Correlation Between Consumption Of Cefoperazone Combined With Sulbactam Or Tazobactam And Antimicrobial Resistance Rates In Acinetobacter Baumannii At A University Affiliated Hospital

Objective To investigate the correlation between consumption of cefoperazone/sulbactam or cefoperazone/tazobactam with different ratio and the antimicrobial resistance rates in Acinetobacter baumannii at a university affiliated hospital,and study the selective pressure of antimicrobial resistance in consumption of cefoperazone/sulbactam or cefoperazone/tazobactam.Methods The data on the consumption amount of cefoperazone/sulbactam with ratio of 2:1 or 1:1 and cefoperazone/tazobactam with ratio of 4:1 or 8:1 between January 2001 to December 2010 was obtained from the computer center database.The annual antimicrobial consumption was calculated by Excel 2007 software.Consumption of cefoperazone/sulbactam or cefoperazone/tazobactam was expressed as defined daily dose(DDD)based on the WHO anatomical therapeutic chemical classification index.DDDs/1000 is shown as DDD per 1000 patient days.The antimicrobial resistance rates in A.baumannii to piperacillin/tazobactam,ampicillin/sulbactam,ceftazidime,cefotaxime,cefoperazone/sulbactam,cefepime,aztreonam,imipenem,meropenem,amikacin and levofloxacin from 2001 to 2010 were computed by WHONET 5.4 software in the Department of Microbiology.Trends in consumption of cefoperazone/sulbactam or cefoperazone/tazobactam and the antimicrobial resistance rates of A.baumannii were analyzed through the linear regression.Pearson's and Spearman's correlation coefficients were determined the correlation between different trends of cefoperazone/sulbactam or cefoperazone/tazobactam consumption and the antimicrobial resistance rates of A.baumannii with SPSS 13.0 software.Results The trend of resistance rates to 9 kinds of antimicrobial agents in A.baumannii were significantly rising from 2001 to 2010,including cefoperazone/sulbactam,piperacillin/tazobactam,ceftazidime,cefotaxime,cefepime,imipenem,meropenem,amikacin and levofloxacin(R2>0.3),except ampicillin/sulbactam and aztreonam.Over 2001 or 2004 to 2010 period,the consumption of cefoperazone/sulbactam with 1:1 ratio or 2:1 ratio and total cefoperazone/sulbactam with ratio of 1:1 and 2:1 were not obviously increased.During 2001 to 2005 period of time,the trend of total cefoperazone/sulbactam consumption was statistically elevated(R2=0.932)and decreased over 2006 to 2010 period(R2=0.791).Over 2005 to 2010 period,the consumption of cefoperazone/tazobactam with 4:1 ratio and total cefoperazone/tazobactam with ratio of 4:1 and 8:1 kept a significant rising trend(R2=0.818,0.950).During 2006 to 2010 period of time,the consumption of cefoperazone/tazobactam with 4:1 ratio was statistically steady.The correlation results showed that the stable consumption of cefoperazone/sulbactam with 1:1 ratio had none correlation with the resistance rates of A.baumannii.The stable consumption of cefoperazone/sulbactam with 2:1 ratio and total cefoperazone/sulbactam were negatively correlated with the resistance rates of A.baumannii to cefotaxime(r=-0.929 and-0.939)and meropenem(r=-0.939 and-0.923).The increased consumption of total cefoperazone/sulbactam was correlated with the resistance rates of ceftazidime,cefepime,amikacin and levofloxacin(r=0.975,0.900,0.986 and-1.000,respectively)in A.baumannii.The decreased consumption was negatively correlated with that of cefoperazone/sulbactam,piperacillin/tazobactam,ceftazidime,cefepime,imipenem,amikacin,levofloxacin,aztreonam,cefotaxime and meropenem(r=-0.934,-0.930,-0.931,-0.914,-0.905,-0.946,-0.937,-0.914,-0.948 and-0.919,respectively).The increased consumption of total cefoperazone/tazobactam was correlated with the resistance rates of cefoperazone/sulbactam,piperacillin/tazobactam,ceftazidime,cefepime,imipenem,amikacin,levofloxacin,cefotaxime and meropenem in A.baumannii(r=0.891,0.928,0.878,0.886,0.929,0.920,0.889,0.888 and 0.927,respectively).Furthermore,the increase or stationary consumption of cefoperazone/tazobactam with 4:1 ratio was correlated with the resistance rates of piperacillin/tazobactam and meropenem(r=0.824 and 0.886)or cefoperazone/sulbactam(r=0.900).In addition,the resistance rate of A.baumannii to cefoperazone/sulbactam was correlated with the resistance rates to other drugs.Conclusion These results demonstrated that different correlation was between different consumption of cefoperazone/sulbactam or cefoperazone/tazobactam with various proportion and antimicrobial resistance rates of A.baumannii at this hospital.If cefoperazone/sulbactam or cefoperazone/tazobactam consumption were stable trend,there was no or negative correlation with the resistance rates of A.baumannii,and the antimicrobial resistance in A.baumannii may not be increased.The increase consumption of cefoperazone/sulbactam has less correlation with the resistance rates of A.baumannii,and may be relatively smaller for the selective pressure of resistance,and would be not correlation with the resistance of itself.If cefoperazone/tazobactam consumption was increase trend,there was more correlated with antimicrobial resistance rates,included CFP/SUL and TZP resistance.The strongly selective pressure of antimicrobial drugs may be emerged.Therefore,curtailing the use of cefoperazone/tazobactam,and appropriate use of cefoperazone/sulbactam could retard further emergence and spread of antimicrobial resistance in A.baumannii.