Association between Antimicrobial Consumption and the Prevalence of Nosocomial Carbapenem-Resistant Escherichia coli and Klebsiella pneumoniae in a Tertiary Hospital in Northern Taiwan

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  • 1 Department of Pharmacy, MacKay Memorial Hospital, Taipei, Taiwan;
  • | 2 Nursing and Management, Mackay Junior College of Medicine, Taipei, Taiwan;
  • | 3 Division of Infectious Diseases, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan;
  • | 4 Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan;
  • | 5 MacKay Medical College, New Taipei City, Taiwan;
  • | 6 Department of Internal Medicine, St. Joseph’s Hospital, Yunlin County, Taiwan
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Carbapenem-resistant Enterobacteriales has become a threat in Taiwan. This is the first local study focusing on the association between carbapenem-resistant Enterobacteriales and antimicrobial consumption. From January 2012 to December 2020, data were collected in a tertiary care hospital in Taipei, Taiwan. Antimicrobial consumption was estimated by the defined daily dose/1,000 patient-days. During the same period, the prevalence of carbapenem-resistant Escherichia coli (CREC) and carbapenem-resistant Klebsiella pneumoniae (CRKP) were collected through routine surveillance data. The following retrospective analyses were conducted: 1) analysis of antimicrobial consumption over time, (2) analysis and forecast of CREC and CRKP prevalence over time, and 3) analysis of correlation between antimicrobial consumption and the prevalence of CREC and CRKP. The consumption of piperacillin/tazobactam (β = 0.615), fluoroquinolones (β = 0.856), meropenem (β = 0.819), and doripenem (β = 0.891) increased during the observation period (P < 0.001), and the consumption of aminoglycosides (β = −0.852) and imipenem/cilastatin (β = −0.851) decreased (P < 0.001). The prevalence of CRKP rose over time (β = 0.522, P = 0.001) and correlated positively with the consumption of fluoroquinolones, levofloxacin, penicillin/β-lactamase inhibitor, piperacillin/tazobactam, meropenem, and doripenem (P < 0.05). The prevalence of CRKP and CREC both correlated negatively with consumption of aminoglycosides (P < 0.01). The prevalence of CRKP in our hospital increased as the forecast predicted based on an autoregressive integrated moving average model. This study provides alarming messages for members participating in antimicrobial stewardship programs, including the increasing prevalence of CRKP, the increasing consumption of broad-spectrum antibiotics, and the positive correlation between them.

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Author Notes

Address correspondence to Chun-Ming Lee, Department of Internal Medicine, St. Joseph’s Hospital, No. 74, Sinsheng Rd., Huwei Township, Yunlin County 63201, Taiwan. E-mail: leecm4014@yahoo.com.tw

These authors contributed equally to this work.

Authors’ addresses: Mei-Chun Lee, Department of Pharmacy, MacKay Memorial Hospital, Taipei, Taiwan, and Nursing and Management, Mackay Junior College of Medicine, Taipei, Taiwan, E-mail: a5787@mmh.org.tw. Hsun Chang and Alice Ying-Jung Wu, Division of Infectious Diseases, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan, E-mails: rrscbta24@gmail.com and watrlilies@gmail.com. Fang-Ju Sun, Nursing and Management, Mackay Junior College of Medicine, Taipei, Taiwan, and Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan, E-mail: fjsun.b612@mmh.org.tw. Chien-Hung Lu, Department of Pharmacy, MacKay Memorial Hospital, Taipei, Taiwan, E-mail: horng22@mmh.org.tw. Chun-Ming Lee, Nursing and Management, Mackay Junior College of Medicine, Taipei, Taiwan, Division of Infectious Diseases, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan, MacKay Medical College, New Taipei City, Taiwan, and Department of Internal Medicine, St. Joseph’s Hospital, Yunlin County, Taiwan, E-mail: leecm4014@yahoo.com.tw.

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