Higher third-generation cephalosporin prescription proportion is associated with lower probability of reducing carbapenem use: a nationwide retrospective study

Abstract

BackgroundThe ongoing extended spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) pandemic has led to an increasing carbapenem use, requiring release of guidelines for carbapenem usage in France in late 2010. We sought to determine factors associated with changes in carbapenem use in intensive care units (ICUs), medical and surgical wards between 2009 and 2013.MethodsThis ward-level multicentre retrospective study was based on data from French antibiotic and multidrug-resistant bacteria surveillance networks in healthcare facilities. Antibiotic use was expressed in defined daily doses per 1000 patient-days. Factors associated with the reduction in carbapenem use (yes/no) over the study period were determined from random-effects logistic regression model (493 wards nested within 259 healthcare facilities): ward characteristics (type, size…), ward antibiotic use (initial antibiotic use [i.e., consumption of a given antibiotic in 2009], initial antibiotic prescribing profile [i.e., proportion of a given antibiotic in the overall antibiotic consumption in 2009] and reduction in the use of a given antibiotic between 2009 and 2013) and regional ESBL-PE incidence rate in acute care settings in 2011.ResultsOver the study period, carbapenem consumption in ICUs (n = 85), medical (n = 227) and surgical wards (n = 181) was equal to 73.4, 6.2 and 5.4 defined daily doses per 1000 patient-days, respectively. Release of guidelines was followed by a significant decrease in carbapenem use within ICUs and medical wards, and a slowdown in use within surgical wards. The following factors were independently associated with a higher probability of reducing carbapenem use: location in Eastern France, higher initial carbapenem prescribing profile and reductions in consumption of fluoroquinolones, glycopeptides and piperacillin/tazobactam. In parallel, factors independently associated with a lower probability of reducing carbapenem use were ICUs, ward size increase, wards of cancer centres, higher initial third-generation cephalosporin (3GC) prescribing profile and location in high-risk regions for ESBL-PE.ConclusionsOur study suggests that a decrease in 3GCs in the overall antibiotic use and the continuation of reduction in fluoroquinolone use, could allow reducing carbapenem use, given the well-demonstrated role of 3GCs and fluoroquinolones in the occurrence of ESBL-PE. Thus, antibiotic stewardship programs should target wards with higher 3GC prescription proportions to reduce them.

Prevalence, Characteristics and Clonal Distribution of Extended-Spectrum β-Lactamase- and AmpC β-Lactamase-Producing Escherichia coli Following the Swine Production Stages, and Potential Risks to Humans

“…The third-generation cephalosporin (3GC)-resistant Enterobacteriaceae, including the extended spectrum β-lactamase (ESBL)- or AmpC β-lactamase (AmpC)-producing Escherichia coli (ESBL/AmpC-EC), and the carbapenem Enterobacteriaceae, including carbapenemase (CP)-producing E. coli (CP-EC), have been reported as a serious global threat to public health. The 3GCs and carbapenems show excellent activity against Gram-positive and Gram-negative bacteria and are particularly prescribed in treating multidrug-resistant bacterial infections ( Muller et al, 2018 ). The spread of ESBL/AmpC-EC or CP-EC is of great concern because it could aid the emergence and spread of pathogens that are difficult to treat even with an antimicrobial agent of choice regarded as a final treatment option ( Nathisuwan et al, 2001 ; Cortes et al, 2010 ).…”

Epidemiology of carbapenem-resistant Escherichia coli and first report of blaVIM carbapenemases gene in calves from India

“…Resistance to carbapenems is mediated by various factors such as the loss of outer membrane porins, production of carbapenemases and overexpressed efflux pumps [2]. The increasing frequency of Gram-negative bacteria producing extended spectrum β -lactamase enzymes has led to higher carbapenem usage which has resulted in the wider occurrence and spread of carbapenemase-producing Enterobacteriaceae [3–4]. These bacteria in sewage and waste water may contaminate the wider environment and spread resistance genes into many species [5].…”

Prescription of antibiotics as a source of emerging antibiotic resistance: Knowledge, attitudes, and practices of medical staff in the Dassa-Glazoué and Savalou-Bantè's health zones (Benin, West Africa)

“…This observation explains the emergence of resistance through the production of BLSE and carbapenem observed in Benin [13][14][15][16]. It is also well known that the use of third-generation cephalosporins is responsible for the slight reduction in carbapenem resistance [17].…”