The Japanese Nosocomial Infections Surveillance (JANIS) is one of the largest national antimicrobial resistance (AMR) surveillance systems in the world. In particular, the JANIS Clinical Laboratory (CL) division collects comprehensive specimen-based data from diagnostic microbiology laboratories of participating hospitals to monitor the isolation rate of 11 major bacteria and specific AMR bacteria, and creating antibiograms of approximately 20 bacterial species. Data in the JANIS web-database system are also annually tabulated and provided to the WHO Global Antimicrobial Resistance Surveillance System (GLASS). To create a network of international AMR surveillance systems among Asian countries, Japan is developing an international web-database system named ASIan Antimicrobial Resistance Surveillance Network (ASIARS-Net) based on the JANIS system, but is open-source and available confidentially at almost no cost. JANIS further continues to evolve in multiple directions, some of which are selected and discussed in end of this review.

BackgroundEnterococcus spp. are particularly important etiological agents of nosocomial infections. However, the clinical characteristics of and risk factors for enterococcal infections in clinical settings are poorly understood.MethodsThe sample included patients with Enterococcus spp. infections detected from clinical samples at Nagasaki University Hospital between 2010 and 2011 and patients with enterococcal colonization (control patients). In this retrospective study, the risk factors for enterococcal infections were analyzed by comparing infected and control patients via multivariate logistic regression.ResultsA total of 182 infected (mean age, 64.6 ± 18.2 years; 114 men) and 358 control patients (patients with enterococcal colonization) (mean age, 61.6 ± 22.4 years; 183 men) were included. Enterococcal infections were classified as intraperitoneal (n = 87), urinary tract (n = 28), or bloodstream (n = 20) infections. Cancer and hematological malignancies were the most common comorbidities in enterococcal infections. Carbapenem and vancomycin were administered to 43.8 % and 57.9 % of patients infected with Enterococcus faecalis and Enterococcus faecium, respectively. No vancomycin-resistant enterococci were isolated. Multivariate analysis identified abdominal surgery (odds ratio [OR], 2.233; 95 % confidence interval [CI], 1.529–3.261; p ≤ 0.001), structural abnormalities of the urinary tract (OR, 2.086; 95 % CI, 1.088–4.000; p = 0.027), male sex (OR, 1.504; 95 % CI, 1.032–2.190; p = 0.033), and hypoalbuminemia (OR, 0.731; 95 % CI, 0.555–0.963; p = 0.026) as independent risk factors for enterococcal infections. Multivariate analysis showed abdominal surgery (OR, 2.263; 95 % CI, 1.464–3.498; p ≤ 0.001), structural abnormalities of the urinary tract (OR, 2.634; 95 % CI, 1.194–5.362; p = 0.008), and hypoalbuminemia (OR, 0.668; 95 % CI, 0.490–0.911; p = 0.011) were independent risk factors for E. faecalis infection. Finally, immunosuppressive agent use (OR, 3.837; 95 % CI, 1.397–10.541; p = 0.009) and in situ device use (OR, 3.807; 95 % CI, 1.180–12.276; p = 0.025) were independent risk factors for E. faecium infection.ConclusionsThese findings might inform early initiation of antimicrobial agents to improve clinical success.

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