Correlation between antibiotic use and resistance in a hospital: temporary and ward-specific observations.
OBJECTIVE
The objectives of this study were to determine (1) the increase in antimicrobial resistance to frequently used antibiotics in the hospital setting over time and (2) the correlation between the amount of use of an antibiotic in a specific medical specialty and the observed resistance to that antibiotic in that specialty.


METHODS
The total use of antibiotics and the use of ciprofloxacin (CIP), co-amoxicillin + clavulanic acid (AMCL) and first and second-generation cephalosporins (CEF), respectively, in individual medical specialties were measured between 2001 and 2006 by means of prevalence surveys (two per year). The antimicrobial susceptibility patterns among E. coli isolated from hospitalized patients between 2003 and 2006 were obtained from the Laboratory Information System. Trends over time and correlation between use and resistance were calculated.


RESULTS
6,639 patients were included in the prevalence surveys, of whom 3.0% (195) were treated with CIP, 9.7% (642) with AMCL, and 3.5% (232) with CEF. 4,790 E. coli isolates were obtained from hospitalized patients. Resistance to all antibiotics significantly increased over time, with the regression line showing that the strongest increase in resistance was for CIP (2.6% per year). There were large variations in antimicrobial use between various medical specialties. A significant correlation was found between the ward-specific prevalence of use and the percentage of resistance for CIP (R = 0.81, p < 0.001) and AMCL (R = 0.82, p = 0.003).


CONCLUSIONS
At the level of individual medical specialties within one hospital, a higher prevalence of antimicrobial use among patients was associated with a significantly higher observed antimicrobial resistance. The use of CIP was associated with a stronger increase in resistance than the use of beta-lactams.
Willemsen
I
I
Laboratory for Microbiology and Infection Control, Amphia Hospital, 4800 RK, Breda, The Netherlands. iwillemsen@amphia.nl
Bogaers-Hofman
D
D
Winters
M
M
Kluytmans
J
J
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization / Q000706:statistics & numerical data*; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy* / Q000382:microbiology*; D006761:Hospitals; D006801:Humans; D008826:Microbial Sensitivity Tests
D000900:Anti-Bacterial Agents