Autor: |
Stanić Benić M; Department of Clinical Pharmacology, and Clinical Hospital Center Rijeka, Rijeka, Croatia., Palčevski D; Department of Emergency, Clinical Hospital Center Rijeka, Rijeka, Croatia., Milanič R; Department of Medical Area, University of Udine, Udine, Italy., Skočibušić N; Department of Clinical Pharmacology, and Clinical Hospital Center Rijeka, Rijeka, Croatia., Abram M; Department of Clinical Microbiology, Clinical Hospital Center Rijeka, Croatia.; Department of Microbiology and Parasitology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia., Vlahović-Palčevski V; Department of Clinical Pharmacology, and Clinical Hospital Center Rijeka, Rijeka, Croatia.; Department of Pharmacology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.; Department of Basic Medical Sciences, Faculty of Health Studies, University of Rijeka, Rijeka, Croatia. |
Abstrakt: |
Aim: To decrease the incidence and resistance rates of extended-spectrum β-lactamases (ESBL) Klebsiella pneumoniae (KP) by restriction of the use of third-generation cephalosporins (3GCs) and fluoroquinolones. Methods: Consumption of 3GCs, fluoroquinolones, and carbapenems in association with ertapenem and fluoroquinolone-resistant KP isolates, were analyzed in 21 months by autoregressive integrated moving average models. A follow-up analysis was performed 5 years later. Results: Consumption of 3GCs decreased significantly during the postintervention period. Their restriction was associated with a decrease in ertapenem-resistant KP isolates by 17.5%. Fluoroquinolone, 3GCs, and carbapenem use did not significantly predict the percentage of ertapenem-resistant KP isolates. Fluoroquinolone, but not cephalosporin use, significantly predicted the percentage of fluoroquinolone-resistant isolates, with an increase of 1 defined daily dose (DDD) of fluoroquinolone/100 occupied bed-days (OBDs) corresponding to a 0.32% increase of fluoroquinolone-resistant isolates ( p = 0.008). A decrease of 1 DDD of carbapenem/100 OBD was associated with a 16.94% increase of fluoroquinolone-resistant isolates ( p = 0.007). Five years later, the consumption of all three antimicrobial classes increased significantly compared with the 2011-2013 period, whereas ertapenem-resistant KP rates significantly decreased. Conclusion: This study may bring a valuable contribution to the understanding of the intricate association between antibiotic consumption and bacterial resistance. Reporting a spectrum of different results could present a useful basis for more profound research of various interventions' effects. |