Trends in antimicrobial resistance and empiric antibiotic therapy of bloodstream infections at a general hospital in Mid-Norway: a prospective observational study.
The occurrence of bloodstream infection (BSI) and antimicrobial resistance have been increasing in many countries. We studied trends in antimicrobial resistance and empiric antibiotic therapy at a medium-sized general hospital in Mid-Norway.



Between 2002 and 2013, 1995 prospectively recorded episodes of BSI in 1719 patients aged 16-99 years were included. We analyzed the antimicrobial non-susceptibility according to place of acquisition, site of infection, microbe group, and time period.



There were 934 community-acquired (CA), 787 health care-associated (HCA) and 274 hospital-acquired (HA) BSIs. The urinary tract was the most common site of infection. Escherichia coli was the most frequently isolated infective agent in all three places of acquisition. Second in frequency was Streptococcus pneumoniae in CA and Staphylococcus aureus in both HCA and HA. Of the BSI microbes, 3.5% were non-susceptible to the antimicrobial regimen recommended by the National Professional Guidelines for Use of Antibiotics in Hospitals, consisting of penicillin, gentamicin, and metronidazole (PGM). In contrast, 17.8% of the BSI microbes were non-susceptible to cefotaxime and 27.8% were non-susceptible to ceftazidime. Antimicrobial non-susceptibility differed by place of acquisition. For the PGM regimen, the proportions of non-susceptibility were 1.4% in CA, 4.8% in HCA, and 6.9% in HA-BSI (p < 0.001), and increasing proportions of non-susceptibility over time were observed in HA-BSI, 2.2% in 2002-2005, 6.2% in 2006-2009, and 11.7% in 2010-2013 (p = 0.026), mainly caused by inherently resistant microbes. We also observed increasing numbers of bacteria with acquired resistance, particularly E. coli producing ESBL or possessing gentamicin resistance, and these occurred predominantly in CA- and HCA-BSI.



Generally, antimicrobial resistance was a far smaller problem in our BSI cohort than is reported from countries outside Scandinavia. In our cohort, appropriate empiric antibiotic therapy could be achieved to a larger extent by replacing second- and third-generation cephalosporins with penicillin-gentamicin or piperacillin-tazobactam.
Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Post box 333, Levanger, N-7601, Norway. arne.mehl@hnt.no.|Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway. arne.mehl@hnt.no.|Mid-Norway Sepsis Research Group, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway. arne.mehl@hnt.no.
Arne
0000-0001-6711-0333
A
Mehl
Mid-Norway Sepsis Research Group, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.|Department of Public Health, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.|Department of Endocrinology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
Bjørn Olav
BO
Åsvold
Department of Laboratory Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
Angela
A
Kümmel
Regional Centre for Child and Youth Mental Health and Child Welfare - Central Norway, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
Stian
S
Lydersen
Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Post box 333, Levanger, N-7601, Norway.|Mid-Norway Sepsis Research Group, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.|Centre of Molecular Inflammation Research, Department of Cancer Research and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
Julie
J
Paulsen
Department of Medical Microbiology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
Ingvild
I
Haugan
Mid-Norway Sepsis Research Group, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.|Clinic of Anesthesia and Intensive Care, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.|Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
Erik
E
Solligård
Mid-Norway Sepsis Research Group, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.|Centre of Molecular Inflammation Research, Department of Cancer Research and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.|Department of Infectious Diseases, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
Jan Kristian
JK
Damås
Department of Research and Development, Haukeland University Hospital, Bergen, Norway.|Department of Clinical Science, University of Bergen, Bergen, Norway.
Stig
S
Harthug
Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.|Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
Tom-Harald
TH
Edna
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D024881:Drug Resistance, Bacterial / Q000187:drug effects*; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009664:Norway; D011446:Prospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D055815:Young Adult
D000900:Anti-Bacterial Agents
Antibiotic therapy; Antimicrobial resistance; Bacteraemia; Bacteremia; Bloodstream infection; Empiric antibiotic treatment; Non-susceptibility; Sepsis