Antibiotic consumption as a driver for resistance in Staphylococcus aureus and Escherichia coli within a developing region

Abstract

Background: This study aimed to provide insight into possible antibiotic drivers of methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli resistant to third-generation cephalosporins (3GCREC) in southern and eastern Mediterranean institutions. Methods: MRSA and 3GCREC susceptibility proportions from 19 regional hospitals, previously published by the ARMed project, were correlated with antibiotic use data from the same institutions. Results: Hospitals reporting below-median MRSA proportions had significantly lower total antibiotic use. MRSA proportions increased with greater use of carbapenems (P = .04). In multivariate analysis, a positive correlation was identified with the use of carbapenems (P = .002), combination penicillins (P = .018), and aminoglycosides (P = .014). No difference was ascertained between 3GCREC proportions and total antibiotic use. In multivariate linear regression, a correlation was identified only for 3GCREC (P = .005), but a negative association was evident for beta-lactamase–resistant penicillins (P = .010) and first-generation cephalosporins (P = .012). Conclusions: The results suggest an association between resistance and antibiotic use, especially for carbapenems and third-generation cephalosporins. These data support the urgent implementation of antibiotic stewardship initiatives in hospitals in developing countries that focus on more judicious use of broad-spectrum formulations.