Utilisation-of-third-generation-cephalosporins-and-the-occurrence-of-esbl-microorganisms-in-a-malaysian-general-hospital

Abstract

Introduction: Bacteria had undergone an evolution since the introduction of antibiotics as a way of adaptation. The recent increase in cases of extended-spectrum beta-lactamases (ESBLs) and broad-spectrum antibiotics usage worldwide are of great concern. Objective: This study aims to establish the relationship between third-generation cephalosporin antibiotics usage and the occurrence of ESBL microorganisms in a state hospital in Malaysia. Method: A cross-sectional study utilising data from January 2014 to June 2017 for six-monthly uses of cefoperazone, cefotaxime, ceftazidime, ceftriaxone was expressed in defined daily dose (DDD) per 100 bed-days, while 6-monthly positive cultures of ESBL-producing Escherichia coli, Klebsiella pneumoniae were expressed as the frequency of infection and coloniser cases. Individual trends of antibiotics use-positive culture ESBL over time were analysed descriptively and by linear regression. Result: None of the third-generation cephalosporin use shows a significant trend over time. The most prescribed third-generation cephalosporin was ceftriaxone. The emergence of ESBL E. coli showed a significant reducing trend over time (r2 = 0.931, p < 0.001). No significant correlation was found between antibiotic use and the emergence of ESBL organisms. Conclusion: Our study found no significant correlation between third-generation cephalosporin use and the emergence of ESBL organisms in our setting. The association between third-generation cephalosporin use and ESBL emergence should not be considered universal, as the selection pressure of third-generation cephalosporin might be affected by other factors specific to the institution. The reducing trend of E. coli emergence may be due to the antimicrobial stewardship programme already in place. Additionally, ESBL-producing organisms may appear susceptible to third-generation cephalosporins in our laboratory yet be functionally resistant in vivo.