Editor's Note: Antimicrobial resistance (AMR) has become a major global public health challenge. To enhance capabilities in diagnosing and treating infectious diseases and promote rational use of antimicrobial agents in China, the 11th Academic Conference of the Infectious Diseases Society of China (IDSC) under the China Medicine Education Association was recently held in Beijing. At the conference, Professor Yoshiaki Gu from the Institute of Science Tokyo (Science Tokyo) shared Japan’s experience in AMR control. Infectious Disease Frontier invited Professor Gu to provide an in-depth analysis of the evolving threat of drug-resistant pathogens in Japan, the outcomes of its National Action Plan, and innovative public education initiatives. He further explored critical future directions for antimicrobial drug development and cross-sectoral collaboration under the "One Health" strategy.

IDF: First, could you give us a brief overview of the current situation regarding antimicrobial resistance (AMR) in Japan? Which drug-resistant pathogens pose the greatest threat to public health?

Prof. Gu: Thank you so much for your question. In my opinion, Escherichia coli (E. coli) is the most important pathogen concerning antimicrobial resistance (AMR). This is due to the increasing burden of E. coli-related diseases, including urinary tract infections, observed year by year. While the Japanese government and hospitals have long focused on combating Methicillin-resistant Staphylococcus aureus (MRSA), which remains problematic in healthcare settings, E. coli is currently becoming a greater concern.

IDF: What achievements has Japan made in recent years in the prevention and control of AMR? In your opinion, what key measures have contributed to these achievements? Please share with us the replicable “Japanese experience”.

Prof. Gu: The Japanese government launched its national action plan in 2016. Prior to that, the AMR issue received less attention, even within the healthcare sector. Following the launch of the national action plan, increasing numbers of people, medical facilities, and specialists have initiated campaigns to reduce the inappropriate use of antimicrobial drugs and improve infection prevention and control. These collaborative efforts have been effective. However, we must continue our efforts to achieve further improvement.

IDF: Public education and patient awareness are also important aspects of AMR prevention and control. What effective measures has Japan taken to improve public awareness of the rational use of antimicrobial drugs?

Prof. Gu: That is a very important question. We have made great efforts to raise public awareness of AMR, though these have not yet succeeded in my view. I believe school education is key to helping more people understand the importance of AMR and appropriate antibiotic use. However, progress in this area has been limited so far. Consequently, we are now engaging with schools and local governments to enhance educational initiatives. For example, a colleague of mine has developed an educational card game on AMR, and we will soon launch a pilot project at a nearby elementary school.

IDF: In response to threats such as CRE and the spread of animal-derived drug-resistant genes, in which areas of technological breakthrough or policy mechanisms will Japan give priority to increasing investment in the future?

Prof. Gu: This is indeed a critical yet challenging question. As you noted, the One Health approach—encompassing human, animal, and environmental sectors—is essential to addressing this issue. While cross-disciplinary collaboration has recently commenced, intensified cooperation remains imperative. Equally vital is advancing the development of novel antimicrobial agents, extending beyond traditional antibiotics. Since our primary goal is patient treatment, non-antibiotic therapeutics would also prove highly beneficial. Consequently, such research and development initiatives are pivotal for future success.

Expert Profile

Prof. Yoshiaki Gu

Institute of Science Tokyo (Science Tokyo)

Yoshiaki Gu, MD, MPH and PhD, has been a professor in the Department of Infectious Diseases at the Institute of Science Tokyo since 2021. He is also the director of Science Tokyo Center for Infectious Disease Education and Analysis (TCIDEA). He is the leader of clinical infectious disease management, hospital infection prevention and control, and infection control for the entire university. He has expertise in clinical management and epidemiology in infectious diseases.