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Strategies in aminoglycoside use and impact upon resistance
Abstract:
Assessment of amikacin resistance over a 10-year period at our institution revealed that the number of resistant strains remained stable. Qualitatively, amikacin-resistant Enterobacteriaceae and Pseudomonas were fairly stable. There was a slight increase in amikacin-resistant Acinetobacter and staphylococci. Different factors influencing the emergence and spread of resistant hospital bacteria have been studied at different periods and compared with similar data on gentamicin-resistant strains. Transmissible plasmids, multiple mechanisms of resistance, and high levels of resistance were more frequent in gentamicin-resistant strains. In the amikacin-resistant strains, the level of resistance was 16 to 32 mg/liter with few autotransferable plasmids. A synergistic or additive effect with cephalosporins, which may be a factor in decreasing the risk of selection of the resistant strains since there is no plasmid-mediated resistance to cephalosporins, was demonstrated in Enterobacteriaceae. To control the development of aminoglycoside resistance in hospitals, it may be necessary to restrict the use of more than the one drug to which resistance is developing; to use the antibiotic at the right dosage and, when necessary, in a combination that may prevent the emergence of resistant organisms and plasmids; and to develop measures to control bacterial and R factor transmission.
Insights
Amikacin resistance in hospital bacteria remained stable over 10 years, with slight increases in Acinetobacter and staphylococci. Controlling aminoglycoside resistance requires strategic antibiotic use and infection control measures.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Aminoglycoside antibiotics like amikacin are crucial for treating serious bacterial infections.
- Monitoring antimicrobial resistance patterns is essential for effective treatment strategies.
- Hospital-acquired infections pose a significant challenge due to the potential for resistant pathogens.
Purpose of the Study:
- To assess the 10-year trend of amikacin resistance in bacterial strains at an institution.
- To compare amikacin resistance with gentamicin resistance, examining influencing factors.
- To investigate mechanisms and potential control strategies for aminoglycoside resistance.
Main Methods:
- Retrospective analysis of amikacin resistance data over a 10-year period.
- Qualitative assessment of resistant Enterobacteriaceae, Pseudomonas, Acinetobacter, and staphylococci.
- Comparison of resistance mechanisms, plasmid presence, and resistance levels between amikacin- and gentamicin-resistant strains.
- Evaluation of synergistic effects with cephalosporins in Enterobacteriaceae.
Main Results:
- Overall amikacin resistance remained stable, with slight increases observed in Acinetobacter and staphylococci.
- Amikacin-resistant strains showed lower levels of resistance and fewer autotransferable plasmids compared to gentamicin-resistant strains.
- Gentamicin-resistant strains exhibited more frequent transmissible plasmids, multiple resistance mechanisms, and higher resistance levels.
- A synergistic or additive effect between amikacin and cephalosporins was noted in Enterobacteriaceae, potentially reducing selection pressure.
Conclusions:
- Amikacin resistance has shown relative stability, though vigilance is needed for specific pathogens.
- Understanding resistance mechanisms and plasmid mediation is key to differentiating resistance patterns.
- Combined antibiotic therapy and stringent infection control are vital for managing aminoglycoside resistance in healthcare settings.