A 56-month Prospective Surveillance Study on the Epidemiology of Aminoglycoside Resistance in a Belgian General Hospital

Abstract

In this survey, we studied the effect of extensive amikacin usage on the epidemiology of aminoglycoside resistance in a general hospital. The baseline resistance in the 12 months before amikacin was 5.8% for amikacin, 15.2% for gentamicin, 16.4% for tobramycin and 14.0% for netilmicin. During the following 44 months, amikacin was the aminoglycoside of first choice. In the first 2 years of this phase, resistance to amikacin did not change significantly. Later, amikacin resistance rose significantly, mainly due to the introduction of amikacin-resistant Enterobacter aerogenes strains. In general there was a significant decrease in resistance to gentamicin and tobramycin. Resistance mechanisms were examined in 380 strains. AAC(3)V, and AAC(6')I alone or coupled with ANT(2") or AAC(3) were the most prevalent enzymes. In the amikacin phase, we noticed a significant increase of strains harbouring the AAC(6')I enzyme, while strains with the AAC(3)V were less frequently isolated. Strains with permeability resistance did not become more prevalent during the period of extensive amikacin use.

Resistance to amikacin and gentamicin among Gram-negative bloodstream isolates in a university hospital between 1989 and 1994

“…The literature on the relationship between the use of aminoglycosides and the development of resistance is rather controversial and complex [25–28]. Some investigators reported increased AN resistance following unrestricted use of this compound [29–32]. However, it is difficult to conclude from those studies whether the use of AN was the only incriminating factor.…”

Epidemiology of aminoglycoside resistance in a large animal hospital

“…In contrast, some hospitals report increased amikacin resistance with increased usage, while others do not (Gaynes etal. 1988;Nhieu and Collatz 1988;Jacoby et al 1990;Muscato et al 1991;King et al 1992;Maes and Vanhoof 1992).…”

Enterobacter spp.: pathogens poised to flourish at the turn of the century.

“…Since that early report, susceptibility to all of the major groups of anti-microbial agents has declined (8,10,26,31,47,76,77,107,111,121,122,230). In general, the prevalence of resistance to the ␤-lactam antibiotics, aminoglycosides, trimethoprim-sulfamethoxazole, and quinolones has increased with time, and this is associated with increased use of the respective drugs in a given environment (1,2,6,42,81,82,109,143). Increases in the prevalence of resistance to ␤-lactam antibiotics have been associated with increased use of the newer cephalosporins (11,12,37,42,48,73,109,110,158,159,164,193,234,239).…”

“…The first mechanism is most often involved in the resistance of Enterobacter spp. to ␤-lactam antibiotics and aminoglycosides, while the last two are most often involved in resistance to quinolones and trimethoprim-sulfamethoxazole (32,41,45,46,84,100,101,107,129,130,138,141,143,175,178,183,184,187,190,192,216).…”