Antibiotic Reduction Campaigns Do Not Necessarily Decrease Bacterial Resistance: the Example of Methicillin-Resistant Staphylococcus aureus

Lidia Kardas-Słoma 1, 2 Pierre-Yves Boëlle 3 Lulla Opatowski 4, 5 Didier Guillemot 5, 6 Laura Temime 1
1 MESuRS - Laboratoire Modélisation, épidémiologie et surveillance des risques sanitaires
2 UPMC - Université Pierre et Marie Curie - Paris 6
3 ESIM - Epidémiologie des maladies infectieuses et modélisation
4 PhEMI - Pharmacoépidémiologie et maladies infectieuses
5 CeRBEP - Centre de Ressources en Biostatistiques, Epidémiologie et Pharmaco-épidémiologie appliquées aux Maladies Infectieuses
6 AP-HP Hôpital Raymond Poincaré [Garches]
Abstract : Interventions designed to reduce antibiotic consumption are under way worldwide. While overall reductions are often achieved, their impact on the selection of antibiotic-resistant selection cannot be assessed accurately from currently available data. We developed a mathematical model of methicillin-sensitive and methicillin-resistant Staphylococcus aureus (MSSA and MRSA) transmission inside and outside the hospital. A systematic simulation study was then conducted with two objectives: to assess the impact of antibiotic class-specific changes during an antibiotic reduction period and to investigate the interactions between antibiotic prescription changes in the hospital and the community. The model reproduced the overall reduction in MRSA frequency in French intensive-care units (ICUs) with antibiotic consumption in France from 2002 to 2003 as an input. However, the change in MRSA frequency depended on which antibiotic classes changed the most, with the same overall 10% reduction in antibiotic use over 1 year leading to anywhere between a 69% decrease and a 52% increase in MRSA frequency in ICUs and anywhere between a 37% decrease and a 46% increase in the community. Furthermore, some combinations of antibiotic prescription changes in the hospital and the community could act in a synergistic or antagonistic way with regard to overall MRSA selection. This study shows that class-specific changes in antibiotic use, rather than overall reductions, need to be considered in order to properly anticipate the impact of an antibiotic reduction campaign. It also highlights the fact that optimal gains will be obtained by coordinating interventions in hospitals and in the community, since the effect of an intervention in a given setting may be strongly affected by exogenous factors.
Keywords : Anti-Bacterial Agents/therapeutic use Methicillin-Resistant Staphylococcus aureus/growth & development Statistical Staphylococcal Infections/transmission Staphylococcal Infections/microbiology Staphylococcal Infections/epidemiology Staphylococcal Infections/drug therapy Anti-Bacterial Agents/chemistry Anti-Bacterial Agents/classification Models Drug Interactions France/epidemiology Humans Intensive Care Units Methicillin Resistance/drug effects Methicillin-Resistant Staphylococcus aureus/drug effects
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Lidia Kardas-Słoma, Pierre-Yves Boëlle, Lulla Opatowski, Didier Guillemot, Laura Temime. Antibiotic Reduction Campaigns Do Not Necessarily Decrease Bacterial Resistance: the Example of Methicillin-Resistant Staphylococcus aureus. Antimicrobial Agents and Chemotherapy, American Society for Microbiology, 2013, 57 (9), pp.4410-4416. ⟨10.1128/AAC.00711-13⟩. ⟨hal-02089146⟩

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