Modeling and forecasting Acinetobacter baumannii resistance to set appropriate use of cefoperazone-sulbactam: Results from trend analysis of antimicrobial consumption and development of resistance in a tertiary care hospital

Abstract

Antibiotic resistance in Acinetobacter baumannii (AB) is increasingly recognized as a major threat to global health. The extensive use of antimicrobial chemotherapy in clinical environments is considered a factor associated with the enhanced occurrence of antimicrobial resistance. The autoregressive integrated moving average model was used to forecast the trend of drug resistance of AB in the coming years, combined with assessment of relationships between antibiotic consumption and AB resistance to set appropriate antibiotic use. A total of 4,377 AB isolates were collected and were associated with a resistance rate of >80% of major antibiotics. A significant increase in resistance in AB to cefoperazone-sulbactam (C-S) (r(2) = 0.98, P = .001) was observed. C-S consumption was correlated with the development of resistance in AB (r = 0.99, P = .02). From 2009-2012, the percentage of AB resistance to C-S was <35%; however, it increased sharply (67.3%) because the annual consumption of C-S was >20 defined daily dose (DDD)/1,000 patient days in 2013.Increased consumption of C-S may contribute to the emergence of multidrug-resistant AB and the increasing prevalence of hospital-acquired infection. A recommendation of limiting the use of C-S to <20 DDD/1,000 patient days annually was proposed for inhibiting the sharp increment of the AB resistance rate in our hospital.