Major discrepancy between factual antibiotic resistance and consumption in South of France: analysis of 539,037 bacterial strains

Abstract

The burden of antibiotic resistance is currently estimated by mathematical modeling, without real count of resistance to key antibiotics. Here we report the real rate of resistance to key antibiotics in bacteria isolated from humans during a 5 years period in a large area in southeast in France. We conducted a retrospective study on antibiotic susceptibility of 539,107 clinical strains isolated from hospital and private laboratories in south of France area from January 2014 to January 2019. The resistance rate to key antibiotics as well as the proportion of bacteria classified as Difficult-to-Treat (DTR) were determined and compared with the Mann–Whitney U test, the χ2 test or the Fisher’s exact test. Among 539,037 isolates, we did not observe any significant increase or decrease in resistance to key antibiotics for 5 years, (oxacillin resistance in Staphylococcus aureus, carbapenem resistance in enterobacteria and Pseudomonas aeruginosa and 3rd generation cephalosporin resistance in Escherichia coli and Klebsiella pneumoniae). However, we observed a significant decrease in imipenem resistance for Acinetobacter baumannii from 2014 to 2018 (24.19–12.27%; p = 0.005) and a significant increase of ceftriaxone resistance in Klebsiella pneumoniae (9.9–24.03%; p = 0.001) and Enterobacter cloacae (24.05–42.05%; p = 0.004). Of these 539,037 isolates, 1604 (0.3%) had a DTR phenotype. Over a 5-year period, we did not observe a burden of AR in our region despite a high rate of antibiotic consumption in our country. These results highlight the need for implementation of real-time AR surveillance systems which use factual data.

The Effect of Decreased Antipseudomonal Drug Consumption on Pseudomonas aeruginosa Incidence and Antimicrobial Susceptibility Profiles over 9 Years in a Lebanese Tertiary Care Center

“…Moreover, Pseudomonas' carbapenem resistance had a mean rate of 30.3% ± 3.3% and 33% ± 7.7% for IPM and MEM, respectively, consistent with previous studies [16]. Interestingly, Pseudomonas' carbapenem resistance was unaffected by the decrease in consumption of IPM, which is in line with the findings of other studies [16][17][18]. Although some studies report a correlation between hospital resistance of PAE and carbapenem consumption levels [19], our results echo the findings of Álvarez-Marín et al (2021) showing that the correlation between carbapenem consumption and incidence density of carbapenem-resistant Pseudomonas Aeruginosa is minimal [20].…”

What Doesn’t Kill Them Makes Them Stronger: The Impact of the Resistance Patterns of Urinary Enterobacterales Isolates in Patients from a Tertiary Hospital in Eastern Europe

“…[26]. Similarly, Gianella et al conducted a research in the region of Emilia-Romagna, Italy, and identified higher numbers of DTR patterns, representing 11% of all isolates, with K. pneumoniae accounting for all but one strains [23], while reports from France [27], Hungary [28] or United States [10] highlighted a much lower prevalence of DTR, constantly reported as maximum 1%. Interestingly, there is a wide spectrum of DTR variance among bacterial species, the highest shares of DTR being found among UTIs caused by A. baumannii [10].…”

Trends of Multidrug-Resistant Pathogens, Difficult to Treat Bloodstream Infections, and Antimicrobial Consumption at a Tertiary Care Center in Lebanon from 2015–2020: COVID-19 Aftermath

“…As for E. faecium , we distinguish between vancomycin-resistant (VREfm) and vancomycin-susceptible. We also calculated the isolate density of difficult to treat (DTR) organisms as previously described [ 28 , 29 , 30 ]. This implies resistance to carbapenems, beta-lactams, fluoroquinolones, and additional antimicrobials where applicable (i.e., piperacillin-tazobactam, aztreonam in Pae and Ab; vancomycin, linezolid in Sau and Efm).…”