The Effect of Antimicrobial Policy Implementation on Carbapenem Resistance: A University Hospital Experience

Year 2022, , 678 - 682, 28.09.2022

Okan Derin , Fatma Şeker , Nilay Aksoy , Pakize Yıgıt , Mehmet Yılmaz , Ali Mert

https://doi.org/10.33808/clinexphealthsci.1010571

Abstract

Objective: The resistance of Gram-negative bacteria to antibiotics is a global issue that leads to increased mortality and treatment costs. The aim of this study is to see how a newly formed carbapenem control team affected the prevalence of carbapenem-resistant Gram-negative rods and antibiotic consumption expenses in 2017 compared to the year before.
Methods: The rate of carbapenem antibiotic usage in Intensive Care Units and Bone Marrow Transplantation services, as well as the findings of culture materials obtained from various body parts of the same patients, between January 1, 2016, and December 31, 2017 were assessed.
Results: While there was an ordinary restriction on carbapenem consumption in 2016, carbapenem consumption has been more restricted in 2017. The carbapenem-resistant Gram-negative bacteria patterns of culture materials are examined and compared with Defined Daily Dose data of carbapenems. After the restriction, a significant decrease in the consumption of carbapenems was detected. The decline in carbapenem-resistant Gram-negative bacteria and decreasing antibiotic consumption were found to have a moderately positive correlation (r=0.641, p=0.02). A 60.9% decrease was observed in carbapenem costs after carbapenem restriction, on the other hand, an increase in other unrestricted antibiotics was apparent.
Conclusion: Antimicrobial restriction policies can help minimize the rate of carbapenem-resistant Gram-negative rods, which is a serious problem in healthcare. We demonstrated that a decrease in carbapenem-resistant Gram-negative rods isolation rates can lead to a decrease in healthcare-associated infections. Although there is no decrease in the direct antibiotics cost, a drop in carbapenem-resistant may lower the expenses of drastic consequences of infections with carbapenem-resistant and its cost. we can conclude that the Antibiotic Control Policy should be modified based on this new information.

Keywords

Gram-Negative Bacteria, resistance, carbapenem

Thanks

Nur Ozturk

References

• Robertson J, Iwamoto K, Hoxha I, Ghazaryan L, Abilova V, Cvijanovic A, Pyshnik H, Darakhvelidze M, Makalkina L, Jakupi A, Dzhakubekova A, Carp A, Cizmovic L, Rachina S, Radonjic V, Yusufi S, Aksoy M, Ibragimova M, Godman B, Kluge H, Pedersen HB. Antimicrobial Medicines Consumption in Eastern Europe and Central Asia – An Updated Cross-National Study and Assessment of Quantitative Metrics for Policy Action. Front Pharmacol 2019;9:1156.
• Browne AJ, Chipeta MG, Haines-Woodhouse G, Kumaran EPA, Hamadani BHK, Zaraa S, Henry NJ, Deshpande A, Reiner RC Jr, Day NPJ, Lopez AD, Dunachie S, Moore CE, Stergachis A, Hay SI, Dolecek C. Global antibiotic consumption and usage in humans, 2000-18: a spatial modelling study. Lancet Planet Health 2021 Dec;5(12):e893-e904.
• Versporten A, Bolokhovets G, Ghazaryan L, Abilova V, Pyshnik G, Spasojevic T, Korinteli I, Raka L, Kambaralieva B, Cizmovic L, Carp A, Radonjic V, Maqsudova N, Celik HD, Payerl-Pal M, Pedersen HB, Sautenkova N, Goossens H; WHO/Europe- ESAC Project Group. Antibiotic use in eastern Europe: a cross-national database study in coordination with the WHO Regional Office for Europe. Lancet Infect Dis 2014;14(5):381- 387.
• Selcuk A. The point prevalence and inappropriateness of antibiotic use at hospitals in Turkey: a systematic review and meta-analysis. J Chemother 2021;33(6):390-399.
• Hayashi Y, Paterson DL. Strategies for reduction in duration of antibiotic use in hospitalized patients. Clin Infect Dis 2011;52(10):1232-1240.
• Slama TG, Amin A, Brunton SA, File TM Jr, Milkovich G, Rodvold KA, Sahm DF, Varon J, Weiland D Jr. A clinician’s guide to the appropriate and accurate use of antibiotics: the Council for Appropriate and Rational Antibiotic Therapy (CARAT) criteria. Am J Med 2005;118 Suppl 7A:1S-6S.
• Chang HJ, Hsu PC, Yang CC, Kuo AJ, Chia JH, Wu TL, Lee MH. Risk factors and outcomes of carbapenem-nonsusceptible Escherichia coli bacteremia: a matched case–control study. J Microbiol Immunol Infect 2011;44(2):125-130.
• Şeker F. Bir üniversite hastanesinde karbapenem kısıtlamasının karbapenem dirençli gram negatif çomaklar üzerine etkisi (Master’s thesis, İstanbul Medipol Üniversitesi Sağlık Bilimleri Enstitüsü). Avilable from: URL: https://acikerisim. medipol.edu.tr/xmlui/handle/20.500.12511/7182
• MacKenzie FM, Forbes KJ, Dorai-John T, Amyes SG, Gould IM. Emergence of a carbapenem-resistant Kiebsiella pneumoniae. Lancet 1997;350(9080):783.
• Kwak YG, Choi SH, Choo EJ, Chung JW, Jeong JY, Kim NJ, Woo JH, Ryu J, Kim YS.Risk factors for the acquisition of carbapenem-resistant Klebsiella pneumoniae among hospitalized patients. Microb Drug Resist 2005;11(2):165-169.
• Leavitt A, Navon-Venezia S, Chmelnitsky I, Schwaber MJ, Carmeli Y. Emergence of KPC-2 and KPC-3 in carbapenem-resistant Klebsiella pneumoniae strains in an Israeli hospital. Antimicrob Agents Chemother. 2007;51(8):3026-3029.
• Koh TH, Wang GC, Sng LH. Clonal spread of IMP-1-producing Pseudomonas aeruginosa in two hospitals in Singapore. J Clin Microbiol 2004;42(11):5378-5380.
• TİTCK. Antimikrobiyal Kullanımının Yönetimi: Sorun Nedir? 2016 (Cited 2021 April 02). Available from: URL: http://www. akilciilac.gov.tr/wp-content/uploads/2016/03/aik-bltn-181. pdf. (accessed on 10 oct 2021).
• Keçik M, editor Akılcı Antibiyotik Kullanımı, Türkiye Verileri ve Hedefler. ANKEM; 2016. (Turkish)
• TİTCK. Akılcı İlaç Kullanımı Ulusal Eylem Planı. In: UAİTSDA, editor. Website: TİTCK; 2014. (Turkish)
• TC.Resmi.Gazete. Mali Yılı Bütçe Uygulama Talimatı. Mevzuatı Geliştirme ve Yayın Genel Müdürlüğü; 2003. (Turkish)
• Hoşoğlu S, Esen S, Ozturk R, Altindis M, Ertek M, Kaygusuz S, Caylan R, Demirdag K, Sencan I, Ertem GT, Aslan S, Bosnak V, Aygun P, Erol S, Celen MK. The effect of a restriction policy on the antimicrobial consumption in Turkey: a country-wide study. Eur J Clin Pharmacol.2005;61(10):727-731.
• Arda B, Sipahi OR, Yamazhan T, Tasbakan M, Pullukcu H, Tunger A, Buke C, Ulusoy S. Short-term effect of antibiotic control policy on the usage patterns and cost of antimicrobials, mortality, nosocomial infection rates and antibacterial resistance. J Infect. 2007;55(1):41-48.
• Drew RJ, Turton JF, Hill RL, Livermore DM, Woodford N, Paulus S, Cunliffe NA. Emergence of carbapenem-resistant Enterobacteriaceae in a UK paediatric hospital. J Hosp Infect. 2013;84(4):300-304.
• Ergönül Ö, Aydin M, Azap A, Başaran S, Tekin S, Kaya Ş, Gülsün S, Yörük G, Kurşun E, Yeşilkaya A, Şimşek F, Yılmaz E, Bilgin H, Hatipoğlu Ç, Cabadak H, Tezer Y, Togan T, Karaoğlan I, İnan A, Engin A, Alışkan HE, Yavuz SŞ, Erdinç Ş, Mulazimoglu L, Azap Ö, Can F, Akalın H, Timurkaynak F. Healthcare-associated Gram-negative bloodstream infections: antibiotic resistance and predictors of mortality. J Hosp Infect.2016;94(4):381-385.
• Mathur P, Varghese P, Tak V, Gunjiyal J, Lalwani S, Kumar S, Misra MC. Epidemiology of blood stream infections at a level-1 trauma care center of India. J lab physicians. 2014;6(1):22-27.
• Tabah A, Koulenti D, Laupland K, Misset B, Valles J, Bruzzi de Carvalho F, Paiva JA, Cakar N, Ma X, Eggimann P, Antonelli M, Bonten MJ, Csomos A, Krueger WA, Mikstacki A, Lipman J, Depuydt P, Vesin A, Garrouste-Orgeas M, Zahar JR, Blot S, Carlet J, Brun-Buisson C, Martin C, Rello J, Dimopoulos G, Timsit JF. Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study. Intensive Care Med 2012;38(12):1930-1945.
• Ogutlu A, Guclu E, Karabay O, Utku AC, Tuna N, Yahyaoglu M. Effects of Carbapenem consumption on the prevalence of Acinetobacter infection in intensive care unit patients. Ann Clin Microbiol Antimicrob. 2014;13(1):1-6.
• Altunsoy A, Aypak C, Azap A, Ergönül Ö, Balık I. The impact of a nationwide antibiotic restriction program on antibiotic usage and resistance against nosocomial pathogens in Turkey. Int J Med Sci. 2011;8(4):339.
• Asuman İN, DAĞLI Ö, Akçay SŞ, Engin DÖ, Karagül E, Özyürek SÇ. Antibiotic use and cost in a teaching hospital in İstanbul. J Microb Infect Diseases. 2011;1(03):128-33.
• Tunger O, Karakaya Y, Cetin CB, Dinc G, Borand H. Rational antibiotic use. J Infect Dev Ctries. 2009;3(2):88-93.
• Abdallah M, Badawi M, Amirah MF, Rasheed A, Mady AF, Alodat M, Alharthy A. Impact of carbapenem restriction on the antimicrobial susceptibility pattern of Pseudomonas aeruginosa isolates in the ICU. J Antimicrob Chemother. 2017;72(11):3187-3190.
• Pakyz AL, Oinonen M, Polk RE. Relationship of carbapenem restriction in 22 university teaching hospitals to carbapenem use and carbapenem-resistant Pseudomonas aeruginosa. Antimicrob agents chemother. 2009;53(5):1983-1986.
• Ozgenç O, Genç VE, Ari AA, El Sibel, Saçar S, Ozunlu H, Akgul A, Demirturk N, Cetin CB, Sungur M, Coşkuner SA, Avci M, Ergonul O. Evaluation of the therapeutic use of antibiotics in Aegean Region hospitals of Turkey: a multicentric study. Indian J Med Microbiol. 2011;29(2):124.