Impact of Antibiotic Use on Carbapenem Resistance in Pseudomonas aeruginosa: Is There a Role for Antibiotic Diversity?

Abstract

fIn this study, we aimed to evaluate the relationship between the rates of resistance of Pseudomonas aeruginosa to carbapenems and the levels and diversity of antibiotic consumption. Data were retrospectively collected from 20 acute care hospitals across 3 regions of Switzerland between 2006 and 2010. The main outcome of the present study was the rate of resistance to carbapenems among P. aeruginosa. Putative predictors included the total antibiotic consumption and carbapenem consumption in defined daily doses per 100 bed days, the proportion of very broad-spectrum antibiotics used, and the Peterson index. The present study confirmed a correlation between carbapenem use and carbapenem resistance rates at the hospital and regional levels. The impact of diversifying the range of antibiotics used against P. aeruginosa resistance was suggested by (i) a positive correlation in multivariate analysis between the above-mentioned resistance and the proportion of consumed antibiotics having a very broad spectrum of activity (coefficient ‫؍‬ 1.77; 95% confidence interval, 0.58 to 2.96; P < 0.01) and (ii) a negative correlation between the resistance and diversity of antibiotic use as measured by the Peterson homogeneity index (coefficient ‫؍‬ ؊0.52; P < 0.05). We conclude that promoting heterogeneity plus parsimony in the use of antibiotics appears to be a valuable strategy for minimizing the spread of carbapenem resistance in P. aeruginosa in hospitals.

Influence of regular reporting on local Pseudomonas aeruginosa and Acinetobacter spp. sensitivity to antibiotics on consumption of antibiotics and resistance patterns

“…In the same period, increasing trends of consumption were observed for tigecycline and colistin. 19 However, the evidence is lacking that decrease in utilization is followed by recovery of susceptibility to antibiotics. We observed that the reduction in utilization of carbapenems and piperacillin/tazobactam was associated with a decrease in resistance density of P. aeruginosa isolates.…”

“…Also Previous studies showed that there was positive correlation between increase in utilization of carbapenems and resistance of P. aeruginosa to these antibiotics. 19 However, the evidence is lacking that decrease in utilization is followed by recovery of susceptibility to antibiotics. Our study showed that during a relatively short period of 5 years a decrease in utilization of carbapenems and piperacillin/tazobactam was associated with decreased density of resistant P. aeruginosa isolates ( Figure 1A,B).…”

Mathematical Basis for the Assessment of Antibiotic Resistance and Administrative Counter-Strategies

“…Arguably, heterogeneity in the ecological sense is better captured using the concept of diversity, as introduced in the following section. In order to provide compatibility with the terminology based on the notion of "heterogeneity" suggested in relevant publications on antibiotics resistance [10,8], we cannot completely drop this term.…”

“…In other words, R a is a monotonous function of D a , thus, the two measures can be used interchangeably without loss of information since diversity has only a 1 Please note that the typesettings of the formulas for HI in refs. [10,8] are incorrect. relative meaning, anyway.…”

“…Apparently, the rule also holds for the Gini-Simpson diversity, GS, and the Gini coefficient G. Compared to the Renyi entropy, heterogeneity HI, defined in eq. 5, is easier to comprehend, which might explain that its application in the context of antibiotic resistance is unparalleled up to date ( [10,8]). However, the invariance under species permutations has not been taken into account thus far.…”