Association Between Antibiotic Consumption and Pseudomonas aeruginosa Non-Susceptibility: A Five-Year Ecological Study at Bali Regional General Hospital
DOI:
https://doi.org/10.36733/medicamento.v12i2.14763Keywords:
antibiotic consumption, antimicrobial resistance, antimicrobial stewardship, bed occupancy rate, Pseudomonas aeruginosaAbstract
Background: Pseudomonas aeruginosa is a major cause of healthcare-associated infections (HAIs), which are difficult to eradicate because of the bacterium’s intrinsic and acquired resistance mechanisms. However, evidence regarding the association between hospital antibiotic consumption and antimicrobial resistance remains inconsistent.
Objective: This study determines the association between systemic antibiotic consumption and P. aeruginosa non-susceptibility using five years of hospital surveillance data.
Methods: A retrospective ecological study was conducted using surveillance data from Bali Regional General Hospital between January 2019 and December 2023. The relationship between antibiotic consumption [defined as daily doses (DDD) per 100 patient-days] and resistance was analyzed by a generalized linear model in which the number of non-susceptible isolates was used as the dependent variable. Moreover, antibiotic consumption, the bed occupancy rate (BOR), the calendar year, and the antibiotic agent (with meropenem taken as the reference category) were used as independent variables.
Results: The study included 77 P. aeruginosa isolates and 35 antibiotic-year observations. No statistically significant association was found between antibiotic consumption and non-susceptibility (OR 1.049, 95% CI 0.980–1.122; p = 0.168) or between BOR and non-susceptibility (OR 1.024, 95% CI 0.992–1.057; p = 0.152). Calendar year was inversely associated with the modeled non-susceptibility outcome (OR 0.716, 95% CI 0.592–0.866; p < 0.001). Ceftazidime and cefepime had higher odds of non-susceptibility than meropenem.
Conclusion: Antibiotic consumption does not fully explain P. aeruginosa non-susceptibility. Factors such as antibiotic-specific resistance mechanisms and infection prevention and control practices might also have a role in the differences in non-susceptibility.
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