Previous Antibiotic Exposure and Antimicrobial Resistance Patterns of Acinetobacter spp. and Pseudomonas aeruginosa Isolated from Patients with Nosocomial Infections

Year 2017, Volume: 34 Issue: 6, 527 - 533, 01.11.2017

Zorana M. Djordjevic Marko M. Folic Slobodan M. Jankovic

Abstract

This study showed that there is an association between the resistance density of Acinetobacter spp. and utilization of carbapenems, tigecycline and aminoglycosides. A multifaceted intervention is needed to decrease the incidence rate of Acinetobacter and Pseudomonas hospital infections, as well as their resistance density to available antibiotics. Background: The alarming spread of antibiotic-resistant bacteria causing healthcare-associated infections has been extensively reported in recent medical literature. Aims: To compare trends in antimicrobial consumption and development of resistance among isolates of Acinetobacter spp. and Pseudomonas aeruginosa that cause hospital infections. Study Design: Cross-sectional study. Methods: A study was conducted in a tertiary healthcare institution in central Serbia, during the 7-year period between January 2009 and December 2015. The incidence rate of infections caused by Acinetobacter or Pseudomonas, as well as their resistance density to commonly used antibiotics, were calculated. Utilization of antibiotics was expressed as the number of defined daily doses per 1000 patient-days. Results: A statistically significant increase in resistance density in 2015 compared to the first year of observation was noted for Acinetobacter, but not for Pseudomonas, to third-generation cephalosporins (p=0.008), aminoglycosides (p=0.005), carbapenems (p=0.003), piperacillin/tazobactam (p=0.025), ampicillin/sulbactam (p=0.009) and tigecycline (p=0.048). Conclusion: Our study showed that there is an association between the resistance density of Acinetobacter spp. and utilization of carbapenems, tigecycline and aminoglycosides. A multifaceted intervention is needed to decrease the incidence rate of Acinetobacter and Pseudomonas hospital infections, as well as their resistance density to available antibiotics.

Keywords

Nosocomial infections, Pseudomonas aeruginosa, Acinetobacter, antimicrobial resistance

References

• 1. Agodi A, Barchitta M, Quattrocchi A, Maugeri A, Aldisio E, Marchese AE, et al. Antibiotic trends of Klebsiella pneumoniae and Acinetobacter baumannii resistance indicators in an intensive care unit of Southern Italy, 2008-2013. Antimicrob Resist Infect Control 2015;4:43.
• 2. Rosenthal VD, Maki DG, Mehta Y, Leblebicioglu H, Memish ZA, AlMousa HH, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary of 43 countries for 2007-2012. Deviceassociated module. Am J Infect Control 2014;42:942-56.
• 3. Sievert DM, Ricks P, Edwards JR, Schneider A, Patel J, Srinivasan A, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010. Infect Control Hosp Epidemiol 2013;34:1-14.
• 4. Zavascki AP, Carvalhaes CG, Picão RC, Gales AC. Multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii: resistance mechanisms and implications for therapy. Expert Rev Anti Infect Ther 2010;8:71-93.
• 5. Strateva T, Yordanov D. Pseudomonas aeruginosa - a phenomenon of bacterial resistance. J Med Microbiol 2009;58:1133-48.
• 6. Rogues AM, Dumartin C, Amadéo B, Venier AG, Marty N, Parneix P, et al. Relationship between rates of antimicrobial consumption and the incidence of antimicrobial resistance in Staphylococcus aureus and Pseudomonas aeruginosa isolates from 47 French hospitals. Infect Control Hosp Epidemiol 2007;28:1389-95.
• 7. Xu J, Duan X, Wu H, Zhou Q. Surveillance and correlation of antimicrobial usage and resistance of Pseudomonas aeruginosa: a hospital populationbased study. PLoS One 2013;8:e78604.
• 8. Sousa D, Castelo-Corral L, Gutiérrez-Urbón JM, Molina F, López-Calviño B, Bou G, et al. Impact of ertapenem use on Pseudomonas aeruginosa and Acinetobacter baumannii imipenem susceptibility rates: collateral damage or positive effect on hospital ecology? J Antimicrob Chemother 2013;68:1917-25.
• 9. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections. Am J Infect Control 1988;16:128-40.
• 10. Kiska DL, Gilligan PH. Pseudomonas and Burkholderia. In: Murray PR, Baron EJ, Pfaller MA, editors. Manual of clinical microbiology. Washington [DC]: American Society for Microbiology; 1995:517-25.
• 11. CLSI. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Fourth Informational Supplement. CLSI document M100-S24. Wayne, PA: Clinical and Laboratory Standards Institute; 2014.
• 12. WHO Collaborating Centre for Drug Statistics Methodology, Guidelines for ATC classification and DDD assignment 2013. Oslo: 2012:165-75.
• 13. Djordjevic Z, Folic MM, Zivic Z, Markovic V, Jankovic SM. Nosocomial urinary tract infections caused by Pseudomonas aeruginosa and Acinetobacter species: sensitivity to antibiotics and risk factors. Am J Infect Control 2013;41:1182-7.
• 14. Weiner LM, Fridkin SK, Aponte-Torres Z, Avery L, Coffin N, Dudeck MA, et al. Vital Signs: Preventing Antibiotic-Resistant Infections in Hospitals - United States, 2014. MMWR Morb Mortal Wkly Rep 2016;65:235-41.
• 15. Mancini A, Verdini D, La Vigna G, Recanatini C, Lombardi FE, Barocci S. Retrospective analysis of nosocomial infections in an Italian tertiary care hospital. New Microbiol 2016;39:197-205.
• 16. Viehman JA, Nguyen MH, Doi Y. Treatment options for carbapenemresistant and extensively drug-resistant Acinetobacter baumannii infections. Drugs 2014;74:1315-33.
• 17. Maragakis LL, Perl TM. Acinetobacter baumannii: epidemiology, antimicrobial resistance, and treatment options. Clin Infect Dis 2008;46:1254-63.
• 18. Master RN, Clark RB, Karlowsky JA, Ramirez J, Bordon JM. Analysis of resistance, cross-resistance and antimicrobial combinations for Pseudomonas aeruginosa isolates from 1997 to 2009. Int J Antimicrob Agents 2011;38:291-5.
• 19. Lesho E, Yoon EJ, McGann P, Snesrud E, Kwak Y, Milillo M, et al. Emergence of colistin-resistance in extremely drug-resistant Acinetobacter baumannii containing a novel pmrCAB operon during colistin therapy of wound infections. J Infect Dis 2013;208:1142-51.
• 20. Potron A, Poirel L, Nordmann P. Emerging broad-spectrum resistance in Pseudomonas aeruginosa and Acinetobacter baumannii: Mechanisms and epidemiology. Int J Antimicrob Agents 2015;45:568-85.
• 21. Dumartin C, L'Hériteau F, Péfau M, Bertrand X, Jarno P, Boussat S, et al. Antibiotic use in 530 French hospitals: results from a surveillance network at hospital and ward levels in 2007. J Antimicrob Chemother 2010;65:2028-36.
• 22. MacDougall C, Polk RE. Variability in rates of use of antibacterials among 130 US hospitals and risk-adjustment models for interhospital comparison. Infect Control Hosp Epidemiol 2008;29:203-11.
• 23. Bitterman R, Hussein K, Leibovici L, Carmeli Y, Paul M. Systematic review of antibiotic consumption in acute care hospitals. Clin Microbiol Infect 2016;22:561.
• 24. Goel N, Wattal C, Oberoi JK, Raveendran R, Datta S, Prasad KJ. Trend analysis of antimicrobial consumption and development of resistance in non-fermenters in a tertiary care hospital in Delhi, India. J Antimicrob Chemother 2011;66:1625-30.
• 25. Chen IL, Lee CH, Su LH, Tang YF, Chang SJ, Liu JW. Antibiotic consumption and healthcare-associated infections caused by multidrug-resistant gram-negative bacilli at a large medical center in Taiwan from 2002 to 2009: implicating the importance of antibiotic stewardship. PLoS ONE 2013;8:e65621.
• 26. Cao J, Song W, Gu B, Mei YN, Tang JP, Meng L, et al. Correlation between carbapenem consumption and antimicrobial resistance rates of Acinetobacter baumannii in a university-affiliated hospital in China. J Clin Pharmacol 2013;53:96-102.
• 27. Mladenovic-Antic S, Kocic B, Velickovic-Radovanovic R, Dinic M, Petrovic J, Randjelovic G, et al. Correlation between antimicrobial consumption and antimicrobial resistance of Pseudomonas aeruginosa in a hospital setting: a 10-year study. J Clin Pharm Ther 2016;41:532-7.
• 28. Potron A, Poirel L, Nordmann P. Emerging broad-spectrum resistance in Pseudomonas aeruginosa and Acinetobacter baumannii: Mechanisms and epidemiology. Int J Antimicrob Agents 2015;45:568-85.
• 29. Tacconelli E, Cataldo MA, Dancer SJ, De Angelis G, Falcone M, Frank U, et al. ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients. Clin Microbiol Infect 2014;20(Suppl 1):1-55.