The Correlation between Defined Daily Dose/1000 Patient-day of Antimicrobials and the Resistance Rate of P. aeruginosa and A. baumannii : A Case Study at Hua-Hin Hospital

Abstract

Objective: To determine the trends of defined daily dose (DDD) per 1000 patient-day among antimicrobial agents, drug resistance to P. aeruginosa and A. baumannii and the relationship between DDD per 1000 patient-day of antimicrobial agents and drug resistance rate. Method: We collected and defined 1) DDD per 1000 patient-day of ceftazidime, imipenem, meropenem, ertapenem, ciprofloxacin, amikacin and gentamicin and 2) the percentage of carbapenem resistant- and multi drug resistant (MDR) P. aeruginosa and A. baumannii at Hua-Hin hospital in 2010 - 2014. Correlation coefficients from simple linear regression were used to test the trends. Results: DDD/1000 patient-day of meropenem had increased while those of imipenem and gentamicin had decreased with statistical significance. The increased use of amikacin (r = 0.894, P = 0.041) and imipenem (r = 0.957, P = 0.011) each was associated with lower rates of MDR-P. aeruginosa while increased ertapenem use was correlated with decreasing MDR-P. aeruginosa (r = -0.90, P = 0.037). Moreover, the lesser use of amikacin associated with reducing rates of imipenem resistant P. aeruginosa (r = -0.90, P = 0.042) but with increasing rate of MDR (r = -0.948, P = 0.014), imipenem (r = -0.950, P = 0.013) and meropenem (r = -0.939, P = 0.018) resistant A. baumannii. Conclusion: The use of amikacin imipenem and ertapenem was related to rate of antimicrobial resistance. Thus, drug use evaluation is needed to solve antibiotic resistance.Keywords: DDD/1000 patient-day, P. aeruginosa, A. baumannii, resistant rat