Antibiotikaverbrauch und Resistenzentwicklung in der Chirurgie

Tammer, Ina; Geginat, Gernot; Lange, S.; Kropf, Siegfried; Lodes, Uwe; Schlüter, Dirk; Lippert, H.; Meyer, Frank

doi:10.1055/s-0033-1351087

Cited by 10 publications

(3 citation statements)

References 36 publications

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“…In recent years, several studies have analyzed the relationship between antibiotic use and development of resistance in Enterobacteriaceae . Consistent with our findings, several studies have described an association between in-hospital antibiotic use and resistance to quinolones in E. coli [ 16 – 18 ] . This association may be particularly relevant for Switzerland with its comparatively higher quinolone consumption than other European countries [ 19 ].…”

Section: Discussionsupporting

confidence: 93%

Intra-hospital differences in antibiotic use correlate with antimicrobial resistance rate in Escherichia coli and Klebsiella pneumoniae: a retrospective observational study

Cusini

Herren

Bütikofer

et al. 2018

Antimicrob Resist Infect Control

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BackgroundMonitoring antimicrobial use and resistance in hospitals are important tools of antimicrobial stewardship programs. We aimed to determine the association between the use of frequently prescribed antibiotics and the corresponding resistance rates in Escherichia coli and Klebsiella pneumoniae among the clinical departments of a tertiary care hospital.MethodsWe performed a retrospective observational study to analyse the use of nine frequently prescribed antibiotics and the corresponding antimicrobial resistance rates in hospital acquired E. coli and K. pneumoniae isolates from 18 departments of our institution over 9 years (2008–2016). The main cross-sectional analysis assessed the hypothetical influence of antibiotic consumption on resistance by mixed logistic regression models.ResultsWe found an association between antibiotic use and resistance rates in E. coli for amoxicillin-clavulanic acid (OR per each step of 5 defined daily dose/100 bed-days 1.07, 95% CI 1.02–1.12; p = 0.004), piperacillin-tazobactam (OR 2.11, 95% CI 1.45–3.07; p < 0.001), quinolones (OR 1.52, 95% CI 1.25–1.86; p < 0.001) and trimethoprim-sulfamethoxazole (OR 1.59, 95% CI 1.19–2.13; p = 0.002). Additionally, we found a significant association when all nine antibiotics were combined in one analysis. The association between consumption and resistance rates was stronger for nosocomial than for community strains. In K. pneumoniae, we found an association for amoxicillin-clavulanic acid (OR 1.07, 95% CI 1.01–1.14; p = 0.025) and for trimethoprim-sulfamethoxazole (OR 2.02, 95% CI 1.44–2.84; p < 0.001). The combined analysis did not show an association between consumption and resistance (OR 1.06, 95% CI 0.99–1.14; p = 0.07).ConclusionsWe documented an association between antibiotic use and resistance rate for amoxicillin-clavulanic acid, piperacillin-tazobactam, quinolones and trimethoprim-sulfamethoxazole in E. coli and for amoxicillin-clavulanic acid and trimethoprim-sulfamethoxazole in K. pneumoniae across different hospital departments. Our data will support stewardship interventions to optimize antibiotic prescribing at a department level.Electronic supplementary materialThe online version of this article (10.1186/s13756-018-0387-0) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 93%

Intra-hospital differences in antibiotic use correlate with antimicrobial resistance rate in Escherichia coli and Klebsiella pneumoniae: a retrospective observational study

Cusini

Herren

Bütikofer

et al. 2018

Antimicrob Resist Infect Control

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“…The more that antibiotics are used and distributed in the environment, the greater the generation of multi-antibiotic resistances (e.g. Mladenovic-Antic et al 2016 ; Tammer et al 2016 ; Barnes et al 2017 ; Mascarello et al 2017 ; Pitiriga et al 2017 ; also see CMO Report 2011 ; Public Health England and Veterinary Medicines Directorate Report 2015 ). After all, resistance can be considered a natural phenomenon and, as already mentioned above, a means by which microorganisms protect themselves against exposure to antibiotics in the environment.…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial resistance (AMR) nanomachines—mechanisms for fluoroquinolone and glycopeptide recognition, efflux and/or deactivation

Phillips‐Jones

Harding

2018

Biophys Rev

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In this review, we discuss mechanisms of resistance identified in bacterial agents Staphylococcus aureus and the enterococci towards two priority classes of antibiotics—the fluoroquinolones and the glycopeptides. Members of both classes interact with a number of components in the cells of these bacteria, so the cellular targets are also considered. Fluoroquinolone resistance mechanisms include efflux pumps (MepA, NorA, NorB, NorC, MdeA, LmrS or SdrM in S. aureus and EfmA or EfrAB in the enterococci) for removal of fluoroquinolone from the intracellular environment of bacterial cells and/or protection of the gyrase and topoisomerase IV target sites in Enterococcus faecalis by Qnr-like proteins. Expression of efflux systems is regulated by GntR-like (S. aureus NorG), MarR-like (MgrA, MepR) regulators or a two-component signal transduction system (TCS) (S. aureus ArlSR). Resistance to the glycopeptide antibiotic teicoplanin occurs via efflux regulated by the TcaR regulator in S. aureus. Resistance to vancomycin occurs through modification of the D-Ala-D-Ala target in the cell wall peptidoglycan and removal of high affinity precursors, or by target protection via cell wall thickening. Of the six Van resistance types (VanA-E, VanG), the VanA resistance type is considered in this review, including its regulation by the VanSR TCS. We describe the recent application of biophysical approaches such as the hydrodynamic technique of analytical ultracentrifugation and circular dichroism spectroscopy to identify the possible molecular effector of the VanS receptor that activates expression of the Van resistance genes; both approaches demonstrated that vancomycin interacts with VanS, suggesting that vancomycin itself (or vancomycin with an accessory factor) may be an effector of vancomycin resistance. With 16 and 19 proteins or protein complexes involved in fluoroquinolone and glycopeptide resistances, respectively, and the complexities of bacterial sensing mechanisms that trigger and regulate a wide variety of possible resistance mechanisms, we propose that these antimicrobial resistance mechanisms might be considered complex ‘nanomachines’ that drive survival of bacterial cells in antibiotic environments.

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“…But unreasonable use of antibiotics will increase the selective pressure of antimicrobials commonly used, which is one of the important factors leading to antimicrobial resistance (AMR), and some evidence showed that increased use of antibiotics could lead to the emergence of AMR [11][12][13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Risk factors correlated with antibiotic-induced carbapenem resistant in Gram-negative bacilli in China: a retrospective cohort study

Chen

Xiang

et al. 2020

Preprint

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Background: Increasing resistance to carbapenem, particularly common in Gram-negative bacilli (GNB), has become a growing public health concern around the world. The objective of this study was to investigate risk factors associated with antibiotic-induced carbapenem resistant in Gram-negative bacilli (CR-GNB) among inpatients. Methods: A retrospective cohort study was conducted in one of the largest tertiary A-level hospitals including patients with GNB cultured from any of the clinical specimens who had been admitted for more than 2 calendar days from January 2017 to June 2019. Kaplan-Meier analysis and Cox proportional hazard model were used to estimate the hazard of CR-GNB induction by antibiotics. Results: 2490 patients including 7 cohorts were included. After cox proportional risk model analysis, carbapenems, β-lactamase inhibitors, and cephalosporins had significantly higher hazards than other types of antimicrobial (P<0.001). But even without using any antimicrobials, the hazard would increase with the length of hospital stay. On multivariate analysis, carbapenem was the most principal hazard factor for antibiotic-induced CR-GNB (hazard ratio [HR], 2.968; 95% confidence interval [CI], 1.706～5.162), followed by ICU admission (HR, 1.815; 95% CI, 1.507～2.186), cephalosporin (HR, 1.605; 95% CI, 1.288～1.999), tracheotomy (HR, 1.563; 95% CI, 1.251～1.952) and β-lactamase inhibitor (HR, 1.542; 95% CI, 1.237～1.921). However, quinolone effects on antibiotic-induced CR-GNB were not statistically significant. Conclusions: Prior carbapenem was a strong risk factor for antibiotic-induced CR-GNB, but quinolone was not associated with that. Rational use of carbapenems should be implemented and antimicrobial stewardship policies should be adjusted according to the characteristics of each hospital.

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Antibiotikaverbrauch und Resistenzentwicklung in der Chirurgie

Cited by 10 publications

References 36 publications

Intra-hospital differences in antibiotic use correlate with antimicrobial resistance rate in Escherichia coli and Klebsiella pneumoniae: a retrospective observational study

Intra-hospital differences in antibiotic use correlate with antimicrobial resistance rate in Escherichia coli and Klebsiella pneumoniae: a retrospective observational study

Antimicrobial resistance (AMR) nanomachines—mechanisms for fluoroquinolone and glycopeptide recognition, efflux and/or deactivation

Risk factors correlated with antibiotic-induced carbapenem resistant in Gram-negative bacilli in China: a retrospective cohort study

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