Intra-hospital differences in antibiotic use correlate with antimicrobial resistance rate in Escherichia coli and Klebsiella pneumoniae: a retrospective observational study

Cusini, Alexia; Herren, David; Bütikofer, Lukas; Plüss-Suard, Catherine; Kronenberg, Andreas; Marschall, Jonas

doi:10.1186/s13756-018-0387-0

Cited by 23 publications

(20 citation statements)

References 21 publications

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“…In accordance with previous studies, our results found that the FQR E. coli was significantly associated with FQs consumption [9][10][11][12][13][14][15][16][17][18] . The most important resistance mechanism of E. coli to quinolones is mutation of target gene DNA gyrase and topoisomerase IV.…”

Section: Correlation Between Antibiotics Consumption Intensity and Fqrsupporting

confidence: 93%

Association between the rate of fluoroquinolones-resistant Gram-negative bacteria and antibiotic consumption from China based on 145 tertiary hospitals data in 2014

Yang

Chen

Jiang

et al. 2019

Preprint

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This study aimed to investigate the relationship between the rate of fluoroquinolones-resistant (FQR) gram-negative bacteria and antibiotic consumption intensity in 145 tertiary hospitals from China in 2014.Methods A retrospective study using national surveillance data from 2014 was conducted. Data on the annual consumption of each antibiotic, and the rate of FQR gram-negative bacteria, were collected from each participating hospital, and the correlation between antibiotic consumption and FQR rate was simultaneously investigated.Results The overall antibiotic consumption intensity among the hospitals varied between 23.93 and 115.39 defined daily dosages (DDDs) per 100 patient-days (median, 46.30 DDDs per 100 patient-days). Cephalosporins were the most commonly prescribed antibiotics, followed by fluoroquinolones, penicillins, and carbapenems, and the rate of FQR gram-negative bacteria from each hospital varied. The correlation analysis showed significantly relationship between the percentage of FQR E. coli and the consumption of FQs consumption (r=0.308, p<0.01) and levofloxacin (r=0.252, p<0.01). For FQR K. pneumoniae, not only FQs (r=0.291, p<0.01) and levofloxacin (r=0.260, p<0.01) use but also carbapenems (r=0.242, p<0.01) and overall antibiotics (r=0.247, p<0.01) use showed significant correlation. A strong correlation was observed between the resistant proportion of FQR P. aeruginosa and the consumption of all antibiotics (r=0.260, p<0.01), FQs (r=0.319, p<0.01) and levofloxacin (r=0.377, p<0.01). The percentage of levofloxacin-resistant A. baumannii was significantly correlated with the consumption of all antibiotics (r=0.282, p<0.01), third-generation cephalosporins excluding combinations with beta-lactamase inhibitors (r=0.246, p<0.01), FQs (r=0.254, p<0.01) and levofloxacin (r=0.336, p<0.01). However, the correlation of the ciprofloxacin-resistant A. baumannii and the antibiotics consumption was not found.Conclusions A significant relationship was demonstrated between the antibiotic consumption and the rates of FQR gram-negative bacteria. As unreasonable antibiotics usage remains crucial in the proceeding of resistant bacteria selection, our study could greatly promote the avoidance of unnecessary antibiotic usage.

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Section: Correlation Between Antibiotics Consumption Intensity and Fqrsupporting

confidence: 93%

Association between the rate of fluoroquinolones-resistant Gram-negative bacteria and antibiotic consumption from China based on 145 tertiary hospitals data in 2014

Yang

Chen

Jiang

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…However, the correlation of ciprofloxacin-resistant A. baumannii and the antibiotics consumption was not found. Consistant with previous studies, our results found that the FQR E. coli was significantly associated with FQs consumption [10][11][12][13][14][15][16][17][18][19]. The most important resistance mechanism of E. coli to quinolones is mutation of target gene DNA gyrase and topoisomerase IV.…”

Section: Discussionsupporting

confidence: 69%

Association between the rate of fluoroquinolones-resistant gram-negative bacteria and antibiotic consumption from China based on 145 tertiary hospitals data in 2014

et al. 2020

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Background: The purpose of the study is to discuss the correlation between the resistance rate of gram negative bacteria to fluoroquinolones (FQ) and antibiotic consumption intensity of 145 China tertiary hospitals in 2014. Methods: This retrospective study adopted national monitoring data from 2014. Each participating hospital required to report annual consumption of each antibiotic, and the resistance rate of gram negative bacteria to FQ. Then the correlation between antibiotic usage and fluoroquinolones-resistant (FQR) rate was consequently investigated. Results: One hundred forty-five hospitals were included in the study, and the median antibiotic consumption intensity was 46.30 (23.93-115.39) defined daily dosages (DDDs) per 100 patient-days. Cephalosporins ranks first in the antibiotics consumption, followed by fluoroquinolones, penicillins, and carbapenems. Fluoroquinolones resistance rate varied from hospital to hospital. The correlation analysis showed significant relationship between the percentage of FQR Escherichia coli and the consumption of FQs (r = 0.308, p<0.01) and levofloxacin (r = 0.252, p<0.01). For FQR Klebsiella pneumoniae, not only FQs (r = 0.291, p<0.01) and levofloxacin (r = 0.260, p<0.01) use but also carbapenems (r = 0.242, p<0.01) and overall antibiotics (r = 0.247, p<0.01) use showed significant correlation. The resistant proportion of FQR Pseudomonas aeruginosa was observed to be correlated with the consumption of all antibiotics (r = 0.260, p<0.01), FQs (r = 0.319, p<0.01) and levofloxacin (r = 0.377, p<0.01). The percentage of levofloxacin-resistant Acinetobacter baumannii was significantly correlated with the consumption of all antibiotics (r = 0.282, p<0.01), third-generation cephalosporins excluding combinations with beta-lactamase inhibitors (r = 0.246, p<0.01), FQs (r = 0.254, p<0.01) and levofloxacin (r = 0.336, p<0.01). However, the correlation of the ciprofloxacin-resistant A. baumannii and the antibiotics consumption was not found.

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“…The low influence of connectivity on the incidence of resistant E. cloacae complex variants can be explained by their local selection. While resistance in E. coli and K. pneumoniae typically requires gene acquisition 34,35 , E. cloacae complex can resist cephalosporins and carbapenems through increased AmpC betalactamase and decreased porin expression [36][37][38] . Such resistance emerges through adaptation and de novo mutations that are rapidly selected from the local reservoir of susceptible progenitors 39,40 .…”

Section: Discussionmentioning

confidence: 99%

“…The rationale behind hospital-based antibiotic stewardship is based on the assumption that AMR evolves in hospitals. Yet, there is surprisingly limited evidence to support this assumption [36][37][38] . Ecological studies have repeatedly identified associations between the use of antibiotics and AMR prevalence, but such associations do not necessarily reflect AMR selection 19 .…”

Section: Discussionmentioning

confidence: 99%

Metapopulation ecology links antibiotic resistance, consumption and patient transfers in a network of hospital wards

Shapiro

Leboucher

Myard-Dury

et al. 2019

Preprint

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Antimicrobial resistance (AMR) is a global threat. A better understanding of how antibiotic use and betweenward patient transfers (or connectivity) impact hospital AMR can help optimize antibiotic stewardship and infection control strategies. Here, we used metapopulation ecology to explain variations in infection incidences of 17 ESKAPE pathogen variants in a network of 357 hospital wards. Multivariate models identified the strongest influence of ward-level antibiotic use on more resistant variants, and of connectivity on nosocomial species and carbapenem-resistant variants. Pairwise associations between infection incidence and the consumption of specific antibiotics were significantly stronger when such associations represented a priori AMR selection, suggesting that AMR evolves within the network. Piperacillin-tazobactam consumption was the strongest predictor of the cumulative incidence of infections resistant to empirical sepsis therapy. Our data establish that both antibiotic use and connectivity measurably influence hospital AMR and provide a ranking of key antibiotics by their impact on AMR.

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Intra-hospital differences in antibiotic use correlate with antimicrobial resistance rate in Escherichia coli and Klebsiella pneumoniae: a retrospective observational study

Cited by 23 publications

References 21 publications

Association between the rate of fluoroquinolones-resistant Gram-negative bacteria and antibiotic consumption from China based on 145 tertiary hospitals data in 2014

Association between the rate of fluoroquinolones-resistant Gram-negative bacteria and antibiotic consumption from China based on 145 tertiary hospitals data in 2014

Association between the rate of fluoroquinolones-resistant gram-negative bacteria and antibiotic consumption from China based on 145 tertiary hospitals data in 2014

Metapopulation ecology links antibiotic resistance, consumption and patient transfers in a network of hospital wards

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