Restricting fluoroquinolone, piperacillin-tazobactam use may decrease resistance in nonfermenters
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Reducing fluoroquinolone and piperacillin-tazobactam use may decrease resistance in nonfermenting bacteria, according to a recent study published in Open Forum Infectious Diseases.
Researchers added, however, that they could not confirm that restricting carbapenems or third-generation cephalosporins leads to a decrease in prevalence of antibiotic resistance among Enterobacterales, nonfermenters or gram-positive bacteria in hospitalized patients.
“We have previously assessed the evidence published until April 11, 2014, whether 14 antimicrobial stewardship objectives have an effect in hospitals and long-term care facilities on clinical outcomes, adverse events, costs, and bacterial resistance prevalence. One of these 14 objectives involved using a list of restricted antibiotics,” Emelie (E.C.) Schuts, MD, a PhD student in the department of internal medicine at the University of Amsterdam, told Healio. “At the time, data suggested that resistance rates for restricted antibiotics significantly decreased after implementing a restrictive policy, but inconsistent relations between antibiotic use and resistance rates were also found. In the present systematic review, we have looked into this stewardship objective in greater detail and also performed an update of the initial literature search.”
Schuts and colleagues searched Embase and PubMed/OVID MEDLINE, ultimately including 15 studies that were published through June 4, 2020, in which a restrictive antibiotic policy was applied and the prevalence of resistance and use of antibiotics were reported. The researchers then calculated the overall effect of antimicrobial resistance between postintervention vs. preintervention periods using pooled ORs from a mixed-effects model.
Their meta-analysis demonstrated significant reductions in resistance only with nonfermenters after restricting fluoroquinolones (OR = 0.77; 95% CI, 0.62-0.97) and piperacillin-tazobactam (OR = 0.81; 95% CI, 0.72-0.92). The researchers found high degrees of heterogeneity between studies that restricted carbapenems, third-generation cephalosporins and fluoroquinolones.
“Our findings are in disagreement with current in-hospital practice and with individual studies given that we could not confirm that restricting carbapenems or third-generation cephalosporins leads to decrease in prevalence of antibiotic resistance among Enterobacterales, nonfermenters or gram-positive bacteria in hospitalized patients,” Schuts said. “Given the poor quality of studies with regard to methods used and reporting of data, we feel that there is a strong need for high-quality studies to address this. Our study could start a debate on exploring alternative interventions that could bring a way to reduce prevalence of antimicrobial resistance in hospitalized patients.”
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