Correlation between antimicrobial consumption and the prevalence of carbapenem-resistant Escherichia coli and carbapenem-resistant Klebsiella pneumoniae at a university hospital in Thailand

Abstract

Summary What is Known and Objective Carbapenem‐resistant Enterobacteriaceae (CRE) are virulent gram‐negative bacilli and cause urgent healthcare problems worldwide. One of the main factors leading to the emergence of CRE is antimicrobial consumption. The objective of this study was to assess how closely the rate of antimicrobial consumption and the prevalences of carbapenem‐resistant Escherichia coli (CR‐EC) and carbapenem‐resistant Klebsiella pneumoniae (CR‐KP) are correlated. Methods A retrospective study was performed at a university hospital in Thailand from January 2013 to September 2016. The prevalence of E coli and K pneumoniae was represented as percentages per species per quarter. The antimicrobial consumption rate per quarter was expressed as the defined daily dose (DDD)/1000 patient‐days. Evaluation of the relationships between the rate of antimicrobial consumption and the prevalences of CR‐EC and CR‐KP was conducted via Pearson's or Spearman's correlation analyses. Results and Discussion During the study period, the prevalence of CR‐EC and CR‐KP was less than 6%; however, significantly increasing prevalences were reported for both CR‐EC (r = 0.55, P = 0.03) and CR‐KP (r = 0.87, P < 0.01). There was a significant increasing trend in the consumption of meropenem (r = 0.65, P = 0.01), levofloxacin (r = 0.63, P = 0.01), ceftriaxone (r = 0.55, P = 0.03), ertapenem (r = 0.52, P = 0.05) and the carbapenem group (r = 0.64, P = 0.01). A significant correlation was observed between CR‐KP prevalence and total carbapenem consumption (r = 0.55, P = 0.04). Moreover, levofloxacin consumption had a significant positive relationship with the prevalence of CR‐KP (r = 0.65, P = 0.01). No positive correlation was found with the prevalence of CR‐EC. What is New and Conclusion The rate of consumption of levofloxacin and carbapenems was the important key factor correlated with the rate of emergence of CR‐KP. This is the first report demonstrating the correlation between levofloxacin consumption and CR‐KP prevalence.

Different induction effects of antibiotic on Klebsiella pneumoniae and Escherichia coli: a retrospective study from China

“…However, there was no relevant research, and further studies were necessary to explore the mechanism. We also found that increasing the use of carbapenem or quinolones did not lead to a signi cant increase in the resistance of carbapenem among Enterobacteriaceae which was similar to a few previous studies [34][35][36]. But some studies showed that carbapenem or uoroquinolone use had a positive relationship with the incidence of CRE [35,37].…”

Molecular characterisation of, and antimicrobial resistance in,Clostridioides difficilefrom Thailand, 2017-2018

“…One possible reason is that the successful spread of this RT was mainly due to its resistance to fluoroquinolones which provided an advantage over other less resistant RTs (38). Although there is high consumption of fluoroquinolones, such as levofloxacin, in the country (39), Thailand already harbours C. difficile RT 017, another epidemic RT with a high prevalence of resistance to fluoroquinolones, as well as other antimicrobials (14). Thus, it may have been difficult for C. difficile RT 027 to compete with this local RT compared to other regions.…”

Exploring the Antibiotic Resistance Burden in Livestock, Livestock Handlers and Their Non-Livestock Handling Contacts: A One Health Perspective

“…From the 49 medium-scale farms (MSF), 94 isolates were from Ps, 44 isolates from Cs, and 24 isolates were from NCs. Several studies in farms in South-East Asia have looked at E. coli isolates from different livestock and farm workers (Nguyen et al, 2016;Lugsomya et al, 2018;Prakobsrikul et al, 2019); to build upon these studies we wanted to additionally assess farm production size in relation to P, C, and NC and look for differences between the six groups. To record significant differences between the isolate groups we used AST and WGS with in silico methods (Figure 1) to explore the genomic diversity (Read and Massey, 2014;Abdelgader et al, 2018;Boehmer et al, 2018).…”

“…In locations where there is high AMU, there is also a high AMR burden (O'neill, 2016). This is of critical concern with antibiotic drugs, such as colistin, that are used as a last-resort drugs in humans to treat extensively resistant bacterial infections, e.g., carbapenem resistant Enterobacteriaceae (Wangchinda et al, 2018;Prakobsrikul et al, 2019) where very limited treatment options are available. Where last-resort drugs, such as colistin, are frequently used in livestock and in clinical settings generalized AMR can occur making these crucial drugs void and some bacterial infections untreatable (McEwen and Collignon, 2018).…”