Impact of alcohol-based hand sanitizers, antibiotic consumption, and other measures on detection rates of antibiotic-resistant bacteria in rural Japanese hospitals.

There are limited data available on the relationship between multidrug-resistant bacteria and infection control activities in small to medium-sized hospitals. Therefore, we collected data on the use of alcohol-based hand sanitizers (ABHSs), personal protective equipment, antibiotics, and the levels of detectable bacteria between April 2014 and March 2015 in 11 Japanese hospitals. Average total antibiotic consumption was 100 defined daily doses per 1000 patient-days (PD), and average use of ABHSs, masks, plastic aprons, and gloves was 5 L per 1000 PD, and 1, 2, and 26 pieces per 1 PD, respectively. Average numbers of isolated (isolation rate) Staphylococcus aureus (MRSA), extended-spectrum beta-lactamase (ESBL)-producing bacteria, and multidrug-resistant Pseudomonas aeruginosa (MDRP) were 107 (8% of total bacterial tests performed), 51 (4%), and 4 (0.3%), respectively. Multivariate analyses of ABHS and tazobactam/piperacillin consumption showed a significant negative association with the MRSA isolation rate (adjusted R2 = 0.87). These findings suggest that hand hygiene is more important than antibiotic consumption in small to medium-sized hospitals.