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Published on: May 25, 2017
Nosocomial consequences of antibiotic usage
Abstract:
In 1979, seven years after introduction of gentamicin into the greek market, resistance in Pseudomonas aeruginosa rose in Laiko General Hospital to an incidence of 55% of the isolates. Gentamicin then was the first line antibiotic. In 1983, three years after amikacin was brought onto the market and while it represented 3/5 of all aminoglycoside consumption, resistance against it in strains of Pseudomonas rose suddenly to 23%. However, amikacin prescription was not restricted and, in 1985, resistance rate, including all aminoglycosides and the 3rd generation cephalosporins, exceeded 50%. By analysing all available data, it was evident that: Urine predominates in the isolation of multiresistant strains, while in 1/2 of bacteraemias amikacin-resistant strains are implicated. The ICU is the most common source of isolation and similar strains are spread in all hospital wards. Multiresistant strains are virulent since they were incriminated for a 11% death rate. In 60% of amikacin resistant strains AAC (6') I was detected. Among multiresistant strains serotype O:12 predominated. From the hospital pharmacy data, it was evident that antibiotic consumption refers to greater than 60% of hospital admissions, and amikacin, netilmicin and newer cephalosporins are the first line antibiotics. It is evident that urgent changes are needed in the antibiotic policies in the Laiko General Hospital.
Insights
Antibiotic resistance in Pseudomonas aeruginosa significantly increased at Laiko General Hospital, particularly with amikacin. Urgent policy changes are needed to combat rising multidrug-resistant strains.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Hospital Epidemiology
Background:
- Gentamicin was the primary antibiotic in 1979, with Pseudomonas aeruginosa resistance reaching 55% within seven years.
- Amikacin introduction in 1983 led to a rapid increase in resistance, reaching 23% within three years.
- By 1985, resistance to aminoglycosides and third-generation cephalosporins exceeded 50%.
Purpose of the Study:
- To analyze the trends of antibiotic resistance in Pseudomonas aeruginosa at Laiko General Hospital.
- To identify sources and characteristics of multidrug-resistant strains.
- To evaluate the impact of antibiotic consumption on resistance patterns.
Main Methods:
- Retrospective analysis of antibiotic resistance data from 1979 to 1985.
- Correlation of resistance patterns with antibiotic consumption data.
- Identification of resistance mechanisms (AAC(6')I) and serotypes (O:12) in resistant strains.
Main Results:
- Urine samples were the primary source of multidrug-resistant strains; amikacin-resistant strains were implicated in 50% of bacteremias.
- The Intensive Care Unit (ICU) was the most common isolation source, with resistant strains spreading hospital-wide.
- Multidrug-resistant strains were associated with an 11% mortality rate; AAC(6')I was detected in 60% of amikacin-resistant strains.
Conclusions:
- Rising antibiotic resistance, especially to amikacin, poses a significant threat at Laiko General Hospital.
- High antibiotic consumption, with amikacin and newer cephalosporins as first-line agents, correlates with resistance.
- Urgent revisions to antibiotic policies are essential to mitigate the spread of multidrug-resistant Pseudomonas aeruginosa.
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