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. 2021 May 17;21(1):444.
doi: 10.1186/s12879-021-06140-5.

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

Chunhong Liang #  1 , Xueyan Zhang #  1 , Lijuan Zhou  1 , Guangyi Meng  1 , Liqiu Zhong  1 , Pingzhi Peng  2
Affiliations

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

Chunhong Liang et al. BMC Infect Dis. .

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 assessing correlations.

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). Carbapenem resistance in Acinetobacter baumannii (A. baumannii) significantly increased (P < 0.05) from 18% in 2012 to 60% in 2019. Moreover, significant positive correlations were found between resistance to carbapenems in A. baumannii (P < 0.05) and Escherichia coli (E. coli; P < 0.05) and consumption of carbapenems, while the resistance rate of A. baumannii to carbapenems was positively correlated with cephalosporin/β-lactamase inhibitor (C/BLI) combinations (P < 0.01) and tetracyclines usage (P < 0.05). We also found that use of quinolones was positively correlated with the resistance rate of Burkholderia cepacia (B. cepacia) to carbapenems (P < 0.05), and increasing uses of carbapenems (P < 0.01) and penicillin/β-Lactamase inhibitor (P/BLI) combinations (P < 0.01) were significantly correlated with reduced resistance of Enterobacter cloacae (E. cloacae) to carbapenems.

Conclusion: These results revealed significant correlations between consumption of antibiotics and carbapenem resistance rates 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 confirmed by further studies.

Keywords: Antibacterial consumption; Carbapenems; Drug resistance; Gram-negative bacteria; Microbial.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Inpatient antibiotic use for the entire study period. BL/BLI: β-lactam/β-lactamase inhibitor; C/BLI: cephalosporin/β-lactamase inhibitor; P/BLI: penicillin/β-Lactamase inhibitor. Annual consumption of antibiotics was expressed in defined daily doses (DDDs)/1000 patient-days for various antibiotic classes
Fig. 2
Fig. 2
Trends of isolation rate of Gram-negative bacteria and resistance rates of carbapenem-resistant Gram-negative bacteria for the entire study period. a Trends of isolation rate of Gram-negative bacteria. b Trends of resistance rates of carbapenem-resistant Gram-negative bacteria
Fig. 3
Fig. 3
Associations of resistance to carbapenems with antibacterial usage for the entire study period. BL/BLI: β-lactam/β-lactamase inhibitor; C/BLI: cephalosporin/β-lactamase inhibitor; P/BLI: penicillin/β-Lactamase inhibitor. Consumption of antibiotic was expressed in defined daily doses (DDDs)/1000 patient-days
Fig. 4
Fig. 4
Associations of antibiotic usage and carbapenem resistance rates in E. coli, A. baumannii, E. cloacae, and B. cepacia in the entire study period. a Correlation between usage of carbapenems and carbapenem resistance in E. coli. b Associations of usage of tetracyclines, carbapenems, and C/BLI combinations with carbapenem resistance in A. baumannii. c Associations of usage of carbapenems and P/BLI combinations with carbapenem resistance in E. cloacae. d Correlation between consumption of quinolones and carbapenem resistance in B. cepacia. C/BLI: cephalosporin/β-lactamase inhibitor; P/BLI: penicillin/β-Lactamase inhibitor. Consumption of antibiotic was expressed in defined daily doses (DDDs)/1000 patient-days
Fig. 5
Fig. 5
Correlation between carbapenem usage and the number of Gram-negative isolates resistant to carbapenems in the entire study period. Consumption of carbapenems was expressed in defined daily doses (DDDs)/1000 patient-days
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