ABSTRACT
Fluoroquinolones [FQ] use has been identified as a risk factor for colonization and infection to methicillin resistant Staphylococcus aureus [MRSA], Pseudomonas aeruginosae multiresistant [PMR]. Acinetobacter multiresistant [AMR] and multidrug resistant bacteria [MDRB]. Our study proposes to measure the annual antibiotic use of FQ and antimicrobial resistance in P. aeruginosa, S.aureus, Klebsiella pneumoniae and A. baumannii in an intensive care burn unit. The study was conducted during a 4 year period [1 January 2000 to 31 December 2003]. Antimicrobial susceptibility testing was performed using the disk diffusion method as recommended by the French Society of Microbiology. The consumption of the following antibiotics: ofloxacin, ciprofloxacin was expressed as the antimicrobial use density [AD] taking into account the quantity of antibiotics in Grams converted to defined daily doses [DDD] and the number of day hospitalization. Statistical significance was defined as p value <0.05 for the corresponding correlation coefficient. There were statistically significant relationship between use of ciprofloxacin and resistance in P. aeruginosa to this drug [rs=0.95, p<0.05]. Moreover, the ciprofloxacin consumption was correlated with resistance to imipenem [rs= 0.95, p<0.05] and ceftazidime [rs=0.95, p<0.05] in P. aeruginosa. A restriction use of ciprofloxacin has been taken during 2003, it is followed by a significant decrease of resistance to imipenem, ceftazidime and ciprofloxacin in P. aeruginosa [p< 0,05]. The use of fluoroquinolones was correlated significantly with MRSA [rs= 0.96, p>0.05] in P. aeruginosa. A restriction use of ciprofloxacin has been taken during 2003, it is followed by a significant decrease of resistance to imipenem, ceftazidime and ciprofloxacin in P. aeruginosa [p<0,05]. The use of fluoroquinolones was correlated significantly with MRSA [rs=0.96, P<0.05. The restriction of FQ was significantly associated with a decrease of MRSA. The consumption of ciprofloxacin was also correlated [P<0.05] with resistance of ceftazidime in K. pneumoniae. However, there is not a correlation [P>0.05] between fluoroquinolones use and resistance in A. baumannii as well in ciprofloxacin, imipenem and ceftazidime. Our study illustrates the pressure of selection of fluoroquinolones use in the department of MDRB. The use and or the duration of treatment with these antibiotics should be rationalized as part of efforts to control the emergence of multidrug resistant bacteria
ABSTRACT
Background: The increasing consumption of antibiotics in hospitals and the economic implications of this increase lead to survey this consumption in the various hospital units
Aim: Our study proposes to measure the annual antibiotic use and antimicrobial resistance in an intensive care Burn department in order to manage the control measure
Methods: The study was conducted during a 5 year period [1 January 2000 to 31 December 2004]. The average number of admissions was 204/ year and the mean number of hospitalization was 4036/year. Antimicrobial susceptibility testing was performed by disk diffusion method. Susceptibility testing data were stored in a laboratory data base using whonet 5.3 software. The consumption of following antibiotics: imipenem, ceftazidime, ofloxacin, ciprofloxacin, piperacillin-tazobactam was measured by antimicrobial density [AD] which takes into account the quantity of antibiotics in Grams converted to daily defined dose [DDD] and number of hospitalization days. The daily defined dose [DDD] was proposed by WHO. The calculation of the AD for each molecule was carried out according to the following formula: AD=Quantity consumed in grams for the particular antimicrobial X 1000/ DDD for that antimicrobial X number of days hospitalizations
Results: There was statistically significant relationship between increasing use of ceftazidime and ceftazidime resistant Klebsiella pneumoniae [rs = 0.93; p=0.02] The use of ceftazidime was not significantly associated with resistance to this molecule in P.aeruginosa [rs=0.76; p=0.13]. Concerning the fluoroquinolones, there was statistically significant relation ship between increasing use of ciprofloxacin and rate ciprofloxacin resistant P.aeruginosa [rs = =0.89, P=0.043]. Furthermore, the consumption of ciprofloxacin was significantly correlated to imipenem resistance in P.aeruginosa [rs = 0.87, p=0.05]. However, the consumption of imipenem was not significantly correlated to resistance of this drug in P.aeruginosa [rs==0.54; P=0.4]
Conclusion: The monitoring of both antibiotic consumption andantibiotic resistance is necessary to set up targeted policies and to control their effectiveness. Nevertheless this monitoring must be integrated into global policy of good use and control of antibiotics