Antibiotic consumption as a driver for resistance in Staphylococcus aureus and Escherichia coli within a developing region
published online 09 November 2009. Corrected Proof
Background
This study aimed to provide insight into possible antibiotic drivers of methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli resistant to third-generation cephalosporins (3GCREC) in southern and eastern Mediterranean institutions.
Methods
MRSA and 3GCREC susceptibility proportions from 19 regional hospitals, previously published by the ARMed project, were correlated with antibiotic use data from the same institutions.
Results
Hospitals reporting below-median MRSA proportions had significantly lower total antibiotic use. MRSA proportions increased with greater use of carbapenems (P=.04). In multivariate analysis, a positive correlation was identified with the use of carbapenems (P=.002), combination penicillins (P=.018), and aminoglycosides (P=.014). No difference was ascertained between 3GCREC proportions and total antibiotic use. In multivariate linear regression, a correlation was identified only for 3GCREC (P=.005), but a negative association was evident for beta-lactamase–resistant penicillins (P=.010) and first-generation cephalosporins (P=.012).
Conclusions
The results suggest an association between resistance and antibiotic use, especially for carbapenems and third-generation cephalosporins. These data support the urgent implementation of antibiotic stewardship initiatives in hospitals in developing countries that focus on more judicious use of broad-spectrum formulations.
aInfection Control Unit, Mater Dei Hospital, Msida, Malta
bInfectious Disease Research and Infection Control Unit, Faculty of Medicine, Ain Shams University, Cairo, Egypt
cClinical Microbiology Laboratory, Hacettepe University, Ankara, Turkey
dMicrobiology Laboratory, Hospital Charles Nicolle, Tunis, Tunisia
ePathology and Microbiology Department, Jordan University of Science and Technology, Irbid, Jordan
fMicrobiology Laboratory, St George University Hospital, Beirut, Lebanon
Address correspondence to Dr Michael A Borg, Mater Dei Hospital, Infection Control Unit, Msida, Malta.
This study was undertaken as part of the ARMed (Antibiotic Resistance Surveillance and Control in the Mediterranean Region) project, which was funded by the European Commission under the INCOMED program of the DG Research Fifth Framework Protocol (ICA3-CT-2002-10015).
ABSTRACT
=