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Antimicrobial use and antimicrobial resistance in Enterobacterales and Enterococcus faecium: a time series analysis
F O'Riordan1, F Shiely2, S Byrne3
1Pharmacy Department, Mercy University Hospital, Grenville Place, Cork, Ireland; Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.
Background:
Irish and European antimicrobial resistance (AMR) surveillance data have highlighted increasing AMR in Enterobacterales and vancomycin resistance in Enterococcus faecium (VRE). Antimicrobial consumption (AC) in Irish hospital settings is also increasing.
Methods:
A retrospective time series analysis (TSA) was conducted to evaluate the trends and possible relationship between AC of selected antimicrobials and AMR in Enterobacterales and vancomycin resistance in E. faecium, from January 2017 to December 2020.
Results:
Increased AC was seen with ceftriaxone (P = 0.0006), piperacillin/tazobactam (P = 0.03) and meropenem (P = 0.054), while ciprofloxacin and gentamicin use trended downwards. AMR rates in Escherichia coli, Klebsiella pneumoniae and other Enterobacterales were largely stable or decreasing, an increase in ertapenem resistance in the latter from 0.58% in 2017 to 5.19% in 2020 (P = 0.003) being the main concern. The proportion of E. faecium that was VRE did not changed significantly (64% in 2017; 53% in 2020, P = 0.1). TSA identified a correlation between piperacillin/tazobactam use and the decreasing rate of ceftriaxone resistance in E. coli.
Conclusion:
Our data suggest that the hospital antimicrobial stewardship programme is largely containing, but not reducing AMR in key nosocomial pathogens. An increase in AC following the COVID-19 pandemic appears as yet to have had no impact on AMR rates.
Insights
Hospital antimicrobial stewardship is containing, but not reducing, antimicrobial resistance (AMR) in key pathogens. Increased antimicrobial consumption post-COVID-19 has not yet impacted AMR rates, despite rising resistance in some Enterobacterales.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health
Background:
- Rising antimicrobial resistance (AMR) in Enterobacterales and vancomycin-resistant Enterococcus faecium (VRE) is a concern in Ireland and Europe.
- Increasing antimicrobial consumption (AC) in Irish hospitals parallels AMR trends.
Purpose of the Study:
- To analyze trends in AMR and AC in Irish hospitals.
- To investigate the relationship between AC of specific antimicrobials and AMR in Enterobacterales and VRE.
Main Methods:
- Retrospective time series analysis (TSA) from January 2017 to December 2020.
- Evaluation of AC for ceftriaxone, piperacillin/tazobactam, meropenem, ciprofloxacin, and gentamicin.
- Assessment of AMR rates in Enterobacterales and VRE.
Main Results:
- Increased AC of ceftriaxone, piperacillin/tazobactam, and meropenem observed.
- Ertapenem resistance in Enterobacterales increased significantly (0.58% to 5.19%).
- A correlation was found between piperacillin/tazobactam use and decreased ceftriaxone resistance in E. coli.
Conclusions:
- Hospital antimicrobial stewardship programs are containing AMR but not reducing it.
- Recent increases in AC, including post-COVID-19, have not yet demonstrably affected AMR rates.
- Continued surveillance and stewardship are crucial for managing AMR in healthcare settings.
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