Antimicrobial resistance rates in gram-positive bacteria do not drive glycopeptides use

PLoS One. 2017 Jul 20;12(7):e0181358. doi: 10.1371/journal.pone.0181358. eCollection 2017.

Abstract

Surveillance data are considered essential to appropriate empiric antibiotic therapy and stewardship. The objective of this study was to determine if a change in the rates of antibiotic resistance impacts antibiotic use in European hospitals. Glycopeptides use was selected to study the correlation between resistance rates and antibiotic use because of the restricted spectrum against resistant gram positive bacteria. PubMed, ECDC databases and national/regional surveillance systems were searched to identify glycopeptides´ consumption in defined daily dose per 1000 inhabitant-days (DID) and rate of methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant coagulase negative staphylococci (MRCoNS), and vancomycin-resistant enterococci (VRE) in bloodstream infections (BSIs) in European countries between 1997 and 2015. Time trends were studied and associations between DID and BSI resistance rates were tested using multi-level mixed effect models. To account for the gap in the publication and dissemination of the yearly resistance data, a 2-year lag in the resistance rates was applied. Data on glycopeptides´ DID and resistance rates of target microorganisms in blood cultures were identified among 31 countries over a 19-year period. Glycopeptides use significantly increased (p<0·0001) while rates of MRSA BSIs decreased in majority of the countries (p<0·0001) and MRCoNS and VRE BSIs remained stable. Variation in glycopeptides' DID was not associated with variation in BSIs due to MRSA (p = 0·136) and VRE (p = 0·613). After adjusting for MRCoNS and VRE resistance rates, among 21 countries, 11 (52%) had a concordant and 10 (48%) a discordant trend in yearly glycopeptides´ DID and MRSA BSI rates. No correlation was found between resistance rates and DID data even among 8 countries with more than 5% decrease in MRSA rates over time. (RC -0·009, p = 0·059). Resistance rate of MRSA, MRCoNS, and VRE BSIs does not impact DID of glycopeptides in European hospitals. This finding is key to redefining the role and structure of antimicrobial surveillance and stewardship programmes.

Publication types

  • Observational Study

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Drug Resistance, Bacterial*
  • Drug Utilization*
  • Epidemiological Monitoring
  • Europe
  • Glycopeptides / therapeutic use*
  • Gram-Positive Bacteria / drug effects*
  • Gram-Positive Bacterial Infections / drug therapy*
  • Gram-Positive Bacterial Infections / microbiology
  • Hospitalization
  • Humans
  • Methicillin-Resistant Staphylococcus aureus / drug effects
  • Vancomycin-Resistant Enterococci / drug effects

Substances

  • Anti-Bacterial Agents
  • Glycopeptides

Grants and funding

This research project receives support from the Innovative Medicines Initiative Joint Undertaking under grant agreement numbers 115737 (COMBACTE-MAGNET) and 115618 (DRIVE-AB), resources of which are composed of financial contribution from the European Union Seventh Framework Programme (FP7/2007‐2013) and EFPIA companies in kind contribution. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.