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. 2021 Nov;26(46):2001537.
doi: 10.2807/1560-7917.ES.2021.26.46.2001537.

Antimicrobial resistance and antibiotic consumption in intensive care units, Switzerland, 2009 to 2018

Stefanie Barnsteiner  1 , Florent Baty  2 , Werner C Albrich  1 , Baharak Babouee Flury  1   3 , Michael Gasser  4 , Catherine Plüss-Suard  4 , Matthias Schlegel  1 , Andreas Kronenberg  4 , Philipp Kohler  1 ; Swiss Centre for Antibiotic Resistance (ANRESIS)  4
Affiliations

Antimicrobial resistance and antibiotic consumption in intensive care units, Switzerland, 2009 to 2018

Stefanie Barnsteiner et al. Euro Surveill. 2021 Nov.

Abstract

BackgroundIntensive care units (ICU) constitute a high-risk setting for antimicrobial resistance (AMR).AimWe aimed to describe secular AMR trends including meticillin-resistant Staphylococcus aureus (MRSA), glycopeptide-resistant enterococci (GRE), extended-spectrum cephalosporin-resistant Escherichia coli (ESCR-EC) and Klebsiella pneumoniae (ESCR-KP), carbapenem-resistant Enterobacterales (CRE) and Pseudomonas aeruginosa (CRPA) from Swiss ICU. We assessed time trends of antibiotic consumption and identified factors associated with CRE and CRPA.MethodsWe analysed patient isolate and antibiotic consumption data of Swiss ICU sent to the Swiss Centre for Antibiotic Resistance (2009-2018). Time trends were assessed using linear logistic regression; a mixed-effects logistic regression was used to identify factors associated with CRE and CRPA.ResultsAmong 52 ICU, MRSA decreased from 14% to 6% (p = 0.005; n = 6,465); GRE increased from 1% to 3% (p = 0.011; n = 4,776). ESCR-EC and ESCR-KP increased from 7% to 15% (p < 0.001, n = 10,648) and 5% to 11% (p = 0.002; n = 4,052), respectively. CRE, mostly Enterobacter spp., increased from 1% to 5% (p = 0.008; n = 17,987); CRPA remained stable at 27% (p = 0.759; n = 4,185). Antibiotic consumption in 58 ICU increased from 2009 to 2013 (82.5 to 97.4 defined daily doses (DDD)/100 bed-days) and declined until 2018 (78.3 DDD/100 bed-days). Total institutional antibiotic consumption was associated with detection of CRE in multivariable analysis (odds ratio per DDD: 1.01; 95% confidence interval: 1.0-1.02; p = 0.004).DiscussionIn Swiss ICU, antibiotic-resistant Enterobacterales have been steadily increasing over the last decade. The emergence of CRE, associated with institutional antibiotic consumption, is of particular concern and calls for reinforced surveillance and antibiotic stewardship in this setting.

Keywords: CRE; Carbapenem resistance; Carbapenem-resistant Enterobacterales; Gram-negative bacteria; ICU; Switzerland; antibiotic consumption; intensive care.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Intensive care units represented in the analysis of antimicrobial resistance, Switzerland, 2009–2018 (n = 41)
Figure 2
Figure 2
Trends in resistant pathogens in intensive care, Switzerland, 2009–2018 (n = 34,887)
Figure 3
Figure 3
Trends in overall antibiotic consumption and consumption of preselected antibiotic substances in intensive care, in defined daily doses per 100 bed-days, Switzerland, 2009–2018
See this image and copyright information in PMC

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