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Correlation between carbapenem susceptibility in Pseudomonas aeruginosa and modified antibiotic heterogeneity index:

Keisuke Sawada1,2,3, Takaaki Kato2, Shuji Kono1

  • 1Department of Pharmacy, Federation of National Public Service Personnel Mutual Aid Associations Hirakata Kohsai Hospital, Osaka, Japan.

Antimicrobial Stewardship & Healthcare Epidemiology : ASHE
|February 6, 2025
PubMed
Abstract

Insights

The modified antibiotic heterogeneity index (mAHI) better predicts carbapenem susceptibility in Pseudomonas aeruginosa than other common indicators. This finding supports using mAHI in antimicrobial stewardship to manage resistance.

Area of Science:

  • Infectious Diseases
  • Clinical Microbiology
  • Antimicrobial Stewardship

Background:

  • Carbapenem resistance in Pseudomonas aeruginosa is a significant global health threat.
  • Effective antimicrobial stewardship requires accurate indicators of antimicrobial use.
  • Existing indicators like Defined Daily Doses (DDDs) and Days of Therapy (DOTs) may not fully capture resistance patterns.

Purpose of the Study:

  • To investigate the relationship between antimicrobial use indicators and carbapenem susceptibility in Pseudomonas aeruginosa.
  • To evaluate the modified antibiotic heterogeneity index (mAHI) as a predictor of carbapenem susceptibility.
  • To compare the predictive accuracy of mAHI against other common antimicrobial use indicators.

Main Methods:

  • A survey-based observational study was conducted in 15 community hospitals in Japan.
  • Antimicrobial use indicators including DDDs, DOTs, Antibiotic Heterogeneity Index (AHI), and mAHI were analyzed.
  • Spearman's rank correlation and DeLong's test for receiver operating characteristic curves were used to assess correlations and predictive accuracies.

Main Results:

  • No significant correlation was found between DDDs or DOTs and carbapenem susceptibility.
  • A significant positive correlation was observed between carbapenem susceptibility and mAHI (r = 0.261, P = .02).
  • mAHI demonstrated higher predictive accuracy (AUC = 0.75) for carbapenem susceptibility compared to AHI (AUC = 0.58), with an optimal cutoff of 0.765 for predicting 90% susceptibility.

Conclusions:

  • The mAHI is a more effective predictor of carbapenem susceptibility in Pseudomonas aeruginosa than traditional indicators.
  • mAHI can inform antimicrobial usage patterns and aid in managing carbapenem resistance.
  • Integrating mAHI into antimicrobial stewardship programs can enhance intervention effectiveness in healthcare settings.

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