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Tóth H, Fésűs A, Kungler-Gorácz O, Balázs B, Majoros L, Szarka K, Kardos G. Utilization of Vector Autoregressive and Linear Transfer Models to Follow Up the Antibiotic Resistance Spiral in Gram-negative Bacteria From Cephalosporin Consumption to Colistin Resistance. Clin Infect Dis 2018; 69:1410-1421. [DOI: 10.1093/cid/ciy1086] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/13/2018] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Increasing antibiotic resistance may reciprocally affect consumption and lead to use of broader-spectrum alternatives; a vicious cycle that may gradually limit therapeutic options. Our aim in this study was to demonstrate this vicious cycle in gram-negative bacteria and show the utility of vector autoregressive (VAR) models for time-series analysis in explanatory and dependent roles simultaneously.
Methods
Monthly drug consumption data in defined daily doses per 100 bed-days and incidence densities of gram-negative bacteria (Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, and Acinetobacter baumannii) resistant to cephalosporins or to carbapenems were analyzed using VAR models. These were compared to linear transfer models used earlier.
Results
In case of all gram-negative bacteria, cephalosporin consumption led to increasing cephalosporin resistance, which provoked carbapenem use and consequent carbapenem resistance and finally increased colistin consumption, exemplifying the vicious cycle. Different species were involved in different ways. For example, cephalosporin-resistant Klebsiella spp. provoked carbapenem use less than E. coli, and the association between carbapenem resistance of P. aeruginosa and colistin use was weaker than that of A. baumannii. Colistin use led to decreased carbapenem use and decreased carbapenem resistance of P. aeruginosa but not of A. baumannii.
Conclusions
VAR models allow analysis of consumption and resistance series in a bidirectional manner. The reconstructed resistance spiral involved cephalosporin use augmenting cephalosporin resistance primarily in E. coli. This led to increased carbapenem use, provoking spread of carbapenem-resistant A. baumannii and consequent colistin use. Emergence of panresistance is fueled by such antibiotic-resistance spirals.
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Affiliation(s)
- Hajnalka Tóth
- Department of Medical Microbiology, Faculty of Medicine, Hungary
| | - Adina Fésűs
- Department of Medical Microbiology, Faculty of Medicine, Hungary
- Clinical Pharmacy, Faculty of Pharmacy, Clinical Center, University of Debrecen, Hungary
| | - Orsolya Kungler-Gorácz
- Department of Medical Microbiology, Faculty of Medicine, Hungary
- Clinical Pharmacy, Faculty of Pharmacy, Clinical Center, University of Debrecen, Hungary
| | - Bence Balázs
- Department of Medical Microbiology, Faculty of Medicine, Hungary
| | - László Majoros
- Department of Medical Microbiology, Faculty of Medicine, Hungary
| | - Krisztina Szarka
- Department of Medical Microbiology, Faculty of Medicine, Hungary
| | - Gábor Kardos
- Department of Medical Microbiology, Faculty of Medicine, Hungary
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Michalski D, Ghamrawi RJ, Tsigrelis C. Evaluation of institutional guideline adherence for carbapenem use at a large academic medical center. Infect Dis (Lond) 2017; 50:226-228. [PMID: 28945483 DOI: 10.1080/23744235.2017.1381986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Derek Michalski
- a Department of Pharmacy Services , University Hospitals Cleveland Medical Center , Cleveland , OH , USA
| | - Riane J Ghamrawi
- a Department of Pharmacy Services , University Hospitals Cleveland Medical Center , Cleveland , OH , USA
| | - Constantine Tsigrelis
- b Department of Infectious Diseases and HIV Medicine , University Hospitals Cleveland Medical Center , Cleveland , OH , USA
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