....................................................................................................................... 62 (7) Environment .................................................................................................................................................................. 72 Public Awareness regarding Antimicrobial Resistance in Japan .......................................................................... 74 (1) Survey of the general public .......................................................................................................................................... 74 1) Survey of attitudes among the public ............................................................................................................................ 74 2) Survey of attitudes among patients at medical institutions ............................................................................................ 75 (2) Survey of healthcare providers ...................................................................................................................................... 76 1) Survey of attitudes among clinicians ............................................................................................................................. 76 i 2) Survey of attitudes among clinicians ............................................................................................................................. 77 3) Survey of attitudes among physicians working at clinics .............................................................................................. 79 (3) Surveys of animal producers and clinical veterinarians ................................................................................................ 80 1) Survey of animal producers ............................................................................................................................................ 80 2) Survey of livestock veterinarians ................................................................................................................................... 81 Way Forward ........................................................................................................................................................ 83 Appendix ............................................................................................................................................................................ 84 (1) Japan Nosocomial Infections Surveillance (JANIS) ..................................................................................................... 84 1) Overview ....................................................................................................................................................................... 84 2) Methods for submission ................................................................................................................................................ 84 3) Prospects ....................................................................................................................................................................... 85 (2) National Epidemiological Surveillance of Infectious Disease (NESID) ....................................................................... 85 1) Overview ....................................................................................................................................................................... 85 2) Reporting criteria .......................................................................................................................................................... 85 3) System ........................................................................................................................................................................... 86 4) Prospects ....................................................................................................................................................................... 86 (3) Trend surveillance of antimicrobial-resistant Mycobacterium tuberculosis .................................................................. 86 1) Overview 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