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Relationship Between Rates of Antimicrobial Consumption and the Incidence of Antimicrobial Resistance in Staphylococcus aureus and Pseudomonas aeruginosa Isolates From 47 French Hospitals

Published online by Cambridge University Press:  02 January 2015

A. M. Rogues ,
C. Dumartin ,
B. Amadéo ,
A. G. Venier ,
N. Marty ,
P. Parneix  and
J. P. Gachie
A. M. Rogues*
Affiliation:
Unité INSERM 657—Pharmacoépidémiologie et évaluation de l'impact des produits de santé sur les populations, IFR Santé, Publique Université Victor Ségalen, France Service d'Hygiène Hospitalière, CHU Groupe hospitalier Pellegrin, Bordeaux, France
C. Dumartin
Affiliation:
Centre de Coordination de la Lutte contre les Infections Nosocomiales du Sud-Ouest, CHU Groupe hospitalier Pellegrin, France
B. Amadéo
Affiliation:
Centre de Coordination de la Lutte contre les Infections Nosocomiales du Sud-Ouest, CHU Groupe hospitalier Pellegrin, France
A. G. Venier
Affiliation:
Centre de Coordination de la Lutte contre les Infections Nosocomiales du Sud-Ouest, CHU Groupe hospitalier Pellegrin, France
N. Marty
Affiliation:
Service de Microbiologie, Hôpital Purpan, Toulouse, France
P. Parneix
Affiliation:
Centre de Coordination de la Lutte contre les Infections Nosocomiales du Sud-Ouest, CHU Groupe hospitalier Pellegrin, France
J. P. Gachie
Affiliation:
Unité INSERM 657—Pharmacoépidémiologie et évaluation de l'impact des produits de santé sur les populations, IFR Santé, Publique Université Victor Ségalen, France Service d'Hygiène Hospitalière, CHU Groupe hospitalier Pellegrin, Bordeaux, France
*
Unité INSERM 657, Université Bordeaux 2, France ([email protected])
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Abstract

Objective.

To investigate relationships between rates of antimicrobial consumption and the incidence of antimicrobial resistance in Staphylococcus aureus and Pseudomonas aeruginosa isolates from hospitals.

Methods.

We conducted an observational study that used retrospective data from 2002 and linear regression to model relationships. Hospitals were asked to collect data on consecutive S. aureus and P. aeruginosa isolates, consumption rates for antibiotics (ie, anti-infectives for systemic use as defined by Anatomical Therapeutic Chemical class J01), and hospital characteristics, including infection control policies. Rates of methicillin resistance in S. aureus and rates of ceftazidime and ciprofloxacin resistance in P. aeruginosa were expressed as the percentage of isolates that were nonsusceptible (ie, either resistant or intermediately susceptible) and as the incidence of nonsuceptible isolates (ie, the number of nonsuceptible isolates recovered per 1,000 patient-days). The rate of antimicrobial consumption was expressed as the number of defined daily doses per 1,000 patient-days.

Setting.

Data were obtained from 47 French hospitals, and a total of 12,188 S. aureus isolates and 6,370 P. aeruginosa isolates were tested.

Results.

In the multivariate analysis, fewer antimicrobials showed a significant association between the consumption rate and the percentage of isolates that were resistant than an association between the consumption rate and the incidence of resistance. The overall rate of antibiotic consumption, not including the antibiotics used to treat methicillin-resistant S. aureus infection, explained 13% of the variance between hospitals in the incidence of methicillin resistance among S. aureus isolates. The incidence of methicillin resistance in S. aureus isolates increased with the use of ciprofloxacin and levofloxacin and with the percentage of the hospital's beds located in intensive care units (adjusted multivariate coefficient of determination [aR2], 0.30). For P. aeruginosa, the incidence of ceftazidime resistance was greater in hospitals with higher consumption rates for ceftazidime, levofloxacin, and gentamicin (aR2, 0.37). The incidence of ciprofloxacin resistance increased with the use of fluoroquinolones and with the percentage of a hospital's beds located in intensive care (aR2, 0.28).

Conclusions.

A statistically significant relationship existed between the rate of fluoroquinolone use and the rate of antimicrobial resistance among S. aureus and P. aeruginosa isolates. The incidence of resistant isolates showed a stronger association with the rate of antimicrobial use than did the percentage of isolates with resistance.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 12 , December 2007 , pp. 1389 - 1395
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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References

1.Turnidge, J, Christiansen, K. Antibiotic use and resistance—proving the obvious. Lancet 2005;365 548–549Google Scholar
2.Schlaes, DM, Gerding, DN, John, JF, et al. Society for Healthcare Epidemiology of America and Infectious Diseases Society of America Joint Committee on the Prevention of Antimicrobial Resistance: guidelines for the prevention of antimicrobial resistance in hospitals. Infect Control Hosp Epidemiol 1997;18:275–291.CrossRefGoogle Scholar
3.Muller, AA, Mauny, F, Bertin, M, et al. Relationship between spread of methicillin-resistant Staphylococcus aureus and antimicrobial use in French university hospital. Clin Infect Dis 2003;36 971–978Google Scholar
4.Loeb, MB, Craven, S, McGeer, AJ, et al. Risk factors for resistance to antimicrobial agents among nursing home residents. Am J Epidemiol 2003;157:40–47.Google Scholar
5.Monnet, DL, Toward multinational resistance surveillance systems in Europe. Int J Antimicrob Agents 2000;15:91–101.Google Scholar
6.World Health Organization (WHO). Guidelines for ATC Classification and DDD Assignment. WHO Collaborating Centre for Drug Statistics Methodology, Norwegian Institute of Public Health: Oslo;2005. Available at: http://www.whocc.no/atcddd/. Accessed October 22, 2007.Google Scholar
7.Harbarth, S, Harris, AD, Carmeli, Y, Samore, MH. Parallel analysis of individual and aggregated data on antibiotic exposure and resistance in gram-negative bacilli. Clin Infect Dis 2001;33:1462–1468.CrossRefGoogle ScholarPubMed
8.Monnet, DL, Lopez-Lozano, JM. Campillos, P, Burgos, A, Yague, A, Gonzalo, N. Making sense of antimicrobial use and resistance surveillance data: application of ARIMA and transfer function models. Clin Microbiol Infect 2001;7(suppl 5):29–36.Google Scholar
9.Lopez-Lozano, JM, Monnet, DL, Yagûe, A, et al. Modelling and forecasting antimicrobial resistance and its dynamic relationship to antimicrobial use: a time series analysis. Int J Antimicrob Agents 2000;14:21–31.CrossRefGoogle ScholarPubMed
10.Lepper, PM, Grusa, E, Reichl, H, Högel, J, Trautmann, M. Consumption of imipenem correlates with β-lactam resistance in Pseudomomas aeruginosa. Antimicrob Agents Chemother 2002;46:2920–2925.Google Scholar
11.Monnet, DL, MacKenzie, FM, Lopez-Lozano, JM, et al. Antimicrobial drug use and methicillin-resistant Staphylococcus aureus, Aberdeen, 1996-2000. Emerg Infect Dis 2004;10:1432–1441.Google Scholar
12.Hill, DA, Herford, T, Parratt, D. Antibiotic usage and methicillin-resistant Staphylococcus aureus: an analysis of causality. J Antimicrob Chemother 1998;42 676–677Google Scholar
13.Graffunder, EM, Venezia, RA. Risk factors associated with nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection including previous use of antimicrobials. J Antimicrob Chemother 2002;49 999–1005CrossRefGoogle ScholarPubMed
14.Crowcroft, NS, Ronveaux, O, Monnet, DL, Mertens, R. Methicillin-resistant Staphylococcus aureus and antimicrobial use in Belgian Hospitals. Infect Control Hosp Epidemiol 1999;20:31–36.Google Scholar
15.Westh, H, Scheel Zinn, C, Thamdrup Rosdahl V;the SARISA Study Group. An international multicenter study of antimicrobial consumption and resistance in Staphylococcus aureus isolates from 15 hospitals in 14 countries. Microbial Drug Resistance 2004;10:169–176.Google Scholar
16.Muller, PT, Mauny, F, Talon, D, Donnan, A, Harbarth, S, Bertrand, X. Effect of individual- and group-level antibiotic exposure on MRSA isolation: a multilevel analysis. J Antimicrob Chemother 2006;58:878–881.CrossRefGoogle ScholarPubMed
17.MacDougall, C, Harpe, SE, Powell, JP, Johnson, CK, Edmond, MB, Polk, RE. Pseudomonas aeruginosa, Staphylococcus aureus and fluoroquinolone use. Emerg Infect Dis 2005;11:1197–1204.CrossRefGoogle ScholarPubMed
18.Weber, SG, Gold, HS, Hooper, DC, Karchmer, AW, Carmeli, Y. Fluoroquinolones and the risk for methicillin-resistant Staphylococcus aureus in hospitalized patients. Emerg Infect Dis 2003;9:1415–1422.CrossRefGoogle ScholarPubMed
19.Acar, JF, Goldstein, FW. Trends in bacterial resistance to fluoroquinolones. Clin Infect Dis 1997;24(suppl 1):S67–73.CrossRefGoogle ScholarPubMed
20.Conseil scientifique de l'ONERBA. Bacterial resistance to antibiotics: data from the National Observatory of Bacterial Resistance Epidemiology (ONERBA). Med Mal Infect 2005;35:155–169.Google Scholar
21.Harbarth, S, Liassine, N, Dharan, S, Herrault, P, Auckenthaler, R, Pittet, D. Risk factors for persistent carriage of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2000;31:1380–1385.Google Scholar
22.Bisognano, C, Vaudaux, PE, Lew, DP, et al. Increased expression of fibronectin-binding proteins by fluoroquinolone-resistant Staphylococcus aureus exposed to subinhibitory levels of ciprofloxacin. Antimicrob Agents Chemother 1997;41:906–913.Google Scholar
23.Cook, PP, Catrou, P, Gooch, M, Holbert, D. Effect of reduction in ciprofloxacin use on prevalence of methicillin-resistant Staphylococcus aureus rates within individual units of a tertiary care hospital. J Hosp Infect 2006;64:348–351.Google Scholar
24.Charbonneau, P, Parienti, JJ, Thibon, P, et al. Fluoroquinolone use and methicillin-resistant Staphylococcus aureus isolation rates in hospitalized patients: a quasi experimental study. Clin Infect Dis 2006;42:778–784.CrossRefGoogle ScholarPubMed
25.Talon, D, Muller, A, Thouverez, M, Bertrand, X. MRSA incidence as an indicator of infection control practices: do the results reflect the reality? J Hosp Infect 2004;57:265–266.Google Scholar
26.Muto, CA, Jernigan, JA, Ostrowsky, BE, et al. Society for Healthcare Epidemiology of America guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol 2003;24:362–386.CrossRefGoogle ScholarPubMed
27.MacKenzie, F, Bruce, J, Straelens, MJ, et al. Antimicrobial drug use and infection control practices associated with the prevalence of methicillin-resistant Staphylococcus aureus in European hospitals. Clin Microbiol Infect 2007;13:269–276.Google Scholar
28.White, RL. How do measurements of antibiotic consumption relate to antibiotic resistance? In: Gould, IM, van der Meer, JWN, eds. Antibiotics Policies: Theory and Practice. New York: Springer, 2005:75–103.CrossRefGoogle Scholar
29.Schwaber, MJ, De-Medina, T, Carmeli, Y. Epidemiological interpretation of antibiotic resistance studies—what are we missing? Nat Rev Microbiol 2004;2:979–983.CrossRefGoogle ScholarPubMed
30.Paramythiotou, E, Lucet, JC, Timsit, JF, et al. Acquisition of multidrug-resistant Pseudomonas aeruginosa in patients in intensive care units: role of antibiotics with pseudomonal activity. Clin Infect Dis 2004;38:670–677.Google Scholar
31.Polk, RE, Johnson, CK, McClish, D, Wenzel, RP, Edmond, MB. Predicting hospitals rates of fluoroquinolone-resistant Pseudomonas aeruginosa use in US hospitals and their surrounding communities. Clin Infect Dis 2004;39:497–503.Google Scholar
32.Ray, GT, Baxter, R, DeLorenze, GN. Hospital-level rates of fluoroquinolone use and the risk of hospital-acquired infection with ciprofloxacin-non-susceptible Pseudomonas aeruginosa. Clin Infect Dis 2005;41:441–449.Google Scholar
33.Mohr, JF, Jones, A, Ostrosky-Zeichner, L, Wanger, A, Tillotson, G. Associations between antibiotic use and changes in susceptibility patterns of Pseudomonas aeruginosa in a private, university-affiliated teaching hospital: an 8-year-experience 1995-2002. Int J Antimicrob Agents 2004;24 346–351CrossRefGoogle Scholar