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.
Highlights
Rising global resistance rates and emergence of new resistance mechanisms, along with an almost empty antibiotic drug discovery pipeline, are creating a dramatic scenario in hospitals worldwide.[1, 2] In Europe, bloodstream infections (BSIs) due to antibiotic-resistant organisms have been estimated to kill about 25,000 people and to add about 1Á5 billion euros of additional healthcare costs and productivity losses every year.[3]
Glycopeptides use was selected to study the correlation between resistance rates and antibiotic use because the restricted spectrum of these intravenous drugs covers mainly severe infections due to methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant coagulasenegative staphylococci (MRCoNS) and vancomycin-susceptible enterococci (VSE)
The primary outcomes of this study were the yearly resistance rates of MRSA, methicillin-resistant coagulase negative staphylococci (MRCoNS), and vancomycin-resistant enterococci (VRE) in BSI expressed as percentages and glycopeptides use expressed as defined daily dose (DDD) per 1000 inhabitant–days (DID)
Summary
Rising global resistance rates and emergence of new resistance mechanisms, along with an almost empty antibiotic drug discovery pipeline, are creating a dramatic scenario in hospitals worldwide.[1, 2] In Europe, bloodstream infections (BSIs) due to antibiotic-resistant organisms have been estimated to kill about 25,000 people and to add about 1Á5 billion euros of additional healthcare costs and productivity losses every year.[3]. Updated information from AMR surveillance systems plays a pivotal role in this approach. Knowledge of surveillance data should improve public health at different levels, from the local (patients’ clinical outcomes) to the more global (hospital and community AMR rates) perspective. Data from global surveillance systems should provide information on new worrisome AMR trends and allow policymakers at national and international level to design new strategies to face the threat.[9] Yearly European surveillance data are publicly available from the European Centre for Disease Prevention and Control (ECDC)[10] as well as from many national cohorts.[11,12,13] data linking the antibiotic use and availability of surveillance data of target microorganisms are not available
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
