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News Newsfeeds Dramatic increase of third-generation cephalosporin resistant E. coli in German intensive care units: secular trends in antibiotic drug use and bacterial resistance, 2001-2008
Written by Critical Care
The objective of this study was to analyse secular trends in antibiotic consumption and resistance data from a network of 53 intensive care units (ICUs).
Methods:
Prospective unit and laboratory based surveillance in 53 German ICUs from 2001 through 2008. The data were calculated on the basis of proportions of non-duplicate resistant isolates (RP), resistance densities (i.e. the number of resistant isolates of a species per 1000 patient days) and antimicrobial usage density (AD) expressed as daily defined doses (DDD) and normalised per 1000 patient-days (pd).
Results:
Total mean antibiotic use remained stable over time and amounted to 1172 DDD/1000 pd (range 531 to 2471). Carbapenem use almost doubled to an AD of 151 in 2008. Significant increases were also calculated for quinolone (AD of 163 in 2008) and 3rd and 4th generation cephalosporin use (AD of 117 in 2008). Aminoglycoside consumption decreased substantially (AD was 86 in 2001 and 24 in 2008). Resistance proportions were as follows in 2001 and 2008 respectively: methicillin resistant staphylococcus aureus (MRSA) 26 and 20% (P=0.006; the trend test showed a significant decrease), vancomycin resistant enterococcus (VRE) faecium 2.3 and 8.2% (P=0.008), 3rd generation cephalosporin (3GC) resistant E. coli 1.2 and 19.7% (P<0.001), 3GC resistant K. pneumoniae 3.8 and 25.5% (P<0.001), imipenem resistant A. baumannii 1.1 and 4.5% (P=0.002) and imipenem resistant K. pneumoniae 0.4 and 1.1%. The resistance densities did not change for MRSA but increased significantly for VRE faecium and 3GC resistant E. coli and K. pneumoniae. In 2008, the resistance density of MRSA was 3.73, 0.48 of VRE and 1.39 of 3GC resistant E. coli and 0.82 of K. pneumoniae.
Conclusions:
Although total antibiotic use did not change over time in German ICUs, carbapenem use doubled. This is probably due to the rise in 3rd generation cephalosporin resistant E. coli and K. pneumoniae. Increased carbapenem consumption was associated with carbapenem-resistant K. pneumoniae carbapenemases (KPC)-producing bacteria and imipenem resistant A. baumannii.
Sunday, 13 June 2010 19:00
Introduction:The objective of this study was to analyse secular trends in antibiotic consumption and resistance data from a network of 53 intensive care units (ICUs).
Methods:
Prospective unit and laboratory based surveillance in 53 German ICUs from 2001 through 2008. The data were calculated on the basis of proportions of non-duplicate resistant isolates (RP), resistance densities (i.e. the number of resistant isolates of a species per 1000 patient days) and antimicrobial usage density (AD) expressed as daily defined doses (DDD) and normalised per 1000 patient-days (pd).
Results:
Total mean antibiotic use remained stable over time and amounted to 1172 DDD/1000 pd (range 531 to 2471). Carbapenem use almost doubled to an AD of 151 in 2008. Significant increases were also calculated for quinolone (AD of 163 in 2008) and 3rd and 4th generation cephalosporin use (AD of 117 in 2008). Aminoglycoside consumption decreased substantially (AD was 86 in 2001 and 24 in 2008). Resistance proportions were as follows in 2001 and 2008 respectively: methicillin resistant staphylococcus aureus (MRSA) 26 and 20% (P=0.006; the trend test showed a significant decrease), vancomycin resistant enterococcus (VRE) faecium 2.3 and 8.2% (P=0.008), 3rd generation cephalosporin (3GC) resistant E. coli 1.2 and 19.7% (P<0.001), 3GC resistant K. pneumoniae 3.8 and 25.5% (P<0.001), imipenem resistant A. baumannii 1.1 and 4.5% (P=0.002) and imipenem resistant K. pneumoniae 0.4 and 1.1%. The resistance densities did not change for MRSA but increased significantly for VRE faecium and 3GC resistant E. coli and K. pneumoniae. In 2008, the resistance density of MRSA was 3.73, 0.48 of VRE and 1.39 of 3GC resistant E. coli and 0.82 of K. pneumoniae.
Conclusions:
Although total antibiotic use did not change over time in German ICUs, carbapenem use doubled. This is probably due to the rise in 3rd generation cephalosporin resistant E. coli and K. pneumoniae. Increased carbapenem consumption was associated with carbapenem-resistant K. pneumoniae carbapenemases (KPC)-producing bacteria and imipenem resistant A. baumannii.
Authors: Elisabeth Meyer
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