JAC Advance Access published online on January 7, 2004
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh039
© 2004 by The British Society for Antimicrobial Chemotherapy
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Original article
1 The JONES Group/JMI Laboratories,
Inc., 345 Beaver Kreek Centre, Suite A, North Liberty, IA 52317; University of Iowa College of
Pharmacy, Iowa City, IA;
Received 22 April 2003
; revised 14 October 2003
; accepted 29 October 2003
Background: The MYSTIC Programme is
a global, longitudinal antimicrobial surveillance network of hospitals that
frequently utilize carbapenems. One aspect of the programme is the
ability to capture antimicrobial consumption data from participating
institutions. The current report evaluates these relationships for Enterobacteriaceae
and Pseudomonas aeruginosa over
the initial 3 year period of the programme in the USA. Methods: Between 10 and 15 medical centres participated
during 1999-2001, each submitting up to 200 isolates/year
(7003 strains overall). Evaluations of the relationship between
drug usage and antimicrobial resistance in P. aeruginosa and Enterobacteriaceae for the carbapenems
(imipenem and meropenem), cefepime, ceftazidime, ciprofloxacin,
gentamicin and piperacillin-tazobactam were determined.
Data were analysed based on: (1) aggregate usage results; (2) medical
centre-specific usage compared with resistance rates; and (3) medical
centre-specific usage results compared with yearly changes in resistance
rates ( Results: Resistance (1999-2001) among
Enterobacteriaceae did not change significantly for Conclusions: The availability of aggregate USA
medical centre antimicrobial usage data enabled us to identify several
important trends in the incidence of resistance among P. aeruginosa and Enterobacteriaceae: (1) increased
use of ciprofloxacin associated with a higher resistance among Enterobacteriaceae;
and (2) a correlation between ciprofloxacin categories of resistance
and levels of resistance to other antimicrobial classes in P. aeruginosa. Medical centre-specific antimicrobial
usage and resistance did not demonstrate direct statistical relationships,
and require a continued search for other monitoring methods that
can better identify antimicrobial/environmental factors that lead
to resistance.
Keywords: defined daily doses, correlations, ciprofloxacin,
carbapenems, P. aeruginosa
Antimicrobial usage and resistance trend relationships
from the MYSTIC Programme in North America (1999-2001)
2 The JONES Group/JMI Laboratories,
Inc., 345 Beaver Kreek Centre, Suite A, North Liberty, IA 52317;
3 The JONES Group/JMI Laboratories,
Inc., 345 Beaver Kreek Centre, Suite A, North Liberty, IA 52317; Universidade
Federal de Sao Paulo, Sao Paulo, Brazil
4 The JONES Group/JMI Laboratories,
Inc., 345 Beaver Kreek Centre, Suite A, North Liberty, IA 52317; Tufts
University School of Medicine,
Boston, MA, USA;
R). The parameter of drug usage
was the defined daily dose (DDD)/100 patient days calculated from
total grams administered, using WHO definitions.
-lactams,
but tended to increase slightly for gentamicin (+1.1%)
and ciprofloxacin (+3.1%). P. aeruginosa resistance rates (1999-2001)
for gentamicin (+9.0%) and ciprofloxacin (+10.2%)
increased, in contrast to a significantly decreased resistance rate
for meropenem (-7.7%). Formulary-use changes were
noted: increased meropenem and ciprofloxacin use and decreased consumption
for imipenem, aminoglycosides, ceftazidime and cefepime. Aggregate
ciprofloxacin DDD/100 days rates were directly related (+3.3
DDD) to Enterobacteriaceae and P. aeruginosa resistance
changes, whereas among P. aeruginosa,
usage and resistance were inversely correlated for gentamicin (-3.8
DDD; +9.0% resistant). Medical centre-specific
antimicrobial usage calculations did not demonstrate a correlation
to rates of resistance (r = -0.38
to 0.61) or yearly changes in resistance rates (r = -0.56
to 0.43).
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