Influence of antimicrobial consumption on gram-negative bacteria in inpatients receiving antimicrobial resistance therapy from 2008-2013 at a tertiary hospital in Shanghai, China

Abstract

Irrational use of antimicrobial agents is a major cause of increased antimicrobial resistance. Effective antibiotic stewardship strategies nationwide or in local health care settings are necessary to reduce antibiotic use and bacteria resistance. We evaluated the effectiveness of China's antimicrobial stewardship policy on antimicrobial use and applied time-series analysis methodology to determine the temporal relationship between antibiotic use and gram-negative bacteria resistance at Changhai Hospital from 2008-2013. Isolates investigated included Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa. Consumption of 7 restricted-use antibiotics was dramatically reduced. Resistance to ceftazidime in P aeruginosa and A baumannii and resistance to ciprofloxacin in P aeruginosa significantly decreased. By using cross-correlation analysis, associations between ciprofloxacin resistance in P aeruginosa and fluoroquinolones consumption (r = 0.48; lag = 0; P = .02), ceftazidime resistance in P aeruginosa and third-generation cephalosporins consumption (r = 0.54; lag = -1; P = .01) were identified. No substantial association between other pairs was found. Enhanced nationwide antimicrobial stewardship campaigns launched in 2011 have made great achievements in regard to antibiotic use but have had limited effects on the reversal of gram-negative bacteria resistance in health care settings. Sound infection prevention and control programs to reduce the transmission of resistant pathogens for hospitals in China are urgently needed.