Τίτλος:
Colistin resistance in carbapenemase-producing Klebsiella pneumoniae bloodstream isolates: Evolution over 15 years and temporal association with colistin use by time series analysis
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Colistin is often the only available treatment option against infections caused by carbapenemase-producing Klebsiella pneumoniae (CP-Kp). In this study, the evolution of colistin resistance among CP-Kp and its relationship with colistin use in a tertiary-care hospital in Athens, Greece, was investigated. All CP-Kp blood isolates recovered between January 2002 and June 2016 were tested for susceptibility to colistin by agar dilution and broth microdilution methods. Data on colistin use were collected from the pharmacy database. Time series of colistin use and resistance were analysed using the Box and Jenkins method. A transfer function model was built to quantify the dynamic relationship between colistin use and resistance. Overall, 313 CP-Kp isolates were identified. The percentage colistin resistance increased from 0% in 2002 to 26.9% in 2016 (R2 = 0.5, P < 0.01). A temporal association between colistin use and resistance was observed; an increase in colistin use by 1 DDD/100 patient-days led to a 0.05 increase in the incidence rate of colistin resistance. The time lag between the effect of colistin use on subsequent variations in colistin resistance was 3 months. Colistin use and prior levels of colistin resistance could explain 69% of colistin resistance; in the remaining 31%, other factors might have played a role. The results presented here demonstrate a significant temporal association between colistin use and colistin resistance. These findings have important implications in implementing strategies to contain colistin resistance. © 2018 Elsevier Ltd
Συγγραφείς:
Tansarli, G.S.
Papaparaskevas, J.
Balaska, M.
Samarkos, M.
Pantazatou, A.
Markogiannakis, A.
Mantzourani, M.
Polonyfi, K.
Daikos, G.L.
Περιοδικό:
International Journal of Antimicrobial Agents
Λέξεις-κλειδιά:
colistin; antiinfective agent; bacterial protein; beta lactamase; carbapenemase; colistin, agar dilution; antibiotic resistance; antibiotic sensitivity; Article; bacterium isolate; carbapenemase producing Klebsiella pneumoniae; controlled study; drug use; genetic code; Greece; Klebsiella pneumoniae; nonhuman; priority journal; time series analysis; antibiotic resistance; carbapenem-resistant Enterobacteriaceae; cross infection; drug effect; genetics; human; isolation and purification; Klebsiella infection; Klebsiella pneumoniae; metabolism; microbial sensitivity test; microbiology; time factor, Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; Carbapenem-Resistant Enterobacteriaceae; Colistin; Cross Infection; Drug Resistance, Bacterial; Greece; Humans; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Time Factors
DOI:
10.1016/j.ijantimicag.2018.06.012
