scholarly journals Impact of Antibiotic Use on Carbapenem Resistance in Pseudomonas aeruginosa: Is There a Role for Antibiotic Diversity?

2013 ◽  
Vol 57 (4) ◽  
pp. 1709-1713 ◽  
Author(s):  
C. Plüss-Suard ◽  
A. Pannatier ◽  
A. Kronenberg ◽  
K. Mühlemann ◽  
G. Zanetti
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Broad Spectrum ◽  
Carbapenem Resistance ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Content Type ◽  
Defined Daily Doses ◽  
Consumption Data ◽  
Resistance Rates ◽  
The Impact

ABSTRACTIn this study, we aimed to evaluate the relationship between the rates of resistance ofPseudomonas aeruginosato carbapenems and the levels and diversity of antibiotic consumption. Data were retrospectively collected from 20 acute care hospitals across 3 regions of Switzerland between 2006 and 2010. The main outcome of the present study was the rate of resistance to carbapenems amongP. aeruginosa. Putative predictors included the total antibiotic consumption and carbapenem consumption in defined daily doses per 100 bed days, the proportion of very broad-spectrum antibiotics used, and the Peterson index. The present study confirmed a correlation between carbapenem use and carbapenem resistance rates at the hospital and regional levels. The impact of diversifying the range of antibiotics used againstP. aeruginosaresistance was suggested by (i) a positive correlation in multivariate analysis between the above-mentioned resistance and the proportion of consumed antibiotics having a very broad spectrum of activity (coefficient = 1.77; 95% confidence interval, 0.58 to 2.96;P< 0.01) and (ii) a negative correlation between the resistance and diversity of antibiotic use as measured by the Peterson homogeneity index (coefficient = −0.52;P< 0.05). We conclude that promoting heterogeneity plus parsimony in the use of antibiotics appears to be a valuable strategy for minimizing the spread of carbapenem resistance inP. aeruginosain hospitals.

scholarly journals Changes in the Use of Broad-Spectrum Antibiotics after Cefepime Shortage: a Time Series Analysis

2011 ◽  
Vol 56 (2) ◽  
pp. 989-994 ◽  
Author(s):  
C. Plüss-Suard ◽  
A. Pannatier ◽  
C. Ruffieux ◽  
A. Kronenberg ◽  
K. Mühlemann ◽  
...  
Keyword(s):  
Time Series ◽  
Pseudomonas Aeruginosa ◽  
Broad Spectrum ◽  
Interrupted Time Series ◽  
Antibiotic Policy ◽  
Content Type ◽  
Broad Spectrum Antibiotics ◽  
Before And After ◽  
Alternative Antibiotic ◽  
The Impact

ABSTRACTThe original cefepime product was withdrawn from the Swiss market in January 2007 and replaced by a generic 10 months later. The goals of the study were to assess the impact of this cefepime shortage on the use and costs of alternative broad-spectrum antibiotics, on antibiotic policy, and on resistance ofPseudomonas aeruginosatoward carbapenems, ceftazidime, and piperacillin-tazobactam. A generalized regression-based interrupted time series model assessed how much the shortage changed the monthly use and costs of cefepime and of selected alternative broad-spectrum antibiotics (ceftazidime, imipenem-cilastatin, meropenem, piperacillin-tazobactam) in 15 Swiss acute care hospitals from January 2005 to December 2008. Resistance ofP. aeruginosawas compared before and after the cefepime shortage. There was a statistically significant increase in the consumption of piperacillin-tazobactam in hospitals with definitive interruption of cefepime supply and of meropenem in hospitals with transient interruption of cefepime supply. Consumption of each alternative antibiotic tended to increase during the cefepime shortage and to decrease when the cefepime generic was released. These shifts were associated with significantly higher overall costs. There was no significant change in hospitals with uninterrupted cefepime supply. The alternative antibiotics for which an increase in consumption showed the strongest association with a progression of resistance were the carbapenems. The use of alternative antibiotics after cefepime withdrawal was associated with a significant increase in piperacillin-tazobactam and meropenem use and in overall costs and with a decrease in susceptibility ofP. aeruginosain hospitals. This warrants caution with regard to shortages and withdrawals of antibiotics.

scholarly journals Reduction in Fluoroquinolone Use following Introduction of Ertapenem into a Hospital Formulary Is Associated with Improvement in Susceptibility of Pseudomonas aeruginosa to Group 2 Carbapenems: a 10-Year Study

2011 ◽  
Vol 55 (12) ◽  
pp. 5597-5601 ◽  
Author(s):  
Paul P. Cook ◽  
Michael Gooch ◽  
Shemra Rizzo
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Pearson Correlation ◽  
Tertiary Care ◽  
Carbapenem Resistance ◽  
Antibiotic Use ◽  
Care Hospital ◽  
Hospital Formulary ◽  
Content Type ◽  
Carbapenem Resistant ◽  
Group 2

ABSTRACTWe examined the effect of the addition of ertapenem to our hospital formulary on the resistance of nosocomialPseudomonas aeruginosato group 2 carbapenems (imipenem, meropenem, and doripenem). This was a retrospective, observational study conducted between 1 January 2000 and 31 January 2009 at a large, tertiary-care hospital. Autoregressive integrated moving average (ARIMA) regression models were used to evaluate the effect of ertapenem use on the susceptibility ofPseudomonas aeruginosato group 2 carbapenems as well as on the use of the group 2 carbapenems, ciprofloxacin, and other antipseudomonal drugs (i.e., tobramycin, cefepime, and piperacillin-tazobactam). Resistance was expressed as a percentage of total isolates as well as the number of carbapenem-resistant bacterial isolates per 10,000 patient days. Pearson correlation was used to assess the relationship between antibiotic use and carbapenem resistance. Following the addition of ertapenem to the formulary, there was a statistically significant decrease in the percentage ofPseudomonas aeruginosaisolates resistant to the group 2 carbapenems (P= 0.003). Group 2 carbapenem use and the number of carbapenem-resistantPseudomonas aeruginosaisolates per 10,000 patient days did not change significantly over the time period. There was a large decrease in the use of ciprofloxacin (P= 0.0033), and there was a correlation of ciprofloxacin use with the percentage of isolates resistant to the group 2 carbapenems (ρ = 0.47,P= 0.002). We suspect that the improvement in susceptibility ofPseudomonas aeruginosato group 2 carbapenems was related to a decrease in ciprofloxacin use.

Effectiveness of antimicrobial stewardship programmes in neonatology: a systematic review

2020 ◽  
Vol 105 (6) ◽  
pp. 563-568
Author(s):  
André Ricardo Araujo da Silva ◽  
Amanda Marques ◽  
Clara Di Biase ◽  
Monique Faitanin ◽  
Indah Murni ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Neonatal Intensive Care ◽  
Antiviral Agents ◽  
Final Analysis ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Multi Centre Study ◽  
The Impact

IntroductionAntimicrobial stewardship programmes (ASPs) are recommended to improve antibiotic use in healthcare and reduce antimicrobial resistance (AMR). Our aim was to investigate the effectiveness of ASPs in reducing antibiotic consumption, use of broad-spectrum/restricted antibiotics, antibiotic resistance and healthcare-associated infections (HAIs) in neonates.MethodsWe searched PUBMED, SCIELO, EMBASE and the Cochrane Database (January 2000–April 2019) to identify studies on the effectiveness of ASPs in neonatal wards and/or neonatal intensive care units (NICUs). Outcomes were as follows: reduction of antibiotic consumption overall and of broad-spectrum/target antibiotics, inappropriate antibiotic use, antibiotic resistance and HAIs. ASPs conducted in settings other than acute care hospitals, for children older than 1 month, and ASPs addressing antifungal and antiviral agents, were excluded.ResultsThe initial search identified 53 173 titles and abstracts; following the application of filters and inclusion criteria, a total of six publications were included in the final analysis. All studies, of which one was multi-centre study, were published after 2010. Five studies were conducted exclusively in NICUs. Four articles applied multimodal interventions. Reduction of antibiotic consumption overall and/or inappropriate antibiotic use were reported by four articles; reduction of broad-spectrum/targeted antibiotics were reported by four studies; No article evaluated the impact of ASPs on AMR or the incidence of HAI in neonates.ConclusionASPs can be effectively applied in neonatal settings. Limiting the use of broad-spectrum antibiotics and shorting the duration of antibiotic treatment are the most promising approaches. The impact of ASPs on AMR and HAI needs to be evaluated in long-term studies.

scholarly journals Association of Antibiotic Use with the Resistance Epidemiology of Pseudomonas aeruginosa in a Hospital Setting: A Four-Year Retrospective Time Series Analysis

2021 ◽  
Vol 89 (1) ◽  
pp. 13
Author(s):  
Rania Kousovista ◽  
Christos Athanasiou ◽  
Konstantinos Liaskonis ◽  
Olga Ivopoulou ◽  
Vangelis Karalis
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Broad Spectrum ◽  
Antimicrobial Agents ◽  
Transfer Functions ◽  
Moving Average ◽  
Hospital Setting ◽  
Antibiotic Use ◽  
Positive Correlations ◽  
Resistance Rates ◽  
Hospital Acquired

Background: Even though, Pseudomonas aeruginosa is a common cause of hospital-acquired infections, treatment is challenging because of decreasing rates of susceptibility to many broad-spectrum antibiotics. Methods: Consumption data of eight broad spectrum antimicrobial agents and resistance rates of P. aeruginosa were collected for 48 consecutive months. Autoregressive integrated moving average (ARIMA) and transfer functions models were used to develop relationships between antibiotic use and resistance. Results: Positive correlations between P. aeruginosa resistance and uses of ciprofloxacin (p < 0.001), meropenem (p < 0.001), and cefepime (p = 0.005) were identified. Transfer function models showed the quantified effect of each of these antibiotics on resistance. Regarding levofloxacin, ceftazidime, piperacillin/tazobactam and imipenem, no significant relationships were found. For ceftazidime and levofloxacin, this was probably due to their low consumption, while for imipenem the reason can possibly be ascribed to the already high established P. aeruginosa resistance in the hospital. Conclusion: In the hospital setting, the effect of antimicrobial agents’ consumption on the susceptibility epidemiology of P. aeruginosa differs significantly for each one of them. In this study, the role of precedent use of meropenem, cefepime and ciprofloxacin was quantified in the development of P. aeruginosa resistance.

scholarly journals Correlations of Antibiotic Use and Carbapenem Resistance in Enterobacteriaceae

2013 ◽  
Vol 57 (10) ◽  
pp. 5131-5133 ◽  
Author(s):  
Milena McLaughlin ◽  
M. Renee Advincula ◽  
Michael Malczynski ◽  
Chao Qi ◽  
Maureen Bolon ◽  
...  
Keyword(s):  
Carbapenem Resistance ◽  
Multiple Comparisons ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Epidemiological Studies ◽  
Content Type ◽  
Days Of Therapy ◽  
Clinical Relationship ◽  
Negative Relationships

ABSTRACTEpidemiological studies have shown a link between carbapenem use and resistance; however, the clinical relationship between antibiotic consumption and the epidemiology of carbapenem-intermediate or -resistantEnterobacteriaceae(CIRE) remains unclear. This study sought to analyze temporal antibiotic consumption trends for relationships with incident CIRE. In total, 310,892 days of therapy and 55 deduplicated CIRE were analyzed. When conservative corrections were applied for multiple comparisons, carbapenem class use and piperacillin-tazobactam use retained significant positive and negative relationships with the incidence of CIRE, respectively.

scholarly journals Interplay of OpdP Porin and Chromosomal Carbapenemases in the Determination of Carbapenem Resistance/Susceptibility in Pseudomonas aeruginosa

2021 ◽  
Author(s):  
Jad Atrissi ◽  
Annalisa Milan ◽  
Raffaela Bressan ◽  
Marianna Lucafò ◽  
Vincenzo Petix ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Carbapenem Resistance ◽  
Clinical Isolates ◽  
Content Type ◽  
Resistance Determinants ◽  
Multiple Factors ◽  
The Impact

This study examines the interplay of multiple factors in determining a pattern of resistance or susceptibility to carbapenems in clinical isolates of Pseudomonas aeruginosa , focusing on the role of previously poorly understood determinants. In particular, the impact of carbapenem permeability through OprD and OpdP porins was analyzed, as well as the activity of the chromosomal carbapenemases AmpC and PoxB, going beyond the simple identification of resistance determinants encoded by each isolate.

Hand Hygiene, and Not Ertapenem Use, Contributed to Reduction of Carbapenem-Resistant Pseudomonas aeruginosa Rates

2011 ◽  
Vol 32 (6) ◽  
pp. 584-590 ◽  
Author(s):  
Rodrigo Pires dos Santos ◽  
Thalita Jacoby ◽  
Denise Pires Machado ◽  
Thiago Lisboa ◽  
Sandra Ludwig Gastal ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Regression Analysis ◽  
Tertiary Care ◽  
Carbapenem Resistance ◽  
University Hospital ◽  
Incidence Density ◽  
Level Change ◽  
Carbapenem Resistant ◽  
Defined Daily Doses ◽  
The Impact

Objective.To evaluate the impact of ertapenem use in Pseudomonas aeruginosa carbapenem resistance, taking into account the volume of antimicrobial consumption, the consumption by the entire hospital of alcohol-based antiseptic hand rub, and the density rate of invasive practices.Design.Before-and-after trial.Setting.A tertiary care university hospital in southern Brazil.Methods.Ertapenem was first added to the hospital formulary in June 2006, and it was excluded in February 2009. We evaluated Pseudomonas aeruginosa resistance rates through 3 study periods: period 1, before ertapenem use (17 months); period 2, during ertapenem use (33 months); and period 3, after exclusion of ertapenem (15 months).Results.After introduction of ertapenem, there was a significant decrease in median consumption of imipenem or meropenem, from 2.6 to 2.2 defined daily doses (DDDs) per 100 patient-days (level change from 0.04 to -1.08; P < .01), and an increase in the use of these medications after ertapenem exclusion, from 2.2 to 3.3 DDDs per 100 patient-days (level change from -0.14 to 0.91; P < .01), by segmented regression analysis. There was no difference in the incidence density of carbapenem-resistant P. aeruginosa infection related to ertapenem use throughout the study periods. However, by multiple regression analysis, the reduction in the rate of carbapenem-resistant P. aeruginosa infection correlated significantly with the increase in the volume of alcohol used as hand sanitizer, which was from 660.7 mL per 100 patient-days in period 1 to 2,955.1 mL per 100 patient-days in period 3 (P = .04). Ertapenem use did not impact the rate of carbapenem-resistant P. aeruginosa infection.Conclusions.Use of alcohol-based hand gel, rather than ertapenem, was associated with a reduction in the rates of carbapenem-resistant P. aeruginosa infection. Measures to reduce resistance must include factors other than just antimicrobial stewardship programs alone.

scholarly journals Antibiotic Consumption in the Latvian Teaching Hospital 2000-2008

2009 ◽  
Vol 63 (4-5) ◽  
pp. 253-256
Author(s):  
Elīna Dimiņa ◽  
Mārtiņš Akermanis ◽  
Uga Dumpis
Keyword(s):  
Teaching Hospital ◽  
Enzyme Inhibitor ◽  
Antibiotic Use ◽  
Educational Interventions ◽  
Antibiotic Consumption ◽  
Resistance Selection ◽  
Defined Daily Doses ◽  
Multiresistant Bacteria ◽  
Bed Days ◽  
The Impact

Antibiotic Consumption in the Latvian Teaching Hospital 2000-2008 Antibiotics are one of the most commonly used drugs in hospital care and significantly contribute to healthcare costs. Recently, there has been significant interest raised on the environmental impact of antibiotic use, in particular on how it effects resistance selection pressure. Rapid global spread of multiresistant bacteria requires improved understanding on how changes in antibiotic use affect resistance selection. We present a unique study on antibiotic consumption and its trends over an eight-year period. Data were obtained from the pharmaceutical database system. The study period extended from January 2000 through December 2008. Antibiotic use was expressed as a rate — defined daily doses (DDD) per 100 patient days (DDD/100) in a quarter year. The total amount of antibiotics used for systemic treatment at the beginning of the period (first quarter of 2000) was 38.7 DDD per 100 bed days and increased to 72.6 DDD per 100 bed days (r = 0.81) by the 4th quarter of 2008. Despite variability during the study period, a significant trend was observed with an average increase of 0.97 (95% CI: 1.2; 3.2) per quarter. Penicillin was the most common antibiotic group used at the hospital in the study period and demonstrated the greatest increase in consumption (r = 0.92). The consumption rates of fluoroquinolones were high and also showed a significant increase (r = 0.76). We observed a significant increase of antibiotic consumption in our hospital during the study period, which lacked a clear explanation. This increase was mostly due to increased use of amoxicillinum/enzyme inhibitor and ceftriaxone. Analysis of consumption should be continued to assess the impact of educational interventions.

scholarly journals Short- and Long-Term Impact of a Multifaceted Approach Targeting Fluoroquinolone use in a Tertiary, Non-Teaching Hospital

2022 ◽  
Author(s):  
Brianna Belsky ◽  
Quentin Minson
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Teaching Hospital ◽  
Interrupted Time Series ◽  
Antibiotic Consumption ◽  
Interrupted Time Series Analysis ◽  
Short Term ◽  
Multifaceted Approach ◽  
Defined Daily Doses ◽  
The Impact

Abstract Background. While various strategies for antibiotic restrictions have been validated, their impacts are not well described in smaller, non-teaching facilities. Fluoroquinolones are an appropriate target for restriction based on their propensity for overuse and potential for causing “collateral damage.” Aim. Evaluate the impact of a multifaceted approach to decreasing fluoroquinolone use on fluoroquinolones and alternative antibiotics at a smaller, non-teaching facility. Method. Retrospective, interrupted time series analysis conducted at a single 288-bed, tertiary, non-teaching hospital with 71 adult ICU beds comparing antibiotic consumption measured monthly by defined daily doses per 1000 adjusted patient days (DDD/1000 APD) prior to intervention (January 2011 to August 2014) to short-term (October 2014 to December 2015) and long-term (January 2018 to December 2019) periods following intervention. Results. An increase in downward trends of fluoroquinolone use was observed from prior to intervention (-0.49 DDD/1000 APD) to the short-term period (-1.13 DDD/1000 APD) and to a greater extent in the long-term period following the intervention (-1.32 DDD/1000 APD). Fluoroquinolone consumption decreased from 100.20 DDD/1000 APD in August 2014 to 73.96 DDD/1000 APD in the short-term and 14.89 DDD/1000 APD in the long-term intervention period. Levofloxacin susceptibility for Pseudomonas aeruginosa increased from 61% in 2014 to 83% in 2018. No deleterious effects on Pseudomonas aeruginosa susceptibilities were observed for alternative antibiotics. Conclusion. A multifaceted approach to decreasing fluoroquinolone use at a smaller, tertiary, non-teaching hospital led to a sustained decrease in consumption and a substantial increase in levofloxacin susceptibility to Pseudomonas aeruginosa.

scholarly journals Prospective Multicenter Study of the Impact of Carbapenem Resistance on Mortality in Pseudomonas aeruginosa Bloodstream Infections

2011 ◽  
Vol 56 (3) ◽  
pp. 1265-1272 ◽  
Author(s):  
Carmen Peña ◽  
Cristina Suarez ◽  
Mónica Gozalo ◽  
Javier Murillas ◽  
Benito Almirante ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Deleterious Effect ◽  
Carbapenem Resistance ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Charlson Index ◽  
Incidence Density ◽  
Charlson Score ◽  
Content Type ◽  
The Impact

ABSTRACTThe impact of antimicrobial resistance on clinical outcomes is the subject of ongoing investigations, although uncertainty remains about its contribution to mortality. We investigated the impact of carbapenem resistance on mortality inPseudomonas aeruginosabacteremia in a prospective multicenter (10 teaching hospitals) observational study of patients with monomicrobial bacteremia followed up for 30 days after the onset of bacteremia. The adjusted influence of carbapenem resistance on mortality was studied by using Cox regression analysis. Of 632 episodes, 487 (77%) were caused by carbapenem-susceptibleP. aeruginosa(CSPA) isolates, and 145 (23%) were caused by carbapenem-resistantP. aeruginosa(CRPA) isolates. The median incidence density of nosocomial CRPA bacteremia was 2.3 episodes per 100,000 patient-days (95% confidence interval [CI], 1.9 to 2.8). The regression demonstrated a time-dependent effect of carbapenem resistance on mortality as well as a significant interaction with the Charlson index: the deleterious effect of carbapenem resistance on mortality decreased with higher Charlson index scores. The impact of resistance on mortality was statistically significant only from the fifth day after the onset of the bacteremia, reaching its peak values at day 30 (adjusted hazard ratio for a Charlson score of 0 at day 30, 9.9 [95% CI, 3.3 to 29.4]; adjusted hazard ratio for a Charlson score of 5 at day 30, 2.6 [95% CI, 0.8 to 8]). This study clarifies the relationship between carbapenem resistance and mortality in patients withP. aeruginosabacteremia. Although resistance was associated with a higher risk of mortality, the study suggested that this deleterious effect may not be as great during the first days of the bacteremia or in the presence of comorbidities.

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