Abstract
Acinetobacter baumannii is one of the most difficult-to-treat pathogens worldwide, due to developed resistance. The aim of this study was to evaluate the use of widely prescribed antimicrobials and the respective resistance rates of A. baumannii, and to explore the relationship between antimicrobial use and the emergence of A. baumannii resistance in a tertiary care hospital. Monthly data on A. baumannii susceptibility rates and antimicrobial use, between January 2014 and December 2017, were analyzed using time series analysis (Autoregressive Integrated Moving Average (ARIMA) models) and dynamic regression models. Temporal correlations between meropenem, cefepime, and ciprofloxacin use and the corresponding rates of A. baumannii resistance were documented. The results of ARIMA models showed statistically significant correlation between meropenem use and the detection rate of meropenem-resistant A. baumannii with a lag of two months (p = 0.024). A positive association, with one month lag, was identified between cefepime use and cefepime-resistant A. baumannii (p = 0.028), as well as between ciprofloxacin use and its resistance (p < 0.001). The dynamic regression models offered explanation of variance for the resistance rates (R2 > 0.60). The magnitude of the effect on resistance for each antimicrobial agent differed significantly.
Highlights
Acinetobacter species are Gram-negative bacteria associated with bacteremia and hospital-acquired pneumonia, including ventilator-associated pneumonia, surgical site infection, secondary meningitis, and urinary tract infections [1,2,3]
A. baumannii isolates were tested for susceptibility to all available antimicrobial agents and Clinical & Laboratory Standards Institute (CLSI) criteria were applied [25]
The evolution of mean yearly antimicrobial use expressed as Defined Daily Doses (DDD)/100 patient days from January
Summary
Acinetobacter species are Gram-negative bacteria associated with bacteremia and hospital-acquired pneumonia, including ventilator-associated pneumonia, surgical site infection, secondary meningitis, and urinary tract infections [1,2,3]. Acinetobacter baumannii has been reported as one of the most important and difficult-to-treat pathogens in the hospital setting [4,5]. The number of A. baumannii infections is steadily increasing, while the optimal treatment of these infections has not yet been established [6]. The lack of new antimicrobial agents against A. baumannii and its ability to accumulate multiple antibiotic resistance genes has led to the current situation of multidrug-resistant (MDR) or extensively drug-resistant Acinetobacter isolates [7,8,9]. Multidrug resistance is considered to be non-susceptibility to at least one agent from three or more antibiotic classes that would otherwise serve as clinically effective treatments and has become a significant cause of increased morbidity and mortality in critically ill patients with severe sepsis [10,11]. CRAB is one of the critical priority pathogens on the World
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