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Control of emergence of multi-resistant gram-negative bacilli by exclusive use of amikacin
Abstract:
Results of a three-year prospective study of amikacin as the only aminoglycoside used at the Instituto Nacional de la Nutrición "Salvador Zubirán" are presented. During the initial three-month baseline period, resistance to amikacin, gentamicin, and tobramycin among 870 gram-negative bacterial isolates was 3.2 percent, 17.4 percent, and 11.2 percent, respectively. In this period, the overall consumption of aminoglycosides was 69 percent for gentamicin, 30.5 percent for amikacin, and 0.5 percent for tobramycin. In the following period of exclusive amikacin use, sensitivity patterns of 9,344 gram-negative strains isolated over three years were recorded. During this period, amikacin constituted 99.3 percent of all aminoglycosides used. The percentage of gentamicin-resistant gram-negative strains declined to 7.4 percent (p less than 0.0001), whereas the percentage of amikacin-resistant strains did not change significantly. Quarterly trend analysis of aminoglycoside-resistant strains also demonstrated a significant decrease in gentamicin resistance (p less than 0.005) and an overall steady state of amikacin resistance. It is concluded that the exclusive use of amikacin was not accompanied by a significant increase in amikacin resistance during a three-year period, and may even lead to a decrease in resistance to gentamicin and tobramycin among most gram-negative organisms.
Insights
Exclusive use of amikacin for three years did not increase amikacin resistance in gram-negative bacteria. This strategy may decrease resistance to other aminoglycosides like gentamicin.
Area of Science:
- Microbiology
- Infectious Diseases
- Pharmacology
Background:
- Aminoglycosides are crucial antibiotics for treating gram-negative bacterial infections.
- Rising antibiotic resistance necessitates evaluating antibiotic stewardship strategies.
- Previous resistance patterns showed significant gentamicin and tobramycin resistance compared to amikacin.
Purpose of the Study:
- To assess the impact of exclusive amikacin use on aminoglycoside resistance patterns.
- To evaluate changes in resistance to amikacin, gentamicin, and tobramycin over three years.
- To determine if exclusive amikacin use affects overall aminoglycoside resistance in gram-negative bacteria.
Main Methods:
- Prospective study over three years at a national nutrition institute.
- Baseline data collected on resistance and aminoglycoside consumption.
- Monitoring of gram-negative bacterial isolates' sensitivity patterns during exclusive amikacin use.
Main Results:
- Exclusive amikacin use (99.3% of aminoglycosides) over three years did not significantly increase amikacin resistance (3.2% baseline vs. unchanged).
- Gentamicin resistance significantly decreased from 17.4% to 7.4% (p < 0.0001).
- Tobramycin resistance also showed a declining trend, and gentamicin resistance decreased quarterly (p < 0.005).
Conclusions:
- Exclusive amikacin use is a viable strategy that does not lead to increased amikacin resistance in gram-negative bacteria.
- This approach may contribute to reducing resistance to other aminoglycosides, such as gentamicin and tobramycin.
- Findings support amikacin as a key agent in antibiotic stewardship programs for gram-negative infections.