Time-series analysis of antimicrobial use and resistance trends in a tertiary hospital in China from 2017 to 2022: Implications for national stewardship efforts
Abstract
OBJECTIVES: To evaluate five-year trends (2017-2022) in antimicrobial consumption and antimicrobial resistance in a tertiary hospital in China, and to assess the association between antimicrobial use and resistance using time-series modelling.
METHODS: This retrospective study analysed in-patient hospital antimicrobial consumption using defined daily doses (DDD) and antimicrobial use density (AUD; DDD per 100 patient-days). Temporal trends were evaluated using linear regression, and the association between antimicrobial use and antimicrobial resistance were evaluated using autoregressive integrated moving average (ARIMA) models.
RESULTS: Antimicrobial consumption declined markedly (AUD of 65.51 in 2017 to 40.42 in 2021). Significant reductions were observed in intensive care and major surgical departments. Second- and third-generation cephalosporins were the most commonly used agents while aminoglycosides and imidazole derivatives demonstrated statistically significant downward trends (p < 0.05). Escherichia coli and Klebsiella pneumoniae were consistently among the most commonly isolated organisms. Significant reductions in resistance were observed for Acinetobacter baumannii to tigecycline (32.46%-3.33%, p < 0.001) and imipenem; (71.34% to 21.05%, p = 0.008, and for Pseudomonas aeruginosa to imipenem (54.19% to 16.67%, p = 0.004). In contrast, fluoroquinolones resistance in E. coli increased significantly (46.90% to 74.61%, p = 0.024). ARIMA modelling showed significant…
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Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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