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Antibiotic Consumption and Gram-Negative Resistance Dynamics in the ICU: A Five-Year Autoregressive Integrated Moving

Lejla Rakovac Tupkovic1, Nijaz Tihic2,3, Jasmina Smajic4,5

  • 1Department of Pharmacology, University Clinical Centre Tuzla, Tuzla, BIH.

Cureus
|March 3, 2026
PubMed
Abstract

Insights

Increased hospital antibiotic use, particularly in intensive care units, is linked to rising antimicrobial resistance (AMR) in key bacteria. This highlights the need for antimicrobial stewardship to maintain antibiotic effectiveness.

Area of Science:

  • * Medical Microbiology
  • * Pharmacoepidemiology
  • * Infectious Diseases

Background:

  • * Antimicrobial resistance (AMR) poses a significant global health threat.
  • * Gram-negative bacteria, including Enterobacteriaceae and Acinetobacter, are critical pathogens.
  • * Understanding the link between hospital antibiotic consumption and AMR is vital for effective control strategies.

Purpose of the Study:

  • * To assess the impact of hospital antibiotic consumption on AMR rates.
  • * To investigate resistance patterns in Enterobacteriaceae and Acinetobacter species.
  • * To analyze temporal associations between antibiotic use and resistance at a university clinical center.

Main Methods:

  • * A five-year retrospective, observational pharmacoepidemiological study (2014-2018).
  • * Antibiotic consumption quantified using WHO ATC/DDD methodology (DDD per 100 bed-days).
  • * Temporal associations analyzed using linear regression and ARIMA models for key bacterial isolates.

Main Results:

  • * Total antibiotic consumption increased significantly (61.35 to 73.51 DDD/100 BD).
  • * Intensive care unit (ICU) consumption was substantially higher (up to 178.53 DDD/100 BD).
  • * Fluoroquinolone and carbapenem use correlated positively with resistance in Acinetobacter, K. pneumoniae, and E. coli.

Conclusions:

  • * A significant temporal association exists between broad-spectrum antibiotic consumption and escalating AMR.
  • * ICUs act as reservoirs for multidrug-resistant pathogens due to high selective pressure.
  • * Multidisciplinary antimicrobial stewardship and restricted use of reserve antibiotics are crucial.
Keywords:
antimicrobial agentsantimicrobial drug resistancearima modelatc/ddd methodologygram negative bacteria

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