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Differential Correlation Between Rates of Antimicrobial Drug Consumption and Prevalence of Antimicrobial Resistance in a Tertiary Care Hospital in Greece

Published online by Cambridge University Press:  02 January 2015

Elias Iosifidis ,
Charalampos Antachopoulos ,
Maria Tsivitanidou ,
Aspasia Katragkou ,
Evagelia Farmaki ,
Maria Tsiakou ,
Theano Kyriazi ,
Danai Sofianou  and
Emmanuel Roilides
Elias Iosifidis
Affiliation:
Third Department of Pediatrics, Aristotle Hospital, Hippokration Hospital, Thessaloniki, Greece
Charalampos Antachopoulos
Affiliation:
Third Department of Pediatrics, Aristotle Hospital, Hippokration Hospital, Thessaloniki, Greece
Maria Tsivitanidou
Affiliation:
Departments of Microbiology, Hippokration Hospital, Thessaloniki, Greece
Aspasia Katragkou
Affiliation:
Third Department of Pediatrics, Aristotle Hospital, Hippokration Hospital, Thessaloniki, Greece
Evagelia Farmaki
Affiliation:
Third Department of Pediatrics, Aristotle Hospital, Hippokration Hospital, Thessaloniki, Greece
Maria Tsiakou
Affiliation:
Third Department of Pediatrics, Aristotle Hospital, Hippokration Hospital, Thessaloniki, Greece
Theano Kyriazi
Affiliation:
Pharmacy, Hippokration Hospital, Thessaloniki, Greece
Danai Sofianou
Affiliation:
Departments of Microbiology, Hippokration Hospital, Thessaloniki, Greece
Emmanuel Roilides*
Affiliation:
Third Department of Pediatrics, Aristotle Hospital, Hippokration Hospital, Thessaloniki, Greece
*
Third Department of Pediatrics, Aristotle University, Hippokration Hospital Konstantinoupoleos 49, GR-546 42 Thessaloniki, Greece (roilides@med.auth.gr)
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Abstract

Objective.

To investigate whether there is a correlation between the rates of antimicrobial drug consumption in hospital departments and the prevalence of antimicrobial resistance among clinically important bacteria recovered in the hospital.

Design.

Retrospective study.

Setting.

Tertiary care hospital in Greece.

Methods.

Data on antimicrobial consumption (from January 2001 through December 2004) were expressed as defined daily doses per 100 bed-days. The prevalence of antimicrobial resistance among isolates of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterococcusfaecium recovered during the same time period were calculated by the microbiology department. We then performed the following analyses: (1) a comparison of the consumption rates for different antimicrobial groups in individual hospital departments, (2) a comparison of the prevalence of resistance to different antimicrobials, and (3) a correlation analysis of antimicrobial consumption rates and the prevalence of antimicrobial resistance.

Results.

The rates of antimicrobial consumption and the prevalence of resistance varied substantially among the hospital's departments. The annual rate of consumption for carbapenems correlated with the rate of consumption for glycopeptides and third-generation cephalosporins (P < .05). Among P. aeruginosa isolates, the prevalence of imipenem resistance correlated with the prevalence of resistance to amikacin, ciprofloxacin, and ceftazidime (P < .05). The rate of carbapenem consumption correlated with the prevalence of imipenem resistance among P. aeruginosa and A. baumannii isolates (P < .05). The rate of aminoglycoside consumption correlated with the prevalence of amikacin resistance among P. aeruginosa, K. pneumoniae, and E. coli isolates (P < .05). However, the rate of consumption for fluoroquinolones and glycopeptides had no correlation with the prevalence of ciprofloxacin resistance among gram-negative bacteria or vancomycin resistance among E. faecium isolates.

Conclusions.

These data are suggestive of a differential relationship between antimicrobial consumption and the prevalence of antimicrobial resistance among various species and for various antimicrobial agents. These findings may help to optimize antimicrobial prescription policies in the hospital, especially in departments that have both high rates of antimicrobial consumption and a high prevalence of antimicrobial resistance.

Information

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 7 , July 2008 , pp. 615 - 622
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008 

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References

1. Giske, CG, Monnet, DL, Cars, O, Carmeli, Y; on behalf of ReAct-Action on Antibiotic Resistance. Clinical and economic impact of common multidrug-resistant gram-negative bacilli. Antimicrob Agents Chemother 2008;52:813–821.Google Scholar
2. Meyer, E, Schwab, F, Gastmeier, P, Rueden, H, Daschner, FD. Surveillance of antimicrobial use and antimicrobial resistance in German intensive care units (SARI): a summary of the data from 2001 through 2004. Infection 2006;34:303–309.Google Scholar
3. Ferech, M, Coenen, S, Malhotra-Kumar, S, et al. European Surveillance of Antimicrobial Consumption (ESAC): outpatient antibiotic use in Europe. J Antimicrob Chemother 2006;58:401–407.Google Scholar
4. White, RL, Friedrich, LV, Mihm, LB, Bosso, JA. Assessment of the relationship between antimicrobial usage and susceptibility: differences between the hospital and specific patient-care areas. Clin Infect Dis 2000;31:16–23.Google Scholar
5. Vander Stichele, RH, Elseviers, MM, Ferech, M, Blot, S, Goossens, H. Hospital consumption of antibiotics in 15 European countries: results of the ESAC Retrospective Data Collection (1997–2002). J Antimicrob Chemother 2006;58:159–167.Google Scholar
6. Monroe, S, Polk, R. Antimicrobial use and bacterial resistance. Curr Opin Microbiol 2000;3:496–501.Google Scholar
7. Levy, SB. The 2000 Garrod lecture. Factors impacting on the problem of antibiotic resistance. J Antimicrob Chemother 2002;49:25–30.Google Scholar
8. Gaynes, R, Monnet, D. The contribution of antibiotic use on the frequency of antibiotic resistance in hospitals. Ciba Found Symp 1997;207:47–56.Google Scholar
9. Sandiumenge, A, Diaz, E, Rodriguez, A, et al. Impact of diversity of antibiotic use on the development of antimicrobial resistance. /Antimicrob Chemother 2006;57:1197–1204.Google Scholar
10. Austin, DJ, Kristinsson, KG, Anderson, RM. The relationship between the volume of antimicrobial consumption in human communities and the frequency of resistance. Proc Natl Acad Sci USA 1999;96:1152–1156.Google Scholar
11. Hsueh, PR, Chen, WH, Luh, KT. Relationships between antimicrobial use and antimicrobial resistance in gram-negative bacteria causing nosocomial infections from 1991–2003 at a university hospital in Taiwan. Int J Antimicrob Agents 2005;26:463–472.Google Scholar
12. Frank, U, Kleissle, EM, Daschner, FD, et al. Multicentre study of antimicrobial resistance and antibiotic consumption among 6,780 patients with bloodstream infections. Eur J Clin Microbiol Infect Dis 2006;25:815–817.Google Scholar
13. Mutnick, AH, Rhomberg, PR, Sader, HS, Jones, RN. Antimicrobial usage and resistance trend relationships from the MYSTIC Programme in North America (1999–2001). J Antimicrob Chemother 2004;53:290–296.Google Scholar
14. Neuhauser, MM, Weinstein, RA, Rydman, R, Danziger, LH, Karam, G, Quinn, JP. Antibiotic resistance among gram-negative bacilli in US intensive care units: implications for fluoroquinolone use. JAMA 2003;289:885–888.Google Scholar
15. Martinez, JA, Aguilar, J, Almela, M, et al. Prior use of carbapenems may be a significant risk factor for extended-spectrum β-lactamase-producing Escherichia coli or Klebsiella spp. in patients with bacteraemia. JAntimicrob Chemother 2006;58:1082–1085.Google Scholar
16. Lee, SO, Kim, NJ, Choi, SH, et al. Risk factors for acquisition of imipenem-resistant Acinetobacter baumatmii: a case-control study. Antimicrob Agents Chemother 2004;48:224–228.Google Scholar
17. Katragkou, A, Kotsiou, M, Antachopoulos, C, et al. Acquisition of imipenem-resistant Acinetobacter baumannii in a pediatric intensive care unit: a case-control study. Intensive Care Med 2006;32:1384–1391.Google Scholar
18. Goossens, H, Ferech, M, Vander Stichele, R, Elseviers, M. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 2005;365:579–587.Google Scholar
19. Fridkin, SK, Steward, CD, Edwards, JR, et al. Surveillance of antimicrobial use and antimicrobial resistance in United States hospitals: project 1CARE phase 2. Project Intensive Care Antimicrobial Resistance Epidemiology (ICARE) hospitals. Clin Infect Dis 1999;29:245–252.Google Scholar
20. MacDougall, C, Powell, JP, Johnson, CK, Edmond, MB, Polk, RE. Hospital and community fluoroquinolone use and resistance in Staphylococcus aureus and Escherichia coli in 17 US hospitals. Clin Infect Dis 2005;41:435–440.Google Scholar
21. Bassetti, M, Cruciani, M, Righi, E, et al. Antimicrobial use and resistance among gram-negative bacilli in an Italian intensive care unit (ICU). J Chemother 2006;18:261–267'.Google Scholar
22. de With, K, Meyer, E, Steib-Bauert, M, Schwab, F, Daschner, FD, Kern, WV. Antibiotic use in two cohorts of German intensive care units. J Hosp Infect 2006;64:231–237.Google Scholar
23. Monnet, DL. ABC Calc—antibiotic consumption calculator, version 1.9. Copenhagen, Denmark: Statens Serum Institut, 2003.Google Scholar
24. Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing. 16th informational supplement. Wayne, PA: CLSI, 2006:M100–S16.Google Scholar
25. Hellenic Centre for Infectious Diseases Control (HCIDC) Web page. Available at: http://www.keel.org.gr/en/. Accessed December 31, 2007.Google Scholar
26. Livermore, DM. Multiple mechanisms of antimicrobial resistance in Pseudomonas aeruginosa: our worst nightmare? Clin Infect Dis 2002;34:634–640.Google Scholar
27. Livermore, DM, Woodford, N. The beta-lactamase threat in Enterobacte-riaceae, Pseudomonas and Acinetobacter . Trends Microbiol 2006;14:413–420.Google Scholar
28. Lepper, PM, Grusa, E, Reichl, H, Hogel, J, Trautmann, M. Consumption of imipenem correlates with β-lactam resistance in Pseudomonas aeruginosa . Antimicrob Agents Chemother 2002;46:2920–2925.Google Scholar
29. López-Lozano, JM, Monnet, DL, Yague, A, et al. Modelling and forecasting antimicrobial resistance and its dynamic relationship to antimicrobial use: a time series analysis. Int J Antimicrob Agents 2000;14:21–31.Google Scholar
30. Miller, GH, Sabatelli, FJ, Hare, RS, et al. The most frequent aminoglycoside resistance mechanisms—changes with time and geographic area: a reflection of aminoglycoside usage patterns? Aminoglycoside Resistance Study Groups. Clin Infect Dis 1997;24:S46–62.Google Scholar
31. Loeffler, JM, Garbino, J, Lew, D, Harbarth, S, Rohner, P. Antibiotic consumption, bacterial resistance and their correlation in a Swiss university hospital and its adult intensive care units. Scand J Infect Dis 2003;35:843–850.Google Scholar
32. Lesch, CA, Itokazu, GS, Danziger, LH, Weinstein, RA. Multi-hospital analysis of antimicrobial usage and resistance trends. Diagn Microbiol Infect Dis 2001;41:149–154.Google Scholar
33. Ena, J, Lopez-Perezagua, MM, Martinez-Peinado, C, Cia-Barrio, MA, Ruiz-Lopez, I. Emergence of ciprofloxacin resistance in Escherichia coli isolates after widespread use of fluoroquinolones. Diagn Microbiol Infect Dis 1998;30:103–107.Google Scholar