gms | German Medical Science

Introduction: Rising global resistance rates and emergence of new resistance mechanisms is of deep concern among clinicians worldwide. Multifaceted approaches such as antimicrobial stewardship programme and antimicrobial resistance (AMR) surveillance are being implemented to tackle this problem. Surveillance data are considered essential to appropriate empiric antibiotic therapy and stewardship. In order to validate the impact of surveillance, we conducted a study with an objective to determine if a change in the rates of antibiotic resistance impacts antibiotic use in European hospitals.

Methods: Glycopeptides use was selected to study the correlation between resistance rates and antibiotic use because of the restricted spectrum against resistant gram positive bacteria. The alternative hypothesis tested was that the trend in glycopeptide consumption will be positively correlated with the trend in prevalence of the resistant gram positive bacteria which are most important targets for these antibiotics. PubMed, ECDC databases and national/regional surveillance systems were searched to identify glycopeptides´ consumption in defined daily dose per 1000 inhabitant-days (DID) and rate of methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant coagulase negative staphylococci (MRCoNS), and vancomycin-sensitive enterococci (VSE) in bloodstream infections (BSIs) in European countries between 2005 and 2015. Time trends were studied and associations between DID and BSI resistance rates were tested using multi-level mixed effect models allowing for a random variance at the year wise and country wise estimates to account for interdependence of data. To account for the gap in the publication and dissemination of the yearly resistance data, a 2-year lag in the resistance rates was applied.

Results: Data on glycopeptides´ DID and resistance rates of target microorganisms in blood cultures were identified among 31 countries over a 19-year period. Glycopeptides use significantly increased (1.058 DID/year, p<0·0001) while rates of MRSA BSIs decreased (-0.51%/year, p<0·0001), and VSE BSI and MRCoNS remained stable. Mixed effect models did not show any evidence of association between the trends in glycopeptides’ DID and BSIs due to MRSA (p=0·136) and VRE (p=0·613). No correlation was found between resistance rates and DID data even among 8 countries with more than 5% decrease in MRSA rates over time (RC -0·009, p=0·059). Resistance rate of MRSA, MRCoNS, and VRE BSIs does not impact DID of glycopeptides in European hospitals.

Discussion: Our study revealed that yearly glycopeptides use in European countries significantly increased irrespective of the decreased trend in rates of BSIs due to MRSA and VSE and stable trend of those due to MRCoNS in the past decade. This finding may be attributed to inappropriate therapy and is important in redefining the role and structure of antimicrobial surveillance and stewardship programmes.

Die Autoren geben an, dass kein Interessenkonflikt besteht.

Die Autoren geben an, dass kein Ethikvotum erforderlich ist.