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Temporal Association Between Antibiotic Use and Resistance in Klebsiella Pneumoniae at a Tertiary Care Hospital

Temporal Association Between Antibiotic Use and Resistance in Klebsiella Pneumoniae at a Tertiary Care Hospital

The Question: In this study, we examined the temporal association between the consumption of antibiotics commonly used in Korean hospitals, particularly β-lactam/β-lactamase inhibitors (BLBLIs), third-generation cephalosporins, and fluoroquinolones, and antimicrobial resistance in Klebsiella pneumoniae. Our findings were published in the journal Antimicrobial Resistance and Infection Control.

K. pneumoniae is a significant hospital pathogen that causes several potentially deadly diseases including pneumonia, urinary tract infections, and bloodstream infections. Antibiotic resistance makes these infections more deadly. Over the last several decades, the widespread use of broad-spectrum cephalosporins has resulted in K. pneumoniae strains resistant to these antibiotics becoming endemic in hospitals worldwide. To overcome this resistance, combination antibiotics, such as ampicillin/sulbactam and piperacillin/tazobactams have been introduced in clinical practice. These β-lactam/β-lactamase inhibitor BLBLI combination drugs can specifically overcome the type of resistance mediated by broad-spectrum cephalosporins, making them an effective alternative to carbapenems for which antibiotic resistance is increasing. However, there is a lack of understanding of the relationship between these drugs and resistance, particularly as it relates to seasonal use of the drug.

What We Found: Using quarterly consumption and resistance data for BLBLIs, third-generation cephalosporins, and fluoroquinolones at a tertiary care hospital in South Korea, we found that K. pneumoniae resistance to piperacillin/tazobactam significantly increased between 2012 and 2016, and that consumption of BLBLIs was significantly correlated with the rate of resistance to piperacillin/tazobactam. Our results found that this correlation occurred with a lag of about six months. Rates of resistance to third-generation cephalosporins and fluoroquinolones were also correlated with resistance rates on a seasonal basis.

Why It Matters: Increasing resistance to carbapenems in K. pneumoniae means that alternatives to these drugs are needed. This is the first study to describe the temporal relationship between BLBLI use and the resistance to them in K. pneumoniae in a tertiary level hospital. While BLBLIs can be an effective alternative to carbapenems, the strong correlations between use and resistance that we found suggest that replacing carbapenems with BLBLIs is not an ideal long-term solution, as resistance is likely to spread rapidly. Further efforts should be made to ensure that these drugs are not overused so that they may retain their efficacy as a carbapenem-sparing alternative.

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