Trend analysis of antimicrobial consumption and development of resistance in non-fermenters in a tertiary care hospital in Delhi, India
Trend analysis of antimicrobial consumption and development of resistance in non-fermenters in a tertiary care hospital in Delhi, India
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DOI：
10.1093/jac/dkr167
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发表时间：
2011-07-01
影响因子：
5.2
通讯作者：
Prasad, Kamal Jeet
中科院分区：
文献类型：
--
作者：
Goel, Neeraj;Wattal, Chand;Prasad, Kamal Jeet
目的：多重耐药铜绿假单胞菌和鲍曼不动杆菌在全球范围内日益成为重要的医院感染病原菌。为了研究在三级医院的非发酵菌的演变，我们进行了回顾性的10年（1999-2008年）的趋势分析的抗菌药物的消费和耐药性的非发酵菌引起bacteriaemia.Methods：抗生素的消费和耐药性进行了分析，通过线性回归。结果：共进行血培养69010次，培养出15465株细菌，阳性率为22%，其中铜绿假单胞菌771株，曲霉菌754株，共1525株。鲍曼不动杆菌）是非发酵菌。抗生素总用量呈上升趋势，从158增加到319限定日剂量（DDDs）/100床日（r（2）=0.62，P=0.007）。碳青霉烯类抗生素消耗量的相对增加最大（r（2）=0.68，P=0.022），其次是β-内酰胺类/抑制剂组合（r（2）=0.45，P=0.033），而第三代头孢菌素类、氟喹诺酮类和氨基糖苷类抗生素没有显示出显著变化。A.鲍曼不动杆菌对氟喹诺酮类（r（2）=0.63，P=0.006）、氨基糖苷类（r（2）=0.63，P=0.011）和碳青霉烯类（r（2）=0.82，P=0.013）耐药;铜绿假单胞菌对氨基糖苷类（r（2）=0.59，P=0.01）耐药。碳青霉烯类药物的使用与A.鲍曼不动杆菌（r=0.756，P=0.049），而没有观察到其他抗菌药物之间nonfermenters.Conclusions：我们的研究强调了越来越多的问题，高抗菌药物消费。非发酵菌的日益流行和多重耐药A。鲍曼不动杆菌与碳青霉烯类的消耗有关。数据无法证明因果关系。
Objectives: Multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii are becoming increasingly important nosocomial pathogens worldwide. To study the evolution of non-fermenters in a tertiary care hospital, we undertook a retrospective 10 year (1999-2008) trend analysis of antimicrobial consumption and resistance in non-fermenters causing bacteraemia.Methods: Antibiotic consumption and resistance were analysed by linear regression. The Pearson correlation coefficient was used for assessing correlation between them.Results: A total of 69010 blood cultures were performed, which grew 15465 isolates (22% positivity rate), of which 1525 isolates (771 isolates of P. aeruginosa and 754 isolates of A. baumannii) were non-fermenters. Overall antibiotic consumption showed an increasing trend, from 158 to 319 defined daily doses (DDDs)/100 bed-days (r(2)=0.62, P=0.007). The largest relative increase in antibiotic consumption was seen for carbapenems (r(2)=0.68, P=0.022), followed by beta-lactam/inhibitor combinations (r(2)=0.45, P=0.033), whereas third-generation cephalosporins, fluoroquinolones and aminoglycosides showed no significant changes. A significant increase in resistance in A. baumannii to fluoroquinolones (r(2)=0.63, P=0.006), aminoglycosides (r(2)=0.63, P=0.011) and carbapenems (r(2)=0.82, P=0.013) and in P. aeruginosa to aminoglycosides (r(2)=0.59, P=0.01) was observed. Carbapenem consumption was associated with the development of resistance in A. baumannii (r=0.756, P=0.049), whereas no such association was observed for other antimicrobials among non-fermenters.Conclusions: Our study highlights the growing problem of high antimicrobial consumption. The increasing prevalence of non-fermenters and the emergence of multidrug-resistant A. baumannii are associated with the consumption of carbapenems. The data cannot prove cause and effect.