Colistin resistance in carbapenemase-producing Klebsiella pneumoniae bloodstream isolates: Evolution over 15 years and temporal association with colistin use by time series analysis

• Published in: International journal of antimicrobial agents Vol. 52; no. 3; pp. 397 - 403
• Main Authors: Tansarli, Giannoula S., Papaparaskevas, Joseph, Balaska, Mina, Samarkos, Michael, Pantazatou, Angeliki, Markogiannakis, Antonios, Mantzourani, Marina, Polonyfi, Katerina, Daikos, George L.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.09.2018
• Subjects: Anti-Bacterial Agents - pharmacology; Bacteraemia; Bacterial Proteins - metabolism; beta-Lactamases - metabolism; Carbapenem-Resistant Enterobacteriaceae - drug effects; Carbapenem-Resistant Enterobacteriaceae - isolation & purification; Carbapenem-Resistant Enterobacteriaceae - metabolism; Colistin - pharmacology; Colistin resistance; Colistin use; Cross Infection - drug therapy; Cross Infection - microbiology; Drug Resistance, Bacterial - genetics; Greece; Humans; Klebsiella Infections - drug therapy; Klebsiella pneumoniae; Klebsiella pneumoniae - drug effects; Klebsiella pneumoniae - isolation & purification; Klebsiella pneumoniae - metabolism; Microbial Sensitivity Tests; Time Factors; Time series; Greece; Bacteraemia; Colistin use; Colistin resistance; Klebsiella pneumoniae; Time series
• ISSN: 0924-8579; 1872-7913
• DOI: 10.1016/j.ijantimicag.2018.06.012

•In a 15-year period, 313 carbapenemase-producing K. pneumoniae blood isolates were recovered and tested for susceptibility.•The colistin resistance rate increased from 0% in 2002 to 26.9% in 2016 (R2 = 0.5, P < 0.01).•Time series analysis revealed a temporal association between colistin use and resistance.•An increase in colistin use by 1 DDD/100 patient-days led to a 0.05 increase in the incidence rate of colistin resistance.•Colistin use and prior levels of colistin resistance could explain 69% of colistin resistance. Colistin is often the only available treatment option against infections caused by carbapenemase-producing Klebsiella pneumoniae (CP-Kp). In this study, the evolution of colistin resistance among CP-Kp and its relationship with colistin use in a tertiary-care hospital in Athens, Greece, was investigated. All CP-Kp blood isolates recovered between January 2002 and June 2016 were tested for susceptibility to colistin by agar dilution and broth microdilution methods. Data on colistin use were collected from the pharmacy database. Time series of colistin use and resistance were analysed using the Box and Jenkins method. A transfer function model was built to quantify the dynamic relationship between colistin use and resistance. Overall, 313 CP-Kp isolates were identified. The percentage colistin resistance increased from 0% in 2002 to 26.9% in 2016 (R2 = 0.5, P < 0.01). A temporal association between colistin use and resistance was observed; an increase in colistin use by 1 DDD/100 patient-days led to a 0.05 increase in the incidence rate of colistin resistance. The time lag between the effect of colistin use on subsequent variations in colistin resistance was 3 months. Colistin use and prior levels of colistin resistance could explain 69% of colistin resistance; in the remaining 31%, other factors might have played a role. The results presented here demonstrate a significant temporal association between colistin use and colistin resistance. These findings have important implications in implementing strategies to contain colistin resistance.