Correlation between antibiotic consumption and the occurrence of multidrug-resistant organisms in a Malaysian tertiary hospital: a 3-year observational study

Sci Rep. 2022 Feb 24;12(1):3106. doi: 10.1038/s41598-022-07142-2.

Abstract

Inappropriate use of antibiotics has been shown to contribute to the occurrence of multidrug-resistant organisms (MROs). A surveillance study was performed in the largest tertiary care hospital in Kuala Lumpur, Malaysia, from 2018 to 2020 to observe the trends of broad-spectrum antibiotics (beta-lactam/beta-lactamases inhibitors (BL/BLI), extended-spectrum cephalosporins (ESC), and fluoroquinolones (FQ)) and antibiotics against MRO (carbapenems, polymyxins, and glycopeptides) usage and the correlation between antibiotic consumption and MROs. The correlation between 3-year trends of antibiotic consumption (defined daily dose (DDD)/100 admissions) with MRO infection cases (per 100 admissions) was determined using a Jonckheere-Terpstra test and a Pearson's Correlation coefficient. The antimicrobial resistance trend demonstrated a positive correlation between ESC and FQ towards the development of methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum beta-lactamase (ESBL)-producing Klebsiella spp, ESBL-producing Escherichia coli (E. coli), and MRO Acinetobacter baumannii (A. baumannii). Increasing carbapenem consumption was positively correlated with the occurrence of ESBL-producing Klebsiella spp and E. coli. Polymyxin use was positively correlated with ESBL-producing Klebsiella spp, MRO A. baumannii, and carbapenem-resistant Enterobacteriaceae. The findings reinforced concerns regarding the association between MRO development, especially with a surge in ESC and FQ consumption. Stricter use of antimicrobials is thus crucial to minimise the risk of emerging resistant organisms.

Publication types

  • Observational Study

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Carbapenems / pharmacology
  • Cephalosporins / pharmacology
  • Cross Infection / epidemiology
  • Drug Resistance, Multiple, Bacterial / drug effects*
  • Escherichia coli / drug effects
  • Escherichia coli Infections / drug therapy
  • Fluoroquinolones / pharmacology
  • Humans
  • Inappropriate Prescribing / trends*
  • Klebsiella / drug effects
  • Klebsiella Infections / drug therapy
  • Malaysia / epidemiology
  • Methicillin-Resistant Staphylococcus aureus / drug effects
  • Microbial Sensitivity Tests
  • Tertiary Care Centers
  • beta-Lactamase Inhibitors / pharmacology
  • beta-Lactamases

Substances

  • Anti-Bacterial Agents
  • Carbapenems
  • Cephalosporins
  • Fluoroquinolones
  • beta-Lactamase Inhibitors
  • beta-Lactamases