Correlation between Carbapenem Consumption and Carbapenems Susceptibility Profiles of Acinetobacter baumannii and Pseudomonas aeruginosa in an Academic Medical Center in Thailand

Abstract

The emergent issue of carbapenem-resistant Acinetobacter baumannii (A. baumannii) and Pseudomonas aeruginosa (P. aeruginosa) is a major problem in Thailand. The wide use of carbapenems can increase selective pressure of bacterial resistance. The objective of this study was to determine the relationship between carbapenem consumption and the susceptibility rates of A. baumannii and P. aeruginosa, including multi-drug resistance (MDR) strains. This was a retrospective study. Carbapenem consumption and susceptibility profiles were collected from 2007 to 2013 at the Her Royal Highness Princess Maha Chakri Sirindhorn Medical Center, Thailand. We found that the susceptibility rate of A. baumannii to imipenem and meropenem from the sputum and the bronchoalveolar lavage (BAL) specimens was significantly decreased during the study period, but no significant change was found in the P. aeruginosa data. The relationship between carbapenem consumption and the susceptibility rate of A. baumannii had a clear association with the use of ertapenem. We found a statistically significant negative correlation between ertapenem consumption and the susceptibility rate of A. baumannii to imipenem (r = −0.91; p = 0.004) and meropenem (r = −0.97; p = 0.000) in the data from the non-ICU wards. In addition, imipenem use had a moderate negative correlation with the MDR P. aeruginosa data but no statistical significance (r = −0.714; p > 0.05). In conclusion, our study suggested there is an association between carbapenem use and the susceptibility of A. baumannii and P. aeruginosa. Notwithstanding this, information on ecological factors should be considered for further study. These findings showed the need to optimize the carbapenem prescription policy. Avoiding carbapenem overuse and rethinking the appropriate initial therapy might decrease the rate of resistant organisms.

The Effect of Decreased Antipseudomonal Drug Consumption on Pseudomonas aeruginosa Incidence and Antimicrobial Susceptibility Profiles over 9 Years in a Lebanese Tertiary Care Center

“…Although some studies report a correlation between hospital resistance of PAE and carbapenem consumption levels [19], our results echo the findings of Álvarez-Marín et al (2021) showing that the correlation between carbapenem consumption and incidence density of carbapenem-resistant Pseudomonas Aeruginosa is minimal [20]. Importantly, the decrease in consumption of antibiotics was noted to have a greater impact on resistance in the case of Acinetobacter baumanii [8,[21][22][23]. All these findings show that even though antimicrobial selective pressure plays a role in antibiotic resistance [24,25], mechanisms of antimicrobial resistance of are multifactorial (such as carrying resistance genes and other mechanisms) [9,13,26], with a variable role of antimicrobial selective pressure depending on the pathogen, which is akin to the results of other studies [7,9,18,21,27].…”

Plethora of Antibiotics Usage and Evaluation of Carbapenem Prescribing Pattern in Intensive Care Units: A Single-Center Experience of Malaysian Academic Hospital

“…Interestingly, the same proportion at 70% was found during the pandemic period [ 5 ]. However, the issue of increased antibiotic consumption during the pandemic period is mostly reflected in the proportion of patients being prescribed antibiotics [ 2 , 5 ], where few reported the magnitude of antibiotic utilization in ICU with the measure of DDD [ 3 ], which is also an important indicator for usage trend monitoring, the impact of intervention, global comparison [ 16 ], as well as correlation with resistance trends [ 12 , 17 , 18 ]. The decrease in total ICU admissions was attributed to the opening of the COVID-19 ICU with redistribution of manpower and the closure of the operating theatre elective list during the COVID-19 pandemic.…”

“…Furthermore, an increase in antimicrobials resistance (AMR) in ICUs was observed since the COVID-19 pandemic, owing to the compromise in infection control and excessive antimicrobials use [ 10 ]. Carbapenems consumption has a positive correlation with increased resistance to carbapenems among gram-negative organisms such as Acinetobacter baumannii , Pseudomonas aeruginosa , and Enterobacterales [ 11 , 12 , 13 ]. Till the year 2020, surveillance in local hospitals of Malaysia reported that resistance to meropenem was lower than 10% for most gram-negative organisms, except Acinetobacter baumannii (58.5%) [ 14 ].…”

Correlation between Stenotrophomonas maltophilia incidence and systemic antibiotic use: A 10-year retrospective, observational study in Hungary

“…imipenem, meropenem, ertapenem and doripenem), which are often the last safe and effective therapeutic choices in these infections. The correlation between antibiotic use (especially if injudicious) and the prevalence of antimicrobial resistance has been described by numerous studies [ 31 , 32 ]. In addition, shifts in systemic antibiotic consumption may have considerable effects on the epidemiology of infectious agents, both locally and globally [ 33 ].…”