Influence of antimicrobial consumption on gram-negative bacteria in inpatients receiving antimicrobial resistance therapy from 2008-2013 at a tertiary hospital in Shanghai, China.

BACKGROUND: Irrational use of antimicrobial agents is a major cause of increased antimicrobial resistance. Effective antibiotic stewardship strategies nationwide or in local health care settings are necessary to reduce antibiotic use and bacteria resistance.

METHODS: We evaluated the effectiveness of China's antimicrobial stewardship policy on antimicrobial use and applied time-series analysis methodology to determine the temporal relationship between antibiotic use and gram-negative bacteria resistance at Changhai Hospital from 2008-2013. Isolates investigated included Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa.

RESULTS: Consumption of 7 restricted-use antibiotics was dramatically reduced. Resistance to ceftazidime in P aeruginosa and A baumannii and resistance to ciprofloxacin in P aeruginosa significantly decreased. By using cross-correlation analysis, associations between ciprofloxacin resistance in P aeruginosa and fluoroquinolones consumption (r = 0.48; lag = 0; P = .02), ceftazidime resistance in P aeruginosa and third-generation cephalosporins consumption (r = 0.54; lag = -1; P = .01) were identified. No substantial association between other pairs was found.

CONCLUSIONS: Enhanced nationwide antimicrobial stewardship campaigns launched in 2011 have made great achievements in regard to antibiotic use but have had limited effects on the reversal of gram-negative bacteria resistance in health care settings. Sound infection prevention and control programs to reduce the transmission of resistant pathogens for hospitals in China are urgently needed.