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Antimicrobial utilization and resistance of Pseudomonas aeruginosa in a University hospital

Excessive use of antibacterial drugs leads to emergence of bacterial resistance. Nosocomial infections are increasingly caused by multidrug resistant pathogens resulting in increased morbidity, mortality and health care costs. Pseudomonas aeruginosa is one of the most common Gram-negative pathogens causing nosocomial infections which is becoming resistant to many routinely used antipseudomonal agents. The aim of the study was to determine the relationship between antimicrobal use and resistance of P.aeruginosa at the University Hospital Rijeka, Croatia. Antibacterial resistance of P.aeruginosa and utilization of antipseudomonal antibiotics were collected from the existing microbiology laboratory and pharmacy databases for two years (2006-2007). Susceptibility to antibiotics was tested by disk-diffusion method. Utilization of antibiotics was expressed as the number defined daily doses (DDDs) per 100 bed days (BD), as recommended by the WHO. Aggregate resistance rates were presented for a three month period each year (October- December), and aggregate antimicrobial use was presented for the preceding nine month period each year. P. aeruginosa accounted for 19, 5% of all gram negative isolates in 2006. and 21% in 2007. In 2006, resistance to gentamicin and fluoroquinolones (ciprofloxacin and norfloxacin) was 19 % and to carbapenems (imipenem and meropenem) 11%. In 2007 resistance to aminoglycozides (gentamicin) was 41%. The resistance of nearly 20% was found for piperacillin/tazobactam, fluoroquinolones (ciprofloxacin and norfloxacin) and carbapenems (imipenem and meropenem). Ciprofloxacin was the most commonly used antibacterial in 2006 and 2007 (2, 35 DDD/100 BD and 2, 85 DDD/100 BD respectively), followed by gentamicin (2, 11 DDD/100 BD and 2.32 DDD/100 BD respectively) and norfloxacin (1, 34 DDD/100 BD and 1, 41 DDD/100 BD respectively). Results of this study indicate a strong correlation between increased antibiotic use and increased resistance of Pseudomonas aeruginosa. Infection control measures are necessary to preserve the efficacy of the currently available antipseudomonal agents.

Antibiotics; Resistance; Pseudomonas aeruginosa; Hospital

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