Identifying Targets for Antibiotic Use for the Management of Carbapenem-Resistant Acinetobacter baumannii (CRAb) in Hospitals-A Multi-Centre Nonlinear Time-Series Study

• Published in: Antibiotics (Basel) Vol. 11; no. 6; p. 775
• Main Authors: Al-Hashimy, Zainab Said, Conway, Barbara R, Al-Yaqoobi, Mubarak, Khamis, Faryal, Al Mawali, Ghalib Zahran, Al Maashani, Aisha Mahad, Al Hadhrami, Yaqoob Said, Al Alawi, Said Salim, Al Mamari, Mohammed Said, Lattyak, William J, Lattyak, Elizabeth A, Aldiab, Motasem, Gould, Ian, López-Lozano, José-María, Aldeyab, Mamoon A
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 07.06.2022; MDPI
• Subjects: Acinetobacter baumannii; Alcohol; alcohol-based hand rub; Aminoglycoside antibiotics; Aminoglycosides; antibacterial agents; antibiotic stewardship; Antibiotics; Antimicrobial agents; Antimicrobial resistance; carbapenem-resistant Enterobacteriaceae; Cephalosporins; Disease control; Drug dosages; Drug resistance; Fluoroquinolones; hand sanitizers; Hospitals; Hygiene; Mathematical models; Mortality; Multidrug resistant organisms; Nosocomial infections; Piperacillin; Piperacillin-tazobactam; Surveillance; Tazobactam; Thresholds; Time series; Oman; carbapenem-resistant Enterobacteriaceae; Acinetobacter baumannii; thresholds; alcohol-based hand rub; antibiotic consumption; antibacterial agents; hand sanitizers; antibiotic stewardship; non-linear time-series analysis
• DOI: 10.3390/antibiotics11060775
• ISSN: 2079-6382

Solutions are needed to inform antimicrobial stewardship (AMS) regarding balancing the access to effective antimicrobials with the need to control antimicrobial resistance. Theoretical and mathematical models suggest a non-linear relationship between antibiotic use and resistance, indicating the existence of thresholds of antibiotic use beyond which resistance would be triggered. It is anticipated that thresholds may vary across populations depending on host, environment, and organism factors. Further research is needed to evaluate thresholds in antibiotic use for a specific pathogen across different settings. The objective of this study is to identify thresholds of population antibiotic use associated with the incidence of carbapenem-resistant (CRAb) across six hospital sites in Oman. The study was an ecological, multi-centre evaluation that involved collecting historical antibiotic use and CRAb incidence over the period from January 2015 to December 2019. By using non-linear time-series analysis, we identified different thresholds in the use of third-generation cephalosporins, piperacillin-tazobactam, aminoglycoside, and fluoroquinolones across participating hospitals. The identification of different thresholds emphasises the need for tailored analysis based on modelling data from each hospital. The determined thresholds can be used to set targets for each hospital AMS, providing a balance between access to these antibiotics versus controlling CRAb incidence.