title: Antibiotic consumption as a driver for resistance in Staphylococcus aureus and Escherichia coli within a developing region.
abstract: BACKGROUND
  This study aimed to provide insight into possible antibiotic drivers of methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli resistant to third-generation cephalosporins (3GCREC) in southern and eastern Mediterranean institutions.
  
  
  METHODS
  MRSA and 3GCREC susceptibility proportions from 19 regional hospitals, previously published by the ARMed project, were correlated with antibiotic use data from the same institutions.
  
  
  RESULTS
  Hospitals reporting below-median MRSA proportions had significantly lower total antibiotic use. MRSA proportions increased with greater use of carbapenems (P=.04). In multivariate analysis, a positive correlation was identified with the use of carbapenems (P=.002), combination penicillins (P=.018), and aminoglycosides (P=.014). No difference was ascertained between 3GCREC proportions and total antibiotic use. In multivariate linear regression, a correlation was identified only for 3GCREC (P=.005), but a negative association was evident for beta-lactamase-resistant penicillins (P=.010) and first-generation cephalosporins (P=.012).
  
  
  CONCLUSIONS
  The results suggest an association between resistance and antibiotic use, especially for carbapenems and third-generation cephalosporins. These data support the urgent implementation of antibiotic stewardship initiatives in hospitals in developing countries that focus on more judicious use of broad-spectrum formulations.
authors.affiliation: Infection Control Unit, Mater Dei Hospital, Msida, Malta. michael.a.borg@gov.mt
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borg
authors.forename: Peter
authors.initials: P
authors.lastname: Zarb
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Scicluna
authors.forename: Ossama
authors.initials: O
authors.lastname: Rasslan
authors.forename: Deniz
authors.initials: D
authors.lastname: Gür
authors.forename: Saida
authors.initials: S
authors.lastname: Ben Redjeb
authors.forename: Ziad
authors.initials: Z
authors.lastname: Elnasser
authors.forename: Ziad
authors.initials: Z
authors.lastname: Daoud
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003906:Developing Countries; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization / Q000706:statistics & numerical data*; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D019083:Mediterranean Region; D008826:Microbial Sensitivity Tests; D015995:Prevalence; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents