Antimicrobial resistance rates in gram-positive bacteria do not drive glycopeptides use

Abstract

Surveillance data are considered essential to appropriate empiric antibiotic therapy and stewardship. The objective of this study was to determine if a change in the rates of antibiotic resistance impacts antibiotic use in European hospitals. Glycopeptides use was selected to study the correlation between resistance rates and antibiotic use because of the restricted spectrum against resistant gram positive bacteria. PubMed, ECDC databases and national/regional surveillance systems were searched to identify glycopeptides´ consumption in defined daily dose per 1000 inhabitant-days (DID) and rate of methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant coagulase negative staphylococci (MRCoNS), and vancomycin-resistant enterococci (VRE) in bloodstream infections (BSIs) in European countries between 1997 and 2015. Time trends were studied and associations between DID and BSI resistance rates were tested using multi-level mixed effect models. To account for the gap in the publication and dissemination of the yearly resistance data, a 2-year lag in the resistance rates was applied. Data on glycopeptides´ DID and resistance rates of target microorganisms in blood cultures were identified among 31 countries over a 19-year period. Glycopeptides use significantly increased (p<0·0001) while rates of MRSA BSIs decreased in majority of the countries (p<0·0001) and MRCoNS and VRE BSIs remained stable. Variation in glycopeptides’ DID was not associated with variation in BSIs due to MRSA (p = 0·136) and VRE (p = 0·613). After adjusting for MRCoNS and VRE resistance rates, among 21 countries, 11 (52%) had a concordant and 10 (48%) a discordant trend in yearly glycopeptides´ DID and MRSA BSI rates. No correlation was found between resistance rates and DID data even among 8 countries with more than 5% decrease in MRSA rates over time. (RC -0·009, p = 0·059). Resistance rate of MRSA, MRCoNS, and VRE BSIs does not impact DID of glycopeptides in European hospitals. This finding is key to redefining the role and structure of antimicrobial surveillance and stewardship programmes.

Trends in and correlations between antibiotic consumption and resistance of Staphylococcus aureus at a tertiary hospital in China before and after introduction of an antimicrobial stewardship programme

“…[19] showed in a meta-analysis a positive correlation between the rate of MRSA and the glycopeptide usage. However, this was not corroborated in an eight-country study, with more than 5% decrease of MRSA infection, which found only a negative correlation between glycopeptide use and MRSA rates [22]. Moreover, Mascitti et al .…”

Linking infection control to clinical management of infections to overcome antimicrobial resistance

“…Even when data are available, it seems that the prescribers do not trust it. For example, an epidemiological study correlated resistance rates of Gram-positive bacteria and glycopeptide antibiotic use in 31 countries over a period of 19 years [58]. In the majority of countries, use of glycopeptides increased and the rates of MRSA bloodstream infections decreased, while bloodstream infections with meticillinresistant coagulase negative staphylococci and vancomycinresistant enterococci were unchanged.…”

Purification and characterization of nisin P produced by a strain of Streptococcus gallolyticus

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