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Abejew AA, Wubetu GY, Fenta TG. Relationship between Antibiotic Consumption and Resistance: A Systematic Review. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2024; 2024:9958678. [PMID: 38476862 PMCID: PMC10932619 DOI: 10.1155/2024/9958678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/20/2023] [Accepted: 02/24/2024] [Indexed: 03/14/2024]
Abstract
Background Unreserved use of antibiotics exerted selective pressure on susceptible bacteria, resulting in the survival of resistant strains. Despite this, the relationship between antibiotic resistance (ABR) and antibiotic consumption (ABC) is rarely studied. This systematic review aims to review the relationship between ABC and ABR from 2016 to 2022. Methods Articles published over 7 years (2016-2022) were searched from December 23 to 31, 2022. The search strategy was developed by using keywords for ABC and ABR. From 3367 articles, 58 eligible articles were included in the final review. Results The pooled ABC was 948017.9 DPDs and 4108.6 DIDs where over 70% of antibiotics were from the Watch and Reserve category based on the WHO AWaRe classification. The average pooled prevalence of ABR was 38.4%. Enterococcus faecium (59.4%), A. baumannii (52.6%), and P. aeruginosa (48.6%) were the most common antibiotic-resistant bacteria. Cephalosporins (76.8%), penicillin (58.3%), and aminoglycosides (52%) were commonly involved antibiotics in ABR. The positive correlation between ABR and consumption accounted for 311 (81%). The correlation between ABR P. aeruginosa and ABC accounted for 87 (22.7%), followed by 78 (20.3%) and 77 (20.1%) for ABR E. coli and K. pneumoniae with ABCs, respectively. Consumption of carbapenems and fluoroquinolones was most commonly correlated with resistance rates of P. aeruginosa, K. pneumoniae, E. coli, and A. baumannii. Conclusion There is a positive correlation between ABC and the rate of ABR. The review also revealed a cross-resistance between the consumption of different antibiotics and ABR. Optimizing antibiotic therapy and reducing unnecessary ABC will prevent the emergence and spread of ABR. Thus, advocating the implementation of stewardship programs plays a pivotal role in containing ABR.
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Affiliation(s)
- Asrat Agalu Abejew
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | | | - Teferi Gedif Fenta
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Tomic T, Henman M, Tadic I, Antic Stankovic J, Santric Milicevic M, Maksimovic N, Odalovic M. Antimicrobial utilization and resistance in Pseudomonas aeruginosa using segmented regression analysis: a comparative study between Serbia and eight European Countries. Int J Clin Pharm 2023:10.1007/s11096-023-01603-y. [PMID: 37284904 PMCID: PMC10246517 DOI: 10.1007/s11096-023-01603-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/10/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND In Europe, Serbia occupies a high position in antibiotic utilization and antimicrobial resistance (AMR). AIM The aim was to analyse utilization trends of meropenem, ceftazidime, aminoglycosides, piperacillin/tazobactam and fluoroquinolones (2006-2020), and the reported AMR in Pseudomonas aeruginosa (2013-2020) in Serbia and to compare with data from eight European countries (2015-2020). METHOD Joinpoint regression was used to analyse antibiotic utilization data (2006-2020) and the reported AMR in Pseudomonas aeruginosa (2013-2020). Data sources were relevant national and international institutions. Antibiotic utilization and AMR in Pseudomonas aeruginosa data in Serbia were compared with eight European countries. RESULTS There was a significantly increased trend for ceftazidime utilization and reported resistance in Pseudomonas aeruginosa, Serbia (p < 0.05) (2018-2020). For ceftazidime, piperacillin/tazobactam, and fluoroquinolones resistances in Pseudomonas aeruginosa an increased trend was observed, Serbia (2013-2020). A decrease in both the utilization of aminoglycosides, Serbia (p < 0.05) (2006-2018) and contemporaneous Pseudomonas aeruginosa resistance (p > 0.05) was detected. Fluoroquinolone utilization (2015-2020) was highest in Serbia compared to Netherlands and Finland, 310 and 305% higher, similar compared to Romania, and 2% less compared to Montenegro. Aminoglycosides (2015-2020) were 2550 and 783% more used in Serbia compared to Finland and Netherlands, and 38% less regarding Montenegro. The highest percentage of Pseudomonas aeruginosa resistance was in Romania and Serbia (2015-2020). CONCLUSION The use of piperacillin/tazobactam, ceftazidime and fluoroquinolones should be carefully monitored in clinical practice due to increased Pseudomonas aeruginosa resistance. The level of utilization and AMR in Pseudomonas aeruginosa is still high in Serbia compared to other European countries.
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Affiliation(s)
- Tanja Tomic
- Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, Belgrade, Serbia.
| | - Martin Henman
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - Ivana Tadic
- Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, Belgrade, Serbia
| | | | | | | | - Marina Odalovic
- Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, Belgrade, Serbia
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Ankrah D, Owusu H, Aggor A, Osei A, Ampomah A, Harrison M, Nelson F, Aboagye GO, Ekpale P, Laryea J, Selby J, Amoah S, Lartey L, Addison O, Bruce E, Mahungu J, Mirfenderesky M. Point Prevalence Survey of Antimicrobial Utilization in Ghana's Premier Hospital: Implications for Antimicrobial Stewardship. Antibiotics (Basel) 2021; 10:antibiotics10121528. [PMID: 34943740 PMCID: PMC8698913 DOI: 10.3390/antibiotics10121528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 12/19/2022] Open
Abstract
The first comprehensive point prevalence survey at the Korle Bu Teaching Hospital (KBTH) was performed as part of the 2019 Global Point Prevalence Survey (Global-PPS) on antimicrobials. The aim was to establish a PPS baseline for the whole hospital and to identify required stewardship interventions. The PPS was conducted over three days in June 2019 using the GLOBAL-PPS standardized method for surveillance of antimicrobial utilization in hospitals to evaluate antimicrobial prescribing. In all, 988 patients were admitted to 69 wards. Overall antimicrobial prevalence was 53.3%. More community-acquired infections (CAI) were treated empirically compared to health-care associated infections (94.0% vs. 86.1% respectively, p = 0.002). Main indications for prescribing antimicrobials were pneumonia (18.4%), skin and soft tissue infections (11.4%) and sepsis (11.1%). Among antimicrobials, systemic antibiotics accounted for 83.5%, of which amoxicillin with beta-lactam inhibitor (17.5%), metronidazole (11.8%) and ceftriaxone (11.5%) dominated. Guideline compliance was 89.0%. Stop/review dates were completed in 33.4% and documented reason was recorded in 53.0% of all prescriptions. If the findings in this PPS can be addressed antimicrobial stewardship at the KBTH stands to improve significantly.
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Affiliation(s)
- Daniel Ankrah
- Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana; (H.O.); (A.A.); (A.O.); (A.A.); (M.H.); (F.N.); (G.O.A.); (P.E.); (J.L.); (J.S.); (S.A.); (L.L.); (O.A.); (E.B.)
- Correspondence:
| | - Helena Owusu
- Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana; (H.O.); (A.A.); (A.O.); (A.A.); (M.H.); (F.N.); (G.O.A.); (P.E.); (J.L.); (J.S.); (S.A.); (L.L.); (O.A.); (E.B.)
| | - Asiwome Aggor
- Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana; (H.O.); (A.A.); (A.O.); (A.A.); (M.H.); (F.N.); (G.O.A.); (P.E.); (J.L.); (J.S.); (S.A.); (L.L.); (O.A.); (E.B.)
| | - Anthony Osei
- Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana; (H.O.); (A.A.); (A.O.); (A.A.); (M.H.); (F.N.); (G.O.A.); (P.E.); (J.L.); (J.S.); (S.A.); (L.L.); (O.A.); (E.B.)
| | - Agneta Ampomah
- Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana; (H.O.); (A.A.); (A.O.); (A.A.); (M.H.); (F.N.); (G.O.A.); (P.E.); (J.L.); (J.S.); (S.A.); (L.L.); (O.A.); (E.B.)
| | - Mark Harrison
- Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana; (H.O.); (A.A.); (A.O.); (A.A.); (M.H.); (F.N.); (G.O.A.); (P.E.); (J.L.); (J.S.); (S.A.); (L.L.); (O.A.); (E.B.)
| | - Frempomaa Nelson
- Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana; (H.O.); (A.A.); (A.O.); (A.A.); (M.H.); (F.N.); (G.O.A.); (P.E.); (J.L.); (J.S.); (S.A.); (L.L.); (O.A.); (E.B.)
| | - Grace Owusu Aboagye
- Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana; (H.O.); (A.A.); (A.O.); (A.A.); (M.H.); (F.N.); (G.O.A.); (P.E.); (J.L.); (J.S.); (S.A.); (L.L.); (O.A.); (E.B.)
| | - Priscilla Ekpale
- Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana; (H.O.); (A.A.); (A.O.); (A.A.); (M.H.); (F.N.); (G.O.A.); (P.E.); (J.L.); (J.S.); (S.A.); (L.L.); (O.A.); (E.B.)
| | - Jennifer Laryea
- Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana; (H.O.); (A.A.); (A.O.); (A.A.); (M.H.); (F.N.); (G.O.A.); (P.E.); (J.L.); (J.S.); (S.A.); (L.L.); (O.A.); (E.B.)
| | - Julia Selby
- Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana; (H.O.); (A.A.); (A.O.); (A.A.); (M.H.); (F.N.); (G.O.A.); (P.E.); (J.L.); (J.S.); (S.A.); (L.L.); (O.A.); (E.B.)
| | - Serwaa Amoah
- Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana; (H.O.); (A.A.); (A.O.); (A.A.); (M.H.); (F.N.); (G.O.A.); (P.E.); (J.L.); (J.S.); (S.A.); (L.L.); (O.A.); (E.B.)
| | - Linda Lartey
- Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana; (H.O.); (A.A.); (A.O.); (A.A.); (M.H.); (F.N.); (G.O.A.); (P.E.); (J.L.); (J.S.); (S.A.); (L.L.); (O.A.); (E.B.)
| | - Okaikor Addison
- Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana; (H.O.); (A.A.); (A.O.); (A.A.); (M.H.); (F.N.); (G.O.A.); (P.E.); (J.L.); (J.S.); (S.A.); (L.L.); (O.A.); (E.B.)
| | - Elizabeth Bruce
- Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana; (H.O.); (A.A.); (A.O.); (A.A.); (M.H.); (F.N.); (G.O.A.); (P.E.); (J.L.); (J.S.); (S.A.); (L.L.); (O.A.); (E.B.)
| | - Joyce Mahungu
- North Middlesex University Hospital NHS Trust, London N18 1QX, UK; (J.M.); (M.M.)
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Hayakawa Ito de Sousa AT, Dos Santos Costa MT, Makino H, Cândido SL, de Godoy Menezes I, Lincopan N, Nakazato L, Dutra V. Multidrug-resistant mcr-1 gene-positive Klebsiella pneumoniae ST307 causing urinary tract infection in a cat. Braz J Microbiol 2021; 52:1043-1046. [PMID: 33713022 PMCID: PMC8105429 DOI: 10.1007/s42770-021-00466-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 02/28/2021] [Indexed: 10/21/2022] Open
Abstract
RESUMO The Klebsiella pneumoniae (K. pneumoniae) bacterium is responsible for many opportunistic infections such as sepsis, and a multidrug-resistant (MDR) clone sequence type (ST) 307 has recently begun to spread. The objective of this study was to report the first occurrence of this virulent genotype, which was found in the context of a urinary infection in a domestic feline in Brazil. The K. pneumoniae isolate was identified from the urine of a 6-month-old male crossbreed cat using 16S rRNA sequencing. It was then subjected to antimicrobial susceptibility testing, followed by multilocus sequence typing analysis, and PCR detection of virulence and resistance genes. The antimicrobial susceptibility profile demonstrated that the isolate was MDR and associated with the presence of the colistin resistance gene (mcr-1). Genotyping allowed us to classify the isolate as K. pneumoniae ST307 with the presence of wabG, uge, and entB genes. MDR K. pneumoniae is important in human and veterinary medicine because it causes many types of infections. Clonal propagation of virulent or MDR genotypes such as K. pneumoniae ST307 is a global concern. This report of ST307 isolation from a urine sample in a domestic feline is the first in Brazil.
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Affiliation(s)
- Alessandra Tammy Hayakawa Ito de Sousa
- Laboratory of Microbiology, Veterinary Hospital, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil.
- School of Veterinary Medicine, Federal University of Mato Grosso, Cuiabá, Brazil.
| | | | - Herica Makino
- Laboratory of Microbiology, Veterinary Hospital, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Stéfhano Luis Cândido
- Laboratory of Microbiology, Veterinary Hospital, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Isabela de Godoy Menezes
- Mycology Laboratory, Faculty of Pharmaceutical Sciences (FCF), University of São Paulo, São Paulo, Brazil
| | - Nilton Lincopan
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Luciano Nakazato
- Laboratory of Microbiology, Veterinary Hospital, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Valéria Dutra
- Laboratory of Microbiology, Veterinary Hospital, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
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Zaha DC, Bungau S, Uivarosan D, Tit DM, Maghiar TA, Maghiar O, Pantis C, Fratila O, Rus M, Vesa CM. Antibiotic Consumption and Microbiological Epidemiology in Surgery Departments: Results from a Single Study Center. Antibiotics (Basel) 2020; 9:antibiotics9020081. [PMID: 32069828 PMCID: PMC7168146 DOI: 10.3390/antibiotics9020081] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/10/2020] [Accepted: 02/10/2020] [Indexed: 02/06/2023] Open
Abstract
The spectrum and antibiotic sensitivity of isolated strains vary between departments, hospitals, countries; the discrepancies are related to the use and dosage of these antibiotics. The purpose of our research was to compare the type of pathogens and the susceptibility of the isolated strains, as well as the use of antibiotics in the surgical departments of the Emergency Clinical County Hospital, Oradea, Romania; for one year, all the patients admitted to the mentioned sections were monitored. Antibiotic sensitivity of isolated strains was expressed using cumulative antibiogram. The total consumption of antibiotics was 479.18 DDD/1000 patient-days in the surgical sections. The most commonly used drugs were cephalosporins third and first generation, and clindamycin. Infections of wounds, urinary tract and fluids were most commonly diagnosed, and the most isolated was Escherichia coli, followed by Staphylococcus aureus and Enterococcus faecalis. The most commonly prescribed antimicrobial was ceftriaxone, but its sensitivity was low. This study revealed that the intake of antimicrobials in the surgical sections is increased and the comparison of antimicrobial prescriptions, sensitivity rates, and the spectrum of isolated pathogens showed differences between antimicrobials.
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Affiliation(s)
- Dana Carmen Zaha
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq., 410081 Oradea, Romania; (D.C.Z.); (D.U.); (C.M.V.)
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 29 N. Jiga St., 410028 Oradea, Romania;
- Correspondence: ; Tel.: +40-726-776-588
| | - Diana Uivarosan
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq., 410081 Oradea, Romania; (D.C.Z.); (D.U.); (C.M.V.)
| | - Delia Mirela Tit
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 29 N. Jiga St., 410028 Oradea, Romania;
| | - Teodor Andrei Maghiar
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq., 410081 Oradea, Romania; (T.A.M.); (O.M.); (C.P.)
| | - Octavian Maghiar
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq., 410081 Oradea, Romania; (T.A.M.); (O.M.); (C.P.)
| | - Carmen Pantis
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq., 410081 Oradea, Romania; (T.A.M.); (O.M.); (C.P.)
| | - Ovidiu Fratila
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq., 410081 Oradea, Romania; (O.F.); (M.R.)
| | - Marius Rus
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq., 410081 Oradea, Romania; (O.F.); (M.R.)
| | - Cosmin Mihai Vesa
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq., 410081 Oradea, Romania; (D.C.Z.); (D.U.); (C.M.V.)
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Changes in the resistance and epidemiological characteristics of Pseudomonas aeruginosa during a ten-year period. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2019; 54:261-266. [PMID: 31628088 DOI: 10.1016/j.jmii.2019.08.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 07/05/2019] [Accepted: 08/14/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE The aim of this study was to investigate the changes over a ten-year period in the resistance and epidemiological characteristics of Pseudomonas aeruginosa strains isolated from the Department of Respiratory in Southwest Hospital. METHODS Antimicrobial resistance was detected using the plate double dilution method. PCR amplification and sequencing were performed to evaluate the carbapenemase genes and the oprD gene. Bacterial genotypes were analyzed by multilocus sequence typing (MLST). Quantitative real-time PCR experiments were performed to assess the expression of efflux pump (mexA and mexX) and ampC gene. RESULTS We collected 233 P. aeruginosa isolates in 2006-2007 and 128 isolates in 2016-2017. The resistance rate of P. aeruginosa strains to the tested antibiotics was significantly lower in 2016-2017 than in 2006-2007. The MLST results showed 27 genotypes in 2006-2007 and 18 genotypes in 2016-2017. ST235 was the most prevalent sequence type, and there was no significant change in the genotypes over the ten-year period. Both VIM-2 and IMP-4 genes were found in 2006-2007, whereas only IMP-4 was found in 2016-2017. The oprD mutational inactivation was the main factor responsible for carbapenem resistance, and the overexpression of mexX had a good correlation with aminoglycoside resistance. CONCLUSION These results indicated that the antibiotic resistance of P. aeruginosa in our respiratory department decreased. The loss of oprD gene was the main mechanism of carbapenem resistance, and mexX overexpression was the major contributing factor to aminoglycoside resistance.
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