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Surveillance and correlation of antibiotic prescription and resistance of Gram-negative bacteria in Singaporean hospitals.
Antimicrob Agents Chemother. 2010 Mar; 54(3):1173-8.AA

Abstract

A surveillance study was performed in four Singapore public hospitals from 2006 to 2008 to determine the correlation between antibiotic prescription and Gram-negative bacterial antimicrobial resistance. Targeted organisms included ceftriaxone- and ciprofloxacin-resistant Escherichia coli and Klebsiella pneumoniae, as well as imipenem-resistant Pseudomonas aeruginosa and Acinetobacter spp. Antibiotic prescription data were collated in the WHO anatomical therapeutic chemical (ATC)/defined daily dose (DDD) format, while antibiotic resistance was expressed as incidence density adjusted for total inpatient-days every quarter. Individual trends were determined by linear regression, while possible associations between antibiotic prescription and resistance were evaluated via cross-correlation analysis. Results over 3 years indicated significantly rising incidence densities of ceftriaxone- and ciprofloxacin-resistant E. coli and imipenem-resistant Acinetobacter spp. (blood isolates only). Antimicrobial-resistant Klebsiella pneumoniae rates declined. The prescription rates of piperacillin-tazobactam, ertapenem, meropenem, ciprofloxacin, and levofloxacin increased significantly, while imipenem and moxifloxacin prescription decreased. Cross-correlation analysis demonstrated possible associations between prescription of fluoroquinolones and ciprofloxacin-resistant E. coli (R(2) = 0.46), fluoroquinolones and ceftriaxone-resistant E. coli (R(2) = 0.47), and carbapenems and imipenem-resistant Acinetobacter spp. (R(2) = 0.48), all at zero time lag. Changes in meropenem prescription were associated with a similar trend in imipenem-resistant Acinetobacter blood isolates after a 3-month time lag. No correlation was found between cephalosporin use and resistance. In conclusion, our data demonstrated correlation between prescription of and Gram-negative bacterial resistance to several, but not all, key antimicrobial agents in Singapore hospitals. In areas where Gram-negative bacterial resistance is endemic and prescription of broad-spectrum antimicrobial agents is high, factors other than antimicrobial usage may be equally important in maintaining high resistance rates.

Authors+Show Affiliations

Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore. liyang_hsu@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20065055

Citation

Hsu, Li-Yang, et al. "Surveillance and Correlation of Antibiotic Prescription and Resistance of Gram-negative Bacteria in Singaporean Hospitals." Antimicrobial Agents and Chemotherapy, vol. 54, no. 3, 2010, pp. 1173-8.
Hsu LY, Tan TY, Tam VH, et al. Surveillance and correlation of antibiotic prescription and resistance of Gram-negative bacteria in Singaporean hospitals. Antimicrob Agents Chemother. 2010;54(3):1173-8.
Hsu, L. Y., Tan, T. Y., Tam, V. H., Kwa, A., Fisher, D. A., & Koh, T. H. (2010). Surveillance and correlation of antibiotic prescription and resistance of Gram-negative bacteria in Singaporean hospitals. Antimicrobial Agents and Chemotherapy, 54(3), 1173-8. https://doi.org/10.1128/AAC.01076-09
Hsu LY, et al. Surveillance and Correlation of Antibiotic Prescription and Resistance of Gram-negative Bacteria in Singaporean Hospitals. Antimicrob Agents Chemother. 2010;54(3):1173-8. PubMed PMID: 20065055.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surveillance and correlation of antibiotic prescription and resistance of Gram-negative bacteria in Singaporean hospitals. AU - Hsu,Li-Yang, AU - Tan,Thean-Yen, AU - Tam,Vincent H, AU - Kwa,Andrea, AU - Fisher,Dale Andrew, AU - Koh,Tse-Hsien, AU - ,, Y1 - 2010/01/11/ PY - 2010/1/13/entrez PY - 2010/1/13/pubmed PY - 2010/6/1/medline SP - 1173 EP - 8 JF - Antimicrobial agents and chemotherapy JO - Antimicrob. Agents Chemother. VL - 54 IS - 3 N2 - A surveillance study was performed in four Singapore public hospitals from 2006 to 2008 to determine the correlation between antibiotic prescription and Gram-negative bacterial antimicrobial resistance. Targeted organisms included ceftriaxone- and ciprofloxacin-resistant Escherichia coli and Klebsiella pneumoniae, as well as imipenem-resistant Pseudomonas aeruginosa and Acinetobacter spp. Antibiotic prescription data were collated in the WHO anatomical therapeutic chemical (ATC)/defined daily dose (DDD) format, while antibiotic resistance was expressed as incidence density adjusted for total inpatient-days every quarter. Individual trends were determined by linear regression, while possible associations between antibiotic prescription and resistance were evaluated via cross-correlation analysis. Results over 3 years indicated significantly rising incidence densities of ceftriaxone- and ciprofloxacin-resistant E. coli and imipenem-resistant Acinetobacter spp. (blood isolates only). Antimicrobial-resistant Klebsiella pneumoniae rates declined. The prescription rates of piperacillin-tazobactam, ertapenem, meropenem, ciprofloxacin, and levofloxacin increased significantly, while imipenem and moxifloxacin prescription decreased. Cross-correlation analysis demonstrated possible associations between prescription of fluoroquinolones and ciprofloxacin-resistant E. coli (R(2) = 0.46), fluoroquinolones and ceftriaxone-resistant E. coli (R(2) = 0.47), and carbapenems and imipenem-resistant Acinetobacter spp. (R(2) = 0.48), all at zero time lag. Changes in meropenem prescription were associated with a similar trend in imipenem-resistant Acinetobacter blood isolates after a 3-month time lag. No correlation was found between cephalosporin use and resistance. In conclusion, our data demonstrated correlation between prescription of and Gram-negative bacterial resistance to several, but not all, key antimicrobial agents in Singapore hospitals. In areas where Gram-negative bacterial resistance is endemic and prescription of broad-spectrum antimicrobial agents is high, factors other than antimicrobial usage may be equally important in maintaining high resistance rates. SN - 1098-6596 UR - https://www.unboundmedicine.com/medline/citation/20065055/Surveillance_and_correlation_of_antibiotic_prescription_and_resistance_of_Gram_negative_bacteria_in_Singaporean_hospitals_ L2 - http://aac.asm.org/cgi/pmidlookup?view=long&pmid=20065055 DB - PRIME DP - Unbound Medicine ER -