title: Influence of antimicrobial consumption on gram-negative bacteria in inpatients receiving antimicrobial resistance therapy from 2008-2013 at a tertiary hospital in Shanghai, China.
abstract: BACKGROUND
  Irrational use of antimicrobial agents is a major cause of increased antimicrobial resistance. Effective antibiotic stewardship strategies nationwide or in local health care settings are necessary to reduce antibiotic use and bacteria resistance.
  
  
  METHODS
  We evaluated the effectiveness of China's antimicrobial stewardship policy on antimicrobial use and applied time-series analysis methodology to determine the temporal relationship between antibiotic use and gram-negative bacteria resistance at Changhai Hospital from 2008-2013. Isolates investigated included Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa.
  
  
  RESULTS
  Consumption of 7 restricted-use antibiotics was dramatically reduced. Resistance to ceftazidime in P aeruginosa and A baumannii and resistance to ciprofloxacin in P aeruginosa significantly decreased. By using cross-correlation analysis, associations between ciprofloxacin resistance in P aeruginosa and fluoroquinolones consumption (r = 0.48; lag = 0; P = .02), ceftazidime resistance in P aeruginosa and third-generation cephalosporins consumption (r = 0.54; lag = -1; P = .01) were identified. No substantial association between other pairs was found.
  
  
  CONCLUSIONS
  Enhanced nationwide antimicrobial stewardship campaigns launched in 2011 have made great achievements in regard to antibiotic use but have had limited effects on the reversal of gram-negative bacteria resistance in health care settings. Sound infection prevention and control programs to reduce the transmission of resistant pathogens for hospitals in China are urgently needed.
authors.affiliation: Department of Health Statistics, Second Military Medical University, Shanghai, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Guo
authors.affiliation: Department of Health Statistics, Second Military Medical University, Shanghai, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: He
authors.affiliation: Department of Information, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Zhiyong
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Information, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Min
authors.initials: M
authors.lastname: Wei
authors.affiliation: Department of Pharmacy, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Zhangwei
authors.initials: Z
authors.lastname: Yang
authors.affiliation: Department of Information, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Yin
authors.initials: Y
authors.lastname: Du
authors.affiliation: Department of Health Statistics, Second Military Medical University, Shanghai, China. Electronic address: wucheng_wu@126.com.
authors.forename: Cheng
authors.initials: C
authors.lastname: Wu
authors.affiliation: Department of Health Statistics, Second Military Medical University, Shanghai, China. Electronic address: hejia63@yeah.net.
authors.forename: Jia
authors.initials: J
authors.lastname: He
mesh_terms: D040981:Acinetobacter baumannii / Q000187:drug effects; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002442:Ceftazidime / Q000627:therapeutic use; D002681:China / Q000453:epidemiology; D002939:Ciprofloxacin / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D017723:Drug Utilization Review; D004926:Escherichia coli / Q000187:drug effects; D024841:Fluoroquinolones / Q000627:therapeutic use; D006090:Gram-Negative Bacteria / Q000187:drug effects*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D007297:Inpatients; D007711:Klebsiella pneumoniae / Q000187:drug effects; D008826:Microbial Sensitivity Tests; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use; D011550:Pseudomonas aeruginosa / Q000187:drug effects; D000078142:Tazobactam; D062606:Tertiary Care Centers
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D002939:Ciprofloxacin; D010397:Penicillanic Acid; D002442:Ceftazidime; D000078142:Tazobactam; D010878:Piperacillin
keywords: Antimicrobial stewardship policy; Cross-correlation analysis; Infection control; Resistance reversal; Time-series analysis