Successfully controlling the incidence of multidrug-resistant Pseudomonas aeruginosa through antibiotic stewardship and infection control programmes at a Chinese university hospital.

Abstract

The purpose of this study was to investigate the effect of imposing infection control programmes (ICPs) and antimicrobial stewardship (AMS) by monitoring the antimicrobial resistance of Pseudomonas aeruginosa. Antimicrobial susceptibility testing was performed in accordance with the Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing guidelines. ICPs and AMS were initiated at the Fourth Hospital from 2013 to 2018. A total of 2,886 P.aeruginosa isolates were assessed. The antimicrobial resistance trends of the P.aeruginosa strains improved after the intervention measures. Multidrug-resistant (MDR) and extensively drug-resistant (XDR) P.aeruginosa contributed to 18.5% and 3.5% of the total P.aeruginosa strains, respectively. Colistin was the most effective antibiotic against 97.6% of XDR-P.aeruginosa and 99.41% of MDR-P.aeruginosa. The consumption of alcohol-based hand gel (ABHG) increased from 0.6L to 10.8L per 1,000 patient-days (PD) (p=0.005). The yearly consumption of antibiotics decreased from 45 to 37.5 defined daily doses (DDD) per 1,000 PD(p=0.04). After 2013, the incidence rate of MDR-P.aeruginosa showed a significant decrease from 22% to 14.1% (p=0.04), and XDR-P.aeruginosa decreased from 5.8% to 0.9%. The use of ABHG was negatively related to MDR-P.aeruginosa morbidity (r=-0.86; p=0.021). The consumption of antibiotics was positively related to MDR-P.aeruginosa morbidity (r=0.86; p=0.021). Successful control of MDR-P.aeruginosa resistance was achieved by imposing comprehensive ICPs and AMS.