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Relationship Between Rates of Antimicrobial Consumption and the Incidence of Antimicrobial Resistance in Staphylococcus aureus and Pseudomonas aeruginosa Isolates From 47 French Hospitals

Published online by Cambridge University Press:  02 January 2015

A. M. Rogues ,
C. Dumartin ,
B. Amadéo ,
A. G. Venier ,
N. Marty ,
P. Parneix  and
J. P. Gachie
A. M. Rogues*
Affiliation:
Unité INSERM 657—Pharmacoépidémiologie et évaluation de l'impact des produits de santé sur les populations, IFR Santé, Publique Université Victor Ségalen, France Service d'Hygiène Hospitalière, CHU Groupe hospitalier Pellegrin, Bordeaux, France
C. Dumartin
Affiliation:
Centre de Coordination de la Lutte contre les Infections Nosocomiales du Sud-Ouest, CHU Groupe hospitalier Pellegrin, France
B. Amadéo
Affiliation:
Centre de Coordination de la Lutte contre les Infections Nosocomiales du Sud-Ouest, CHU Groupe hospitalier Pellegrin, France
A. G. Venier
Affiliation:
Centre de Coordination de la Lutte contre les Infections Nosocomiales du Sud-Ouest, CHU Groupe hospitalier Pellegrin, France
N. Marty
Affiliation:
Service de Microbiologie, Hôpital Purpan, Toulouse, France
P. Parneix
Affiliation:
Centre de Coordination de la Lutte contre les Infections Nosocomiales du Sud-Ouest, CHU Groupe hospitalier Pellegrin, France
J. P. Gachie
Affiliation:
Unité INSERM 657—Pharmacoépidémiologie et évaluation de l'impact des produits de santé sur les populations, IFR Santé, Publique Université Victor Ségalen, France Service d'Hygiène Hospitalière, CHU Groupe hospitalier Pellegrin, Bordeaux, France
*
Unité INSERM 657, Université Bordeaux 2, France (anne-marie.rogues@chu-bordeaux.fr)
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Abstract

Objective.

To investigate relationships between rates of antimicrobial consumption and the incidence of antimicrobial resistance in Staphylococcus aureus and Pseudomonas aeruginosa isolates from hospitals.

Methods.

We conducted an observational study that used retrospective data from 2002 and linear regression to model relationships. Hospitals were asked to collect data on consecutive S. aureus and P. aeruginosa isolates, consumption rates for antibiotics (ie, anti-infectives for systemic use as defined by Anatomical Therapeutic Chemical class J01), and hospital characteristics, including infection control policies. Rates of methicillin resistance in S. aureus and rates of ceftazidime and ciprofloxacin resistance in P. aeruginosa were expressed as the percentage of isolates that were nonsusceptible (ie, either resistant or intermediately susceptible) and as the incidence of nonsuceptible isolates (ie, the number of nonsuceptible isolates recovered per 1,000 patient-days). The rate of antimicrobial consumption was expressed as the number of defined daily doses per 1,000 patient-days.

Setting.

Data were obtained from 47 French hospitals, and a total of 12,188 S. aureus isolates and 6,370 P. aeruginosa isolates were tested.

Results.

In the multivariate analysis, fewer antimicrobials showed a significant association between the consumption rate and the percentage of isolates that were resistant than an association between the consumption rate and the incidence of resistance. The overall rate of antibiotic consumption, not including the antibiotics used to treat methicillin-resistant S. aureus infection, explained 13% of the variance between hospitals in the incidence of methicillin resistance among S. aureus isolates. The incidence of methicillin resistance in S. aureus isolates increased with the use of ciprofloxacin and levofloxacin and with the percentage of the hospital's beds located in intensive care units (adjusted multivariate coefficient of determination [aR2], 0.30). For P. aeruginosa, the incidence of ceftazidime resistance was greater in hospitals with higher consumption rates for ceftazidime, levofloxacin, and gentamicin (aR2, 0.37). The incidence of ciprofloxacin resistance increased with the use of fluoroquinolones and with the percentage of a hospital's beds located in intensive care (aR2, 0.28).

Conclusions.

A statistically significant relationship existed between the rate of fluoroquinolone use and the rate of antimicrobial resistance among S. aureus and P. aeruginosa isolates. The incidence of resistant isolates showed a stronger association with the rate of antimicrobial use than did the percentage of isolates with resistance.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 12 , December 2007 , pp. 1389 - 1395
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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