Abstract
BackgroundTo investigate the trends and correlation between antibacterial consumption and carbapenem resistance in Gram-negative bacteria from 2012 to 2019 in a tertiary-care teaching hospital in southern China.MethodsThis retrospective study included data from hospital-wide inpatients collected between January 2012 and December 2019. Data on antibacterial consumption were expressed as defined daily doses (DDDs)/1000 patient-days. Antibacterials were classified according to the Anatomical Therapeutic Chemical (ATC) classification system. The trends in antimicrobial usage and resistance were analyzed by linear regression, while Pearson correlation analysis was used for assessing correlations.ResultsAn increasing trend in the annual consumption of tetracyclines, β-lactam/β-lactamase inhibitor (BL/BLI) combinations, and carbapenems was observed (P < 0.05). Carbapenem resistance in Acinetobacter baumannii (A. baumannii) significantly increased (P < 0.05) from 18% in 2012 to 60% in 2019. Moreover, significant positive correlations were found between resistance to carbapenems in A. baumannii (P < 0.05) and Escherichia coli (E. coli; P < 0.05) and consumption of carbapenems, while the resistance rate of A. baumannii to carbapenems was positively correlated with cephalosporin/β-lactamase inhibitor (C/BLI) combinations (P < 0.01) and tetracyclines usage (P < 0.05). We also found that use of quinolones was positively correlated with the resistance rate of Burkholderia cepacia (B. cepacia) to carbapenems (P < 0.05), and increasing uses of carbapenems (P < 0.01) and penicillin/β-Lactamase inhibitor (P/BLI) combinations (P < 0.01) were significantly correlated with reduced resistance of Enterobacter cloacae (E. cloacae) to carbapenems.ConclusionThese results revealed significant correlations between consumption of antibiotics and carbapenem resistance rates in Gram-negative bacteria. Implementing proper management strategies and reducing the unreasonable use of antibacterial drugs may be an effective measure to reduce the spread of carbapenem-resistant Gram-negative bacteria (CRGN), which should be confirmed by further studies.
Highlights
To investigate the trends and correlation between antibacterial consumption and carbapenem resistance in Gram-negative bacteria from 2012 to 2019 in a tertiary-care teaching hospital in southern China
Implementing proper management strategies and reducing the unreasonable use of antibacterial drugs may be an effective measure to reduce the spread of carbapenem-resistant Gram-negative bacteria (CRGN), which should be confirmed by further studies
The European Union and European Economic Area estimated that the burden of carbapenem-resistant Klebsiella pneumonia (CRKP) increased the most among the bacterial species studied in terms of the number of infections and deaths during 2007– 2015, followed by carbapenem-resistant Escherichia coli (CREC) [7]
Summary
To investigate the trends and correlation between antibacterial consumption and carbapenem resistance in Gram-negative bacteria from 2012 to 2019 in a tertiary-care teaching hospital in southern China. Increasing antibacterial resistance and associated infections have become a global health threat [1]. Among the many antibiotic-resistant bacteria infections, carbapenem-resistant Gram-negative bacteria (CRGN), which mainly include carbapenem-resistant Enterobacteriaceae (CRE), Acinetobacter baumannii (CRAB) and Pseudomonas aeruginosa (CRPA), pose a significant threat to humanity in terms of mortality, medical burden, and trends in antimicrobial resistance [4]. The European Union and European Economic Area estimated that the burden of carbapenem-resistant Klebsiella pneumonia (CRKP) increased the most (by 6.16 times) among the bacterial species studied in terms of the number of infections and deaths during 2007– 2015, followed by carbapenem-resistant Escherichia coli (CREC) [7]. In the face of rapidly increasing antimicrobial resistance, the World Health Organization (WHO) ranked CRGN as the most urgent bacteria in 2017 [8]
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