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

Abstract

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.