Antimicrobial resistance and antibiotic consumption in a third level pediatric hospital in Mexico City

Abstract

Introduction: The increasing resistance to antibiotics is a public health problem and an imminent therapeutic challenge in hospitals. In this report we aimed to analyze the relationship between antimicrobial resistance and antibiotic consumption in a third-level pediatric hospital.
 Methodology: A cross-sectional analysis was conducted using the information from the microbiology and pharmacy databases of the Pediatric Hospital “Doctor Silvestre Frenk Freund”, during the period 2015-2018. Prevalence of antimicrobial resistance by microorganisms and dispensed grams of selected antibiotics were calculated annually. Antibiotic resistance trend over the time was evaluated using the Chi-square trends test and to assess the correlation between the dispensed grams of antibiotics with their antimicrobial resistance prevalence, we calculated the Pearson's coefficient (r).
 Results: A total of 4,327 isolated bacterial samples were analyzed (56.5% Gram-positive and 44.5% Gram-negative). Most frequently isolated microorganisms were coagulase-negative staphylococci (CoNS), E. coli, K. pneumoniae, P. aeruginosa and S. aureus. We found a significant increase in resistance to clindamycin and oxacillin for CoNS and significant decrease in nitrofurantoin and amikacin resistance for E. coli and K. pneumoniae. We observed a strong positive and statistically significant correlation between amikacin resistance prevalence and amikacin dispensed grams for P. aeruginosa (r = 0.95, p = 0.05).
 Conclusions: The antibiotic resistance profile showed by our study highlights the need of an appropriate antibiotic control use in the Hospital setting.

Relationship between Antibiotic Consumption and Resistance: A Systematic Review

“…The unit of measure for ABC was not uniform for all articles. The units of ABC were standardized to 1000 patient days (DPDs) [ 21 – 23 , 25 , 30 , 31 , 35 , 37 , 40 , 41 , 44 , 46 , 49 – 52 , 55 – 61 , 64 – 68 , 77 ] and 100 patient days (DPDs) [ 20 , 26 – 29 , 32 – 34 , 36 , 38 , 39 , 42 , 43 , 45 , 53 , 69 , 70 , 73 , 76 ], but in addition, DIDs [ 30 , 40 , 47 , 48 , 56 , 59 , 65 , 66 , 68 , 71 , 72 , 74 , 75 ], grams [ 24 ], and average/percentage trend [ 54 , 62 ] were used to measure ABC. Accordingly, about 948017.9 DPDs (904622.9 standardized per 1000 patient days and 4339.5 per 100 patient days) and 4108.6 DIDs were reported, but about 173616.9 and 99800 were reported in average consumption and in grams, respectively.…”

“…There was a very strong correlation between the consumption of meropenem and the incidence of carbapenem-resistant P. aeruginosa [ 44 ] and meropenem-resistant P. aeruginosa [ 69 ], penicillin with the incidence of combined-resistant P. aeruginosa [ 44 ], imipenem [ 57 ], and ertapenem [ 69 ] with imipenem resistance P. aeruginosa [ 57 , 69 ]. There was also a very strong correlation between amikacin consumption and the resistance rate of P. aeruginosa to amikacin [ 24 ] and between piperacillin/tazobactam and piperacillin/tazobactam-resistant P. aeruginosa [ 69 ]. Similarly, there was a strong correlation between imipenem and meropenem and the rate of carbapenem-resistant P. aeruginosa [ 34 ], carbapenems with the rate of imipenem-resistant [ 44 ], meropenem-resistant [ 44 ], carbapenem-resistant [ 44 ], and ceftazidime-resistant [ 77 ] P. aeruginosa .…”