Correlation between meropenem and doripenem use density and the incidence of carbapenem-resistant Pseudomonas aeruginosa

• Published in: International journal of antimicrobial agents 2009-12, Vol.34 (6), p.589-591
• Main Authors: Shigemi, Akari, Matsumoto, Kazuaki, Yaji, Keiko, Shimodozono, Yoshihiro, Takeda, Yasuo, Miyanohara, Hiroaki, Kawamura, Hideki, Orita, Michiyo, Tokuda, Koichi, Nishi, Junichiro, Yamada, Katsushi
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antimicrobial use density; beta-Lactam Resistance; Biological and medical sciences; Carbapenems; Carbapenems - pharmacology; Carbapenems - therapeutic use; Cross-resistance; Drug Utilization - statistics & numerical data; Humans; Infectious Disease; Medical sciences; Microbial Sensitivity Tests; Pharmacology. Drug treatments; Pseudomonas aeruginosa; Pseudomonas aeruginosa - drug effects; Pseudomonas aeruginosa - isolation & purification; Pseudomonas Infections - microbiology; Statistics as Topic; Susceptibility; Thienamycins - therapeutic use
• ISSN: 0924-8579; 1872-7913
• DOI: 10.1016/j.ijantimicag.2009.07.017

Abstract Optimal use of carbapenems is an important issue in the prevention of resistance in Pseudomonas aeruginosa . In this study, we investigated the correlation between antimicrobial use density (AUD) of carbapenems and imipenem/cilastatin (IPM/CS) or meropenem (MEPM) susceptibility of P. aeruginosa strains. The AUD of five carbapenems [IPM/CS, panipenem/betamipron, biapenem, MEPM and doripenem (DRPM)] was examined every 6 months between 2006 and 2008. The AUD was calculated using the defined daily doses methodology developed by the World Health Organisation. A minimum inhibitory concentration of IPM/CS or MEPM of ≤4 mg/L was considered to be sensitive. There was a significant negative correlation between MEPM susceptibility and the total AUD of MEPM and DRPM [ r = −0.823, 95% confidence interval (CI) −0.035 to −0.980; P = 0.044]. Furthermore, there was a significant correlation between MEPM susceptibility and IPM/CS susceptibility ( r = 0.839, 95% CI 0.084 to 0.981; P = 0.037). Cross-resistance was therefore investigated and only 5.6% of MEPM-insensitive strains were susceptible to IPM/CS, although 43.3% of IPM/CS-insensitive strains were susceptible to MEPM. These results suggest that curtailing the use of MEPM and DRPM may curb the emergence not only of MEPM-resistant strains but also IPM/CS-resistant strains.