Enfermedades Infecciosas y Microbiología Clínica
How to measure and monitor antimicrobial consumption and resistanceMedición y monitorización del consumo de antibióticos y resistencias bacterianas
Introduction
Antibiotics have increased life expectancy. Self-medication occurs in many countries where antibiotics are classified as prescription-only medicines. Currently, microbial resistance to treatment with antibiotics constitutes an important public health problem, especially in the hospital environment. In this environment we find significant complexity and density of antibiotic use.
Surveillance of antimicrobial resistance can identify trends in resistance patterns and novel resistances. Antimicrobial stewardship initiatives and infection control programmes play an important role in decreasing inappropriate use and halting the dissemination of resistance. Education of professionals and the public should focus on changing behaviour rather than exclusively increasing knowledge, as the latter could have a paradoxical effect by increasing demand and prescription. Behaviour change should target all prescribers, including veterinarians, since microbes know no boundaries between animals and humans and are capable of exchanging resistance genes.1 This section is focused on certain aspects related to measures of antimicrobial consumption and bacterial resistance.
Section snippets
Ways of measuring antimicrobial consumption
A European Commission press release dated November 17, 2011 outlined an action plan against bacterial resistance to last-line antibiotics, comprising 12 specific measures to be implemented in the next five years.2 Two of the measures aim to heighten awareness regarding the appropriate use of antimicrobials and to strengthen surveillance systems of bacterial resistance and antimicrobial consumption in medicine.
In order to promote rational use and to avoid the development of resistance,
Evolution of human consumption of antimicrobial agents
Although most antimicrobials are prescribed in the community,27 microorganisms isolated from hospital infections usually show more resistant profiles than microorganisms from community infections,28 due to the fact that the proportion of patients receiving antimicrobial agents is much higher in hospitals than in the community,29 and for this reason the exerted selective pressure is much higher in hospitals.
In order to see the evolution of antibiotic consumption in the European Union, we will
Measuring bacterial resistance
Data to measure resistance to antimicrobial agents are first obtained at Clinical Microbiology services, based on cumulative tabulated susceptibility testing results of isolates from individual patients. In Spain and many other countries, this is most often achieved using the laboratory information system (LIS), or susceptibility testing system software. The free Windows-based WHONET software (http://www.who.int/drugresistance/whonetsoftware/en) can also interact with susceptibility test
Antibiotic pressure and the development of bacterial resistance
It is currently accepted that exposure to antibiotics does not directly determine the appearance of resistance in bacteria; it instead causes selective pressure on susceptible bacteria, allowing the proliferation of resistant organisms from pre-existing resistant subpopulations. Antibiotics should be considered, in general terms, as selective agents in a “natural” (Darwinian) process of survival of the fittest. Mutants may appear spontaneously because of mutations generated during DNA
Antibiotic restriction without recovery of bacterial activity
The impact of the use of antimicrobials on resistance to antimicrobials has been tested in some studies.52., 53., 54. Gottesman et al. in Israel53 assessed the impact of the restriction of ciprofloxacin use on the resistance profiles of Escherichia coli from urine isolated in the community. After the intervention, a significant reduction (>40%) in quinolone consumption during the studied period was observed, which was associated with a significant decrease (25%) in the isolation of E. coli
Impact of new antibiotic incorporations in bacterial resistance
The evolution of antimicrobial resistance and a dearth of new antibiotics in the pipeline raise the possibility of untreatable multi-drug resistant (MDR) infections. Recently, there have been some cases of extreme drug-resistant (XDR) bacteria, also known as “superbugs”, which will become more and more common. The WHO recently identified antimicrobial resistance as one of the three greatest threats to human health.58
Why does antibiotic resistance happen? The answer is complex. Levy's theory59
Conflicts of interest
The authors declare that they have no conflicts of interest.
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Cited by (28)
Spanish Antibiogram Committee (COESANT) recommendations for cumulative antibiogram reports
2023, Enfermedades Infecciosas y Microbiologia ClinicaAntimicrobial defined daily dose in neonatal population
2022, Enfermedades Infecciosas y Microbiologia ClinicaCitation Excerpt :To date, development of ASP in neonatal patients have been limited, due in part to the lack of a standardized method for comparing antimicrobial.11 DDD is defined by the World Health Organization (WHO) as the average standard daily dose of a drug used in a 70 kg adult for the most common indication.12,13 However, the validity of the WHO definition of DDD is questionable in hospitalized newborns, in which dosing is adjusted for body weight.1,13
Impact and quality of antimicrobial use in a referral pediatric intensive care unit
2022, Enfermedades Infecciosas y Microbiologia ClinicaCitation Excerpt :Antimicrobial stewardship programs (ASP) have proved their effectiveness in reducing AU in children,1,4,5 but data on the most effective interventions for children and, especially, for the critically ill pediatric population remain limited.1,4 Moreover, the use of classical AU measures in adults, such as “defined daily dose”, is discouraged in children because of the weight-based dosage of antimicrobials in this population.6,7 Data about the impact of PICU AU on the total hospital AU are lacking, although AU density could be up to three times higher than in ward units according to adult experience.8
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2020, Journal of PediatricsCitation Excerpt :Our study has several limitations. Complementary antimicrobial use metrics were not performed, so the possibility of having favored the use of less antimicrobial agents (even of broader spectrum) or the underestimation of antimicrobial exposure inherent to DOT in patients with renal impairment should be borne in mind when interpreting our results.15,20,44 Also, by using days present, the denominator could be up to one-third higher than patient-days, causing antimicrobial use estimates to be lower with days present as compared with patient-days.21