Study On The Drug Use And Drug Resistance Of Acinetobacter Baumannii In Nanjing And Xuzhou, Jiangsu Province

Objective To evaluated the impact of antibiotic use on carbapenem resistance in A.baumannii at 7 teaching hospitals in Jiangsu province from 2008 to 2010,and analyzed trends of the antibacterial drugs use against Acinetobacter baumannii from2007 to 2010 in 19 general tertiary and secondary hospitals of Nanjing region so as to promote rational use of medicines.Methods The consumption was calculated by Excel 2007 software.Consumption of antimicrobials was expressed as defined daily dose(DDD)based on the WHO anatomical therapeutic chemical classification index.Includ carbapenem,fluoroquinolone,aminoglycoside andβ-lactam in Jiangsu Province,andβ-lactam,carbapenem,fluoroquinolone,piperacillin/tazobactam,cefoperazone/sulbactam,tetracycline,cephalosporin in Nanjing region.carbapenem resistance rates were computed using WHONET 5.4 software and trends of antibacterial drugswere analyzed using linear regression.The correlation between consumption and resistance were analyzed by the linear regression.Pearson’s and Spearman’s correlation coefficients.Results In Jiangsu province,carbapenem,fluoroquinolone,aminoglycoside andβ-lactam use(defined as daily dose per 1000 patient days),carbapenem resistance rates(computed using WHONET 5.4 software)and A.baumannii clinical isolates,every 6 months,were analyzed using linear regression.The correlation between antibiotic use and resistance rates or clinical isolates was evaluated using correlation coefficients.There was cross-resistance between imipenem and meropenem resistance(r=0.927,p=0.008).In Nanjing area,increased use of imipenem/cilastatin,meropenem,biapenem,panipenem/betamipron,total carbapenem,levofloxacin,total quinolones,amikacin,isepamicin,and piperacillin/tazobactam were positively correlated with increased imipenem and meropenem resistance(r=0.943,p=0.005;r=0.916,p=0.010;r=0.910,p=0.012;r=0.940,p=0.005;r=0.932,p=0.007;r=0.886,p=0.019;r=0.829,p=0.042;r=0.949,p=0.004;r=0.902,p=0.014).Increased resistance of imipenem/cilastatin with increased A.baumannii clinical isolates(r=0.901,p=0.014).Levofloxacin and fluoroquinolone use in the Nanjing region remained stable over the study period.Usage was more than two times higher than in the Xuzhou region.In Nanjing region,carbapenem,fluoroquinolone,piperacillin/tazobactam consumption were increased and cefoperazone/sulbactam consumption was decreased in general tertiary hospitals(R~2=0.800,P=0.003;R~2=0.628,P=0.019;R~2=0.893,P<0.01;R~2=0.605,P=0.023).Carbapenem,tetracycline,cephalosporin,piperacillin/tazobactam,cefoperazone/sulbactam consumption were increased in general secondary hospitals(R~2=0.791,P=0.003;R~2=0.733,P=0.007;R~2=0.532,P=0.040;R~2=0.781,P=0.004;R~2=0.704,P=0.009).Total carbapenem,tetracycline,piperacillin/tazobactam consumption were increased in 19 hospitals(R~2=0.806,P=0.002;R~2=0.527,P=0.041;R~2=0.911,P<0.01;R~2=0.559,P=0.033).Mean of consumption in all antibacterial drugs every6 months in general tertiary hospitals was more than in general secondary hospitals except ciprofloxacin.Conclusion In Jiangsu province,the increased use of carbapenem,aminoglycoside andβ-lactam correlated with increased imipenem and meropenem resistance.Carbapenem,piperacillin/tazobactam and total drugs use were a significant rising in all general hospitals of Nanjing region.Strengthening the infection control and preventing widespread antibiotic use may contribute to decreased carbapenem resistance in A.Baumannii.