Associations between Antibiotic Use and Resistance in Mahasarakham Hospital
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Abstract
Introduction: Antibiotic resistance is a worldwide public health problem as it increases mortality rate and health care expenditures. A number of factors associated with antibiotic resistance including habits of healthcare personnel, referral system of infected patients and overuse of antibiotics. The objective of this study is to determine associations between antibiotic use and resistance in Mahasarakam hospital. Methods: A retrospective study was conducted using electronic database and antibiogram between 2010 and 2017. Antibiotic use was measured as defined daily dose (DDD). Antibiotic resistance was percentage of reported antibiotic susceptibility as intermediate susceptible or resistance. Trends of antibiotic use, positive culture and antibiotic resistance were analyzed using linear regression. Pearson’s correlation was used to determine associations between antibiotic use and resistance. Results: Between 2010 and 2017, antibiotic use increased from 96.12 DDD/100 patient-days to 111.65 DDD/100 patient-days (p=0.019). Increased carbapenem resistance was found in E.coli and K.pneumoniae (from 1% to 8%, p=0.002 and from 1% to 16%, p=0.001, respectively) and cefoperzone/sulbactam resistance increased in A.baumannii (from 72% to 89%, p=0.004). Carbapenem use was correlated to carbapenem-resistant rate of E.coli (r=0.74, p=0.034) and K.pneumoniae (r=0.79, p=0.019), and correlated to MRSA detection (r=0.844, p=0.008). There was no association between cabapenem use and rate of carbapenem-resistant A.baumannii (r=0.56, p=0.149) and P.aeruginosa (r=-0.07, p=0.862). Piperacillin/tazobactam use was associated with ESBL positive detection (r=-0.74, p=0.037) but not associated with piperacillin/tazobactam-resistant P.aeruginosa rate (r=0.35, p=0.435). Vancomycin use was not associated with vancomycin-resistant E.faecium rate (r=0.10, p=0.904). Discussion and Conclusion: Increases in carbapenems use was associated with Enterobacteriaceae resistance and increase in piperacillin/tazobactam was associated with ESBL producing strain. The hospital should strengthen antibiotic stewardship program to reduce and control antimicrobial resistance.
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