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

Zhang, Di; Hu, Sasa; Sun, Jing; Zhang, Lu; Dong, Haiyan; Feng, Wei; Lei, Jin’e; Dong, Yalin

doi:10.1016/j.jiph.2018.10.003

Cited by 27 publications

(19 citation statements)

References 17 publications

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“…The studies of 65 public general hospitals and 89 tertiary general hospitals showed AUD of antibiotics was decreased in China from 2010 to 2014 and from 2011 to 2015 22,27. However, a previous study showed stable consumptions of several antibiotics, such as second-generation cephalosporins and quinolones, whose consumptions were increased in our study 26. In addition, according to the requirements for Chinese Antimicrobials Special Rectification Activity issued by the National Health Commission, the AUD of antibiotic should be limited to less than 40,28 suggesting that Chinese hospitals still need strong management standards for antibiotic use, especially for the AUD increased types, to promote the selection, dosage, and course of antibiotics 29…”

Section: Discussioncontrasting

confidence: 73%

“…Compared to previous reports, the antibiotic consumption of other studies done in China was similar to our study. In the study of tertiary comprehensive hospital, the use of monobactams, aminoglycosides, macrolides and lincosamides was decreased from 2011 to 2017 26. The studies of 65 public general hospitals and 89 tertiary general hospitals showed AUD of antibiotics was decreased in China from 2010 to 2014 and from 2011 to 2015 22,27.…”

Section: Discussionmentioning

confidence: 99%

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<p>Time series analysis of antibacterial usage and bacterial resistance in China: observations from a tertiary hospital from 2014 to 2018</p>

Zeng

Wang

et al. 2019

IDR

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PurposeTo describe trends and correlation between antibacterial exposure and bacterial resistance from hospitalized patients in a hospital in southern China.Patients and methodsThis study used hospital-wide data regarding antimicrobial resistance and consumption between January 1, 2014 and December 31, 2018. Antibacterial consumption was expressed as antimicrobial use density (AUD). The changes in trends and associations between antibacterial utilization and resistance were analyzed using linear regression and time series analysis.ResultsThe total AUD of all antimicrobials decreased year by year (50.66 in 2014 vs 44.28 in 2018, P=0.03). The annual use of antimicrobials, such as penicillins, monobactams, aminoglycosides, macrolides, and lincosamides, significantly decreased (P<0.05), while the annual use of quinolones and tetracyclines significantly increased (P<0.05). Among the top ten isolated bacteria, antimicrobial resistance trends of Escherichia coli, Pseudomonas aeruginosa, Candida albicans, Staphylococcus aureus, and Staphylococcus epidermidis significantly decreased (P<0.05). Significant positive correlation was found between AUD of carbapenems and resistance rate of Acinetobacter baumannii to imipenem (β=32.87, P<0.01), as well as the correlation between AUD of quinolones and resistance rate of Enterococcus faecium to levofloxacin (β=104.40, P<0.01).ConclusionThe consumption of antibiotics and antibiotic resistance has been significantly improved in this tertiary hospital. Additionally, the efforts of China’s antibiotic management may be suggested by the relationship between indicated antibiotic resistance and consumption. However, overall AUD levels and poor control of the use of antibiotics, such as quinolones and tetracyclines, still require strengthened management.

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Section: Discussioncontrasting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

<p>Time series analysis of antibacterial usage and bacterial resistance in China: observations from a tertiary hospital from 2014 to 2018</p>

Zeng

Wang

et al. 2019

IDR

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“…In the present study, we observed that cephalosporins (except for C/BLI combinations) had the largest consumption variety during the entire study period, despite showing a downward trend. In addition, the consumption of BL/BLI combinations showed an increasing trend, and piperacillintazobactam was the most frequently used antibiotic, which was consistent with a previous study conducted at a tertiary hospital in China [11]. Previous studies have shown that the history of using 3rd generation cephalosporins is an independent risk factor for extended-spectrum β-lactamase (ESBL)producing K. pneumoniae or E. coli bacteremia [12].…”

Section: Discussionsupporting

confidence: 88%

Trends and correlation between antibacterial consumption and carbapenem resistance in Gram-negative bacteria in a tertiary hospital in China from 2012 to 2019

Chen

Zhang

Zhou

et al. 2020

Preprint

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Background: To investigate the trends and correlation between antibacterial consumption and carbapenem resistance in Gram-negative bacteria from 2012 to 2019 in a tertiary-care teaching hospital in southern China.Methods: This retrospective study included data from hospital-wide inpatients collected between January 2012 and December 2019. Data on antibacterial consumption were expressed as defined daily doses (DDDs)/1000 patient-days. Antibacterials were classified according to the Anatomical Therapeutic Chemical (ATC) classification system. The trends in antimicrobial usage and resistance were analyzed by linear regression, while Pearson correlation analysis was used for testing the correlation.Results: An increasing trend in the annual consumption of tetracyclines, β-lactam/β-lactamase inhibitor (BL/BLI) combinations, and carbapenems was observed (P < 0.05). The carbapenem resistance of Acinetobacter baumannii (A. baumannii) significantly increased (P < 0.05) from 18% in 2012 to 60% in 2019. Moreover, a significant positive correlation was found between the resistance to carbapenems in A. baumannii (β = 0.745, P < 0.05) and Escherichia coli (E. coli)(β = 0.736, P < 0.05) and the consumption of carbapenems, while the resistance rate of A. baumannii to carbapenems was positively correlated with cephalosporin/β-lactamase inhibitor (C/BLI) combinations (β = 0.910, P < 0.01) and tetracyclines usage (β = 0.745, P < 0.05). We also found that the use of quinolones was positively correlated with the resistance rate of Burkholderia cepacia (B. cepacia) to carbapenems (β = 0.717, P < 0.05), and the increasing use of carbapenems (β=-0.869, P < 0.01) and penicillin/β-Lactamase inhibitor (P/BLI) combinations (β=-0.871, P < 0.01) were significantly correlated with reduced resistance of Enterobacter cloacae (E. cloacae) to carbapenems.Conclusion: Our results revealed significant correlations between the consumption of antibiotics and rates of carbapenem resistance in Gram-negative bacteria. Implementing proper management strategies and reducing the unreasonable use of antibacterial drugs may be an effective measure to reduce the spread of carbapenem-resistant Gram-negative bacteria (CRGN), which should be further confirmed by more studies.

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“…The ASP significantly decreased tigecycline consumption levels by 55%, which was accompanied by a prominent reduction in its prescription rate. It is well known that unnecessary, increased antibiotic consumption is positively correlated with the emergence of antibiotic resistance [ 33 – 35 ]. Shifting tigecycline prescription from off-label to FDA-approved indications, in addition to shortening therapy duration under appropriate conditions based on international guidelines, collectively reduced its consumption and prescription rates.…”

Section: Discussionmentioning

confidence: 99%

The effect of an antibiotic stewardship program on tigecycline use in a Tertiary Care Hospital, an intervention study

Moghnieh

Abdallah

Awad

et al. 2020

Ann Clin Microbiol Antimicrob

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Background: A drug-oriented antibiotic stewardship intervention targeting tigecycline utilization was launched at Makassed General Hospital, Beirut, Lebanon, in 2016 as a part of a comprehensive Antibiotic Stewardship Program (ASP). In this study, we evaluated the effect of this intervention on changing tigecycline prescription behavior in different types of infections, patient outcome and mortality, along with tigecycline drug use density, when compared to an earlier period before the initiation of ASP. Methods: This is a retrospective chart review of all adult inpatients who received tigecycline for more than 72 h between Jan-2012 and Dec-2013 [period (P) 1 before ASP] and between Oct-2016 and Dec-2018 [period (P) 2 during ASP]. Results: Tigecycline was administered to 153 patients during P1 and 116 patients during P2. The proportion of patients suffering from cancer, those requiring mechanical ventilation, and those with hemodynamic failure was significantly reduced between P1 and P2. The proportion of patients who received tigecycline for FDA-approved indications increased from 19% during P1 to 78% during P2 (P < 0.001). On the other hand, its use in off-label indications was restricted, including ventilator-associated pneumonia (26.1% in P1, 3.4% in P2, P < 0.001), hospital-acquired pneumonia (19.6% in P1, 5.2% in P2, P = 0.001), sepsis (9.2% in P1, 3% in P2, P = 0.028), and febrile neutropenia (15.7% in P1, 0.9% in P2, P < 0.001). The clinical success rate of tigecycline therapy showed an overall significant increase from 48.4% during P1 to 65.5% during P2 (P = 0.005) in the entire patient population. All-cause mortality in the tigecycline-treated patients decreased from 45.1% during P1 to 20.7% during P2 (P < 0.0001). In general, mean tigecycline consumption decreased by 55% between P1 and P2 (P < 0.0001). Conclusion: The drug-oriented ASP intervention targeting tigecycline prescriptions improved its use and patient outcomes, where it helped curb the over-optimistic use of this drug in off-label indications where it is not a suitable treatment option.

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

Cited by 27 publications

References 17 publications

<p>Time series analysis of antibacterial usage and bacterial resistance in China: observations from a tertiary hospital from 2014 to 2018</p>

<p>Time series analysis of antibacterial usage and bacterial resistance in China: observations from a tertiary hospital from 2014 to 2018</p>

Trends and correlation between antibacterial consumption and carbapenem resistance in Gram-negative bacteria in a tertiary hospital in China from 2012 to 2019

The effect of an antibiotic stewardship program on tigecycline use in a Tertiary Care Hospital, an intervention study

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