Antibiotic consumption versus the prevalence of carbapenem-resistant Gram-negative bacteria at a tertiary hospital in China from 2011 to 2017

Di Zhang; Sasa Hu; Jinyao Sun; Lu Zhang; Haiyan Dong; Weiyi Feng; Jin'e Lei; Yalin Dong

doi:10.1016/j.jiph.2018.10.003

Antibiotic consumption versus the prevalence of carbapenem-resistant Gram-negative bacteria at a tertiary hospital in China from 2011 to 2017

J Infect Public Health. 2019 Mar-Apr;12(2):195-199. doi: 10.1016/j.jiph.2018.10.003. Epub 2018 Oct 29.

Authors

Di Zhang¹, Sasa Hu¹, Jinyao Sun¹, Lu Zhang¹, Haiyan Dong¹, Weiyi Feng¹, Jin'e Lei², Yalin Dong³

Affiliations

¹ Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
² Department of Clinical Laboratory, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
³ Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China. Electronic address: [email protected].

PMID: 30385238
DOI: 10.1016/j.jiph.2018.10.003

Abstract

Purpose: China launched a 3-year rectification scheme on the clinical use of antibiotics in 2011, and a specific scheme on carbapenem use in February 2017. This study investigated the trends in and correlations between antibiotic consumption and the prevalence of carbapenem-resistant Gram-negative bacteria (CRGN) at a tertiary hospital during these years, particularly in carbapenem consumption.

Methods: The data were collected calculated per quarter from 2011 to 2017. The trends in antibiotic consumption and resistance were analyzed by regression analysis, while Spearman correlation analysis was used to assess the correlations.

Result: The total consumption of antibiotics halved during the 7-year study period, from 770.15 DDDs/1000 PDs in quarter 1 of 2011 to 395.07 DDDs/1000 PDs in quarter 4 of 2017. Meantime, carbapenem consumption showed the significant increase, from 28.71 DDDs/1000 PDs to 49.2 DDDs/1000 PDs. The detection rates of CRGN (carbapenem-resistant Klebsiella pneumonia, Acinetobacter baumannii, and Pseudomonas aeruginosa) remained stable (P>0.05). The positive correlation was only discovered between the resistance rate of carbapenem-resistant K. pneumonia and the usage of carbapenems, which included meropenem and imipenem, with coefficients of 0.543, 0.537, and 0.497 (P<0.05), respectively. There was no more significant correlation in this study.

Conclusion: The total consumption of antibiotics reduced significantly in the analysed hospital, which could be related to the antimicrobial stewardship programme. However, the carbapenem consumption was increased. The specific index should be established to limit the application of carbapenems. This study identified the positive correlation between the detection rate of carbapenem-resistant K. pneumonia and carbapenem consumption. More research is needed to confirm the impact of restricting and appropriated use of carbapenems on the prevalence of CRGN.

Keywords: Acinetobacter baumannii; Antibiotic consumption; Klebsiella pneumonia; Pseudomonas aeruginosa; carbapenem-resistant Gram-negative bacteria.

MeSH terms

Anti-Bacterial Agents / pharmacology
Anti-Bacterial Agents / therapeutic use*
Carbapenems / pharmacology
Carbapenems / therapeutic use*
China / epidemiology
Correlation of Data
Drug Utilization*
Gram-Negative Bacteria / drug effects*
Gram-Negative Bacteria / isolation & purification
Gram-Negative Bacterial Infections / drug therapy*
Gram-Negative Bacterial Infections / epidemiology
Humans
Prevalence
Retrospective Studies
Tertiary Care Centers
beta-Lactam Resistance*

Substances

Anti-Bacterial Agents
Carbapenems