Giuseppe
Emeritus
[Source: Antimicrobial Agents and Chemotherapy, full text: (LINK). Abstract, edited.]
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Impact of antibiotic use on carbapenem resistance in Pseudomonas aeruginosa: Is there a role for antibiotic diversity?
C. Pl?ss-Suard a, A. Pannatier b, A. Kronenberg c, K. M?hlemann c and G. Zanetti d
Author Affiliations: <SUP>a</SUP>Service of Hospital Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland and School of Pharmaceutical Science, University of Geneva and University of Lausanne, Geneva, Switzerland <SUP>b</SUP>Service of Pharmacy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland and School of Pharmaceutical Science, University of Geneva and University of Lausanne, Geneva, Switzerland <SUP>c</SUP>Institute for Infectious Diseases, University Hospital, Bern, Switzerland <SUP>d</SUP>Service of Hospital Preventive Medicine and Service of Infectious Diseases, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
ABSTRACT
The present study aims at evaluating the relationship between the rates of resistance of Pseudomonas aeruginosa towards carbapenems and the level as well as the diversity of antibiotic consumption. Data were retrospectively collected from 20 acute care hospitals distributed across 3 regions of Switzerland over the period 2006 ? 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, 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% CI 0.58 ? 2.96; p < 0.01) and (ii) a negative correlation between resistance and diversity of antibiotic use as measured by the Peterson homogeneity index (coefficient = −0.52; p < 0.05). It was concluded that promoting heterogeneity plus parsimony in the use of antibiotics appears as a valuable strategy to minimize the spread of carbapenem resistance in P. aeruginosa in hospitals.
FOOTNOTES
Corresponding author: Catherine Pl?ss-Suard, Centre Hospitalier Universitaire Vaudois, M?decine Pr?ventive Hospitali?re, Av du Bugnon 46, 1011 Lausanne, Switzerland, Phone: ++41 79 204 77 84, Fax: ++41 21 314 02 62, Email: Catherine.Pluss@chuv.ch
Copyright ? 2013, American Society for Microbiology. All Rights Reserved.
-C. Pl?ss-Suard a, A. Pannatier b, A. Kronenberg c, K. M?hlemann c and G. Zanetti d
Author Affiliations: <SUP>a</SUP>Service of Hospital Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland and School of Pharmaceutical Science, University of Geneva and University of Lausanne, Geneva, Switzerland <SUP>b</SUP>Service of Pharmacy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland and School of Pharmaceutical Science, University of Geneva and University of Lausanne, Geneva, Switzerland <SUP>c</SUP>Institute for Infectious Diseases, University Hospital, Bern, Switzerland <SUP>d</SUP>Service of Hospital Preventive Medicine and Service of Infectious Diseases, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
ABSTRACT
The present study aims at evaluating the relationship between the rates of resistance of Pseudomonas aeruginosa towards carbapenems and the level as well as the diversity of antibiotic consumption. Data were retrospectively collected from 20 acute care hospitals distributed across 3 regions of Switzerland over the period 2006 ? 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, 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% CI 0.58 ? 2.96; p < 0.01) and (ii) a negative correlation between resistance and diversity of antibiotic use as measured by the Peterson homogeneity index (coefficient = −0.52; p < 0.05). It was concluded that promoting heterogeneity plus parsimony in the use of antibiotics appears as a valuable strategy to minimize the spread of carbapenem resistance in P. aeruginosa in hospitals.
FOOTNOTES
Corresponding author: Catherine Pl?ss-Suard, Centre Hospitalier Universitaire Vaudois, M?decine Pr?ventive Hospitali?re, Av du Bugnon 46, 1011 Lausanne, Switzerland, Phone: ++41 79 204 77 84, Fax: ++41 21 314 02 62, Email: Catherine.Pluss@chuv.ch
Copyright ? 2013, American Society for Microbiology. All Rights Reserved.
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