Drug resistance linked to antibiotic use and patient transfers in hospitals

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The use of the penicillin antibiotic, piperacillin-tazobactam, was the strongest predictor of the emergence of bacteria that are resistant to the standard treatments for life-threatening blood infections in hospitals, according to a large French study.

Understanding the role of antibiotic use patterns and patient transfers in the emergence of drug-resistant microbes is essential to crafting effective prevention strategies, suggests a the study.

Antimicrobial resistance is a growing global health threat, but preventing it takes smart choices at the local level. The current findings provide insights on how antibiotic use patterns and patient transfers in hospitals drive the emergence of resistance, and suggest a new approach for tailoring prevention strategies to an individual hospital or ward.

"Hospitals continue to be important hotspots for antimicrobial resistance because of the confluence of frequent antibiotic use, fragile patients and the potential for highly resistant pathogens to spread through hospital wards when patients are transferred," explains lead author Julie Teresa Shapiro, at the  Centre International de Recherche en Infectiologie (CIRI), University of Lyon, France.

To help hospitals assess the best strategies for preventing the emergence of resistance, Shapiro and her colleagues employed a technique typically used in ecology to study the effect of antibiotic use and patient transfers on infections. They developed a computer model based on a year's worth of data around seven species of infection-causing bacteria, including drug-resistant strains, in 357 hospital wards in France.

"We found that the volume of antibiotic use at the hospital-ward level had a stronger influence on the incidence of more resistant pathogens, while patient transfers had the most influence on hospital-endemic microbes and those resistant to the last-line antibiotics carbapenems," Shapiro says.

They also found that the use of the penicillin antibiotic, piperacillin-tazobactam, was the strongest predictor of the emergence of bacteria that are resistant to the standard treatments for life-threatening blood infections. If this is confirmed in further studies, the authors suggest that the strategy of using piperacillin-tazobactam instead of carbapenems to prevent antimicrobial resistance may need to be reconsidered.

In fact, the study showed that the effects of antibiotic prescription and patient transfer patterns on the emergence of drug resistance varied among different microbes and types of infections, suggesting that a more individualised approach to preventing resistance is necessary.

"Our work highlights the need to tailor strategies against microbial resistance to specific pathogens," concludes senior author Jean-Philippe Rasigade, associate professor of microbiology at the Hospices Civils de Lyon university hospital. "Applying the modelling techniques we used here to other healthcare settings could help inform local and regional antibiotic stewardship and infection control strategies."

Abstract
Antimicrobial resistance (AMR) is a global threat. A better understanding of how antibiotic use and between-ward patient transfers (or connectivity) impact population-level AMR in hospital networks can help optimize antibiotic stewardship and infection control strategies. Here, we used a metapopulation framework to explain variations in the incidence of infections caused by 7 major bacterial species and their drug-resistant variants in a network of 357 hospital wards. We found that ward-level antibiotic consumption volume had a stronger influence on the incidence of the more resistant pathogens, while connectivity had the most influence on hospital-endemic species and carbapenem-resistant pathogens. Piperacillin-tazobactam consumption was the strongest predictor of the cumulative incidence of infections resistant to empirical sepsis therapy. Our data provide evidence that both antibiotic use and connectivity measurably influence hospital AMR. Finally, we provide a ranking of key antibiotics by their estimated population-level impact on AMR that might help inform antimicrobial stewardship strategies.

Authors
Julie Teresa Shapiro, Gilles Leboucher, Anne-Florence Myard-Dury, Pascale Girardo, Anatole Luzzati, Melissa Mary, Jean-François Sauzon, Bénédicte Lafay, Olivier Dauwalder, Frederic Laurent, Gerard Lina, Christian Chidiac, Sandrine Couray-Targe, François Vandenesch, Jean-Pierre Flandrois, Jean-Philippe Rasigade

 

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